摘要
目的检测中海拔地区慢性阻塞性肺疾病(COPD)患者急性加重期及稳定期血浆肺表面活性物质相关蛋白质D(SP-D)及痰趋化因子配体3(CCL3)水平变化,探索2种生物标志物在中海拔COPD急性加重诊断及严重性评估中的临床意义。方法严格按纳入和排除标准,选取2018年5月至2021年3月于青海省人民医院就诊的健康体检者、COPD急性加重期患者以及同期的COPD稳定期患者,分别作为对照组(CON组)、COPD急性加重期组(AECOPD组)及COPD稳定期组(COPD组),每组50例,均为汉族。所有受试者采集清晨空腹静脉血及收集诱导痰,用ELISA法检测血浆SP-D及痰CCL3的浓度,并完善肺功能检查。结果(1)AECOPD组及COPD组患者SP-D、CCL3浓度均显著高于CON组健康体检者,且AECOPD组亦高于COPD组(P<0.05);(2)AECOPD组患者年龄、性别、血浆SP-D及痰CCL3均与FEV1%预计值呈负相关(r=-0.332、-0.291、-0.508、-0.285,P<0.05),而仅血浆SP-D及痰CCL3与过去1年急性加重次数(r=0.473、0.370,P<0.05)及英国医学研究委员会(MRC)呼吸困难指数mMRC评分(r=0.450、0.362,P<0.05)呈正相关;(3)多元逐步回归分析示,AECOPD组患者中与FEV1%预计值密切相关的影响因素为年龄、血浆SP-D及痰CCL3,而mMRC密切相关的影响因素为血浆SP-D及痰CCL3;(4)血浆SP-D和痰CCL3在COPD急性加重诊断中的灵敏度分别为68%、72%,特异度分别为86%、82%。两者联合检测时,ROC曲线下面积、灵敏度、特异度分别为0.898、76%、92%。结论血浆SP-D联合痰CCL3有望成为COPD急性加重期诊断及疾病严重程度评估的潜在生物学标志物。
Objective To detect the change in plasma SP-D and sputum CCL3 of intermediate-altitude AECOPD and chronic obstructive pulmonory disease(COPD)patients,and explore the clinical significance in diagnosis and severity assessment of AECOPD.Methods According to strict inclusion and exclusion criteria,healthy people,AECOPD patients and COPD patients who visited Qinghai Provincial People’s Hospital between May 2018 and March 2021 were included in the study as the control group,AECOPD group,and COPD group(50 cases in each group).All of them were Han nationality.Morning fasting venous blood and induced sputum of all the subjects were collected while the plasma and sputum supernatant was used to measure SP-D and CCL3 concentrations by ELISA.Pulmonary function was also measured.Results(1)SP-D and CCL3 levels in the AECOPD group were significantly higher than in the COPD group,and patients in both groups had higher SP-D and CCL3 concentrations than in the control group(P<0.05).(2)Age,gender,plasma SP-D and sputum CCL3 concentrations in AECOPD patients were all negatively correlated with FEV1%prep(r=-0.332,-0.291,-0.508,-0.285,P<0.05),while plasma SP-D and sputum CCL3 concentrations were positively correlated with exacerbation in the previous year(r=0.473,0.370,P<0.05)and mMRC(r=0.450,0.362,P<0.05).(3)Age,plasma SP-D and sputum CCL3 could affect the FEV1%prep value in AECOPD patients.Only plasma SP-D and sputum CCL3 could affect mMRC.(4)The sensitivity of plasma SP-D and sputum CCL3 in the diagnosis of AECOPD was 68%and 72%,and the specificity was 86%and 82%,respectively.When they were combined,the AUCROC,sensitivity and specificity were 0.898,76%and 92%,respectively.Conclusion The serum SP-D and sputum CCL3 can serve as the biomarkers of severity assessment of AECOPD,and the combination of them can work better in estimating the FEV1%pre,which is one method to estimate the severity of AECOPD.
作者
石雪峰
解友邦
顾玉海
何响
孙泽蕊
多杰
SHI Xue⁃feng;XIE You⁃bang;GU Yu⁃hai;HE Xiang;SUN Ze⁃rui;DUO Jie(Department of Respiration,Qinghai Provincial People's Hospital,Xining 810000,China;Department of Hematology and Rheumatism,Qinghai Provincial People's Hospital,Xining 810000,China)
出处
《军事医学》
CAS
2021年第10期766-770,共5页
Military Medical Sciences
基金
青海省自然科学基金(2017-ZJ-954Q)
青海省人民医院院内指导课题(2018-004)
青海省卫生计生系统重点课题(2017-wjzd-10)
