关键词: 矽肺病, 血清标志物, 胆红素, 肌酐, 中性粒细胞与淋巴细胞比值, 血小板与淋巴细胞比值, 并发症, 预测

Abstract:

Objective To understand the differences of common serum biomarkers between patients with silicosis and healthy populations，analyze the relationship between relevant indicators and the occurrence and development of silicosis，and evaluate their clinical value as potential diagnostic biomarkers for silicosis. Methods Clinical data were collected from hospitalized male patients clinically diagnosed with silicosis at Dazhou Central Hospital from January 2015 to December 2022. A total of 499 male silicosis patients with complete medical records were selected as the observation group，while age-matched healthy males undergoing physical examinations served as the control group，and the data were analyzed. Results The M（P₂₅，P₇₅） of direct bilirubin[3.3（2.4，4.6）umol/L]，creatinine[75.6（66.0，87.0）umol/L]，urea[6.2（4.9，7.9）umol/L]，neutrophil-to-lymphocyte ratio（NLR）[3.4（2.4，5.3）]，and platelet-to-lymphocyte ratio（PLR）[126.3（86.2，182.6）] in the observation group were higher than those in the control group，while hemoglobin[134.0（122.0，145.0）g/L] was lower than in the control group，and the differences were all statistically significant（all P<0.05）. Except for the urea index，the differences in other indicators were statistically significant （all P<0.05），indicating that they were meaningful predictors of silicosis. Bivariate correlation analysis indicated that hemoglobin was negatively correlated with the prediction of silicosis（r=-0.292，P<0.05），while direct bilirubin，creatinine，PLR，and NLR（r=0.139，0.113，0.281，0.264，all P<0.05） were all positively correlated with the prediction of silicosis. The receiver operating characteristic（ROC） curve showed that the area under the curve（AUC） for NLR was 0.733，with specificity of 0.740 and sensitivity of 0.630.The AUC for PLR was 0.731，with specificity of 0.591 and sensitivity of 0.775. The AUC for direct bilirubin was 3.690，with specificity of 0.812 and sensitivity of 0.402. The AUC for creatinine was 0.592，with sensitivity of 0.334 and specificity of 0.818；The AUC for hemoglobin was 0.288，with specificity of 0.994 and sensitivity of 0.012. The AUC for the combined detection of the above significant indicators was 0.862，with specificity of 0.929 and sensitivity of 0.667. The combined detection of these indicators showed significantly higher predictive efficacy for silicosis than any single test alone. Conclusion Elevated levels of bilirubin，urea，creatinine，and blood cell counts in the serum of silicosis patients may serve as potential biomarkers for diagnosing silicosis. The combined detection of bilirubin，creatinine，and blood cell indices can improve the predictive efficacy for silicosis.

Key words: Silicosis, Serum markers, Bilirubin, Creatinine, Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Complications, Prediction.