Bronchoalveolar lavage (BAL) amylase and pepsin levels as potential biomarkers of aspiration pneumonia
Bronchoalveolar lavage (BAL) amylase and pepsin levels as potential biomarkers of aspiration pneumonia
复制标题
支气管肺泡灌洗(BAL)、淀粉酶和胃酶水平可作为吸入性肺炎的潜在生物标志物
DOI：
10.1016/j.pulmoe.2022.04.003
复制
发表时间：
2023-09-01
期刊：
影响因子：
11.7
通讯作者：
Niitsuma，K.
中科院分区：
文献类型：
--
作者：
Suzuki，T.;Saitou，M.;Niitsuma，K.
背景和目的目前尚无确定的吸入性肺炎标志物。我们假设支气管肺泡灌洗（BAL）淀粉酶和胃蛋白酶可能是吸入性肺炎的候选生物标志物。方法这项横断面研究回顾了在会津医疗中心接受临床指示支气管镜检查的同意成年人。 BAL 样品是使用标准化方法获得的。我们的临床实验室测量了淀粉酶水平，并通过 ELISA 评估了胃蛋白酶水平。结果 327 名参与者中，有 48 名参与者根据日本呼吸学会的指南对吸入性肺炎进行了临床诊断。该组BAL唾液淀粉酶和胃蛋白酶水平中位数分别为702.0 U/L和12.7 ng/ml，显着高于非吸入性肺炎患者。 BAL淀粉酶≥204 U/L作为诊断指标的敏感性为77.1%，特异性为84.2%，受试者工作特征（ROC）曲线下面积为0.859（95%置信区间（CI）为0.803-0.915）。同样，BAL 胃蛋白酶水平≥7.45 ng/ml 识别误吸的敏感性为 87.2%，特异性为 59.9%，ROC 曲线下面积为 0.757（95% CI，0.688-0.826）。多变量回归表明，BAL 淀粉酶≥204 U/L 和 BAL 胃蛋白酶≥7.45 ng/ml 与吸入性肺炎的几率显着升高相关（比值比 (OR) 10.0，95% CI，4.51-22.2，OR 8.81 95% CI，3.32-23.4）。吸入性肺炎的危险因素与BAL淀粉酶和胃蛋白酶水平之间没有显着相关性。结论BAL淀粉酶和胃蛋白酶可能是提示吸入性肺炎的有用生物标志物，并且可以是不依赖于已知的吸入性肺炎危险因素的客观标志物。
Background and objectiveThere are currently no established markers for aspiration pneumonia. We hypothesized that bronchoalveolar lavage (BAL) amylase and pepsin might be candidate biomarkers for aspiration pneumonia.MethodsThis cross-sectional study reviewed consenting adults who underwent clinically-indicated bronchoscopy at Aizu Medical Center. BAL samples were obtained using standardized methods. Amylase levels were measured in our clinical laboratory, and pepsin levels were assessed by ELISA.ResultsAspiration pneumonia was clinically diagnosed based on the guidelines of the Japanese Respiratory Society in 48 of the 327 participants. Median BAL salivary amylase and pepsin levels in this group were 702.0 U/L and 12.7 ng/ml respectively, which were significantly higher than in non-aspiration pneumonia patients. BAL amylase ≥204 U/L had 77.1% sensitivity and 84.2% specificity as a diagnostic index, and the area under the receiver operating characteristic (ROC) curve was 0.859 (95% confidence interval (CI), 0.803-0.915). Similarly, BAL pepsin levels of ≥7.45 ng/ml had 87.2% sensitivity and 59.9% specificity for identifying aspiration, and the area under the ROC curve was 0.757 (95% CI, 0.688-0.826). Multivariate regression demonstrated that BAL amylase ≥204 U/L and BAL pepsin ≥7.45 ng/ml were associated with significantly higher odds for aspiration pneumonia (odds ratio (OR) 10.0, 95% CI, 4.51-22.2, and OR 8.81 95% CI, 3.32-23.4, respectively). There were no significant associations between risk factors for aspiration pneumonia and BAL amylase and pepsin levels.ConclusionBAL amylase and pepsin might be useful biomarkers for suggesting aspiration pneumonia, and could be objective markers without relying on known risk factors for aspiration.