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目的探讨煤工尘肺氧化损伤生化指标的早期筛检。方法选择112例煤工尘肺患者作为病例组,144例接尘作业的健康工人作为对照组,采用硝酸还原酶法测定血浆一氧化氮(NO)、硫代巴比妥酸法测定丙二醛(MDA)、亚硝酸盐形成法测定铜锌超氧化物歧化酶(CuZn-SOD)、改良Hafenan氏法测定谷胱甘肽过氧化物酶(GSH-Px)、尿酸酶-过氧化物酶偶联法测定尿酸(UA)、对苯二胺盐酸盐法测定铜蓝蛋白(CP)、化学比色法测定诱导型一氧化氮合酶(iNOS)及总抗氧化能力(T-AOC)。结果病例组与对照组除CP外,其他各项指标差异均有显著性(P<0.05)。ROC曲线下面积比较,MDA、T-AOC、NO和iNOS的曲线下面积大于基准线的面积(P<0.05)。三项氧化损伤指标MDA、T-AOC和iNOS联合构建的判别方程,筛检煤工尘肺的特异度为89.1%,灵敏度为77.7%,符合率为84.0%,均高于单一指标和T-AOC与MDA的串联(P<0.05)T-AOC、iNOS、MDA及NO作为煤工尘肺的早期筛检指标,其中T-AOC最佳,灵敏度70.5%,特异度为68.1%。结论 MDA、T-AOC和iNOS联合筛检较综合反映了煤工尘肺患者的氧化损伤和抗氧化水平,与单一指标及MDA+T-AOC相比降低了误判率。
Objective To explore the early screening of biochemical parameters of oxidative damage in coal worker’s pneumoconiosis. Methods One hundred and twelve coal workers with pneumoconiosis were selected as the case group and 144 healthy workers working as the dust control group were selected as the control group. Plasma nitric oxide (NO) was measured by nitrate reductase method and malondialdehyde MDA), CuZn-SOD by nitrite formation, GSH-Px by Hafenan’s method, uricase-peroxidase UA, paracetamol hydrochloride, and nitric oxide synthase (iNOS) and total antioxidant capacity (T-AOC) were determined by chemical colorimetry. Results The cases and control groups except for CP, the other indicators were significantly different (P <0.05). The area under the curve of ROC curve was larger than that of baseline (P <0.05), MDA, T-AOC, NO and iNOS. Three discriminant equations of oxidative damage index MDA, T-AOC and iNOS were constructed. The specificity of coal worker’s pneumoconiosis was 89.1%, the sensitivity was 77.7% and the coincidence rate was 84.0%, which were all higher than the single indicator and T-AOC T-AOC, iNOS, MDA and NO were the best screening indicators for coal worker’s pneumoconiosis. The sensitivity and specificity of T-AOC were 70.5% and 68.1%, respectively. Conclusion Combined detection of MDA, T-AOC and iNOS comprehensively reflects the oxidative damage and antioxidation of patients with coal worker’s pneumoconiosis, which reduces the false positive rate compared with single indicators and MDA + T-AOC.