血清白细胞介素38与慢性阻塞性肺疾病急性加重合并肺栓塞的相关性  

Correlation between serum interleukin-38 and acute exacerbation of chronic obstructive pulmonary disease with pulmonary embolism

作　　者：朱亚茜[1] 马淑萍[1] 董维刚[1] 张锦香[2] 张莹 Zhu Yaqian;Ma Shuping;Dong Weigang;Zhang Jinxiang;Zhang Ying(Department of Respiratory and Critical Care Medicine,Tianjin Chest Hospital,Tianjin 300222,China;Department of Nutrition,Tianjin Chest Hospital,Tianjin 300222,China;Tianjin Cardiovascular Institute,Tianjin 300222,China)

机构地区：[1]天津市胸科医院呼吸与危重症医学科,天津300222 [2]天津市胸科医院营养科,天津300222 [3]天津市心血管病研究所,天津300222

出　　处：《中华医学杂志》2019年第12期929-933,共5页National Medical Journal of China

摘　　要：目的探讨血清白细胞介素38(IL-38)与慢性阻塞性肺疾病急性加重(AECOPD)合并肺栓塞的相关性。方法选取2015年8月至2018年4月收住天津市胸科医院的疑似合并肺栓塞的AECOPD患者94例,患者均行CT肺动脉造影和下肢静脉彩色超声检查,根据检查结果分为肺栓塞组39例,和非肺栓塞组55例,记录研究对象的一般资料和实验室检查等结果,采用双抗体夹心酶联免疫吸附(ELISA)法检测血清白细胞介素(IL)-38水平,比较两组间以上各指标的差异。采用Pearson相关或Spearman秩相关分析IL-38与各变量之间的相关性;采用二分类Logistic回归分析AECOPD患者伴发肺栓塞的危险因素;绘制受试者工作特征(ROC)曲线评估血清IL-38对AECOPD合并肺栓塞的预测意义。结果肺栓塞组血清IL-38水平显著低于非肺栓塞组[46.3(33.1,58.1)比61.5(46.6,72.5)ng/L](P<0.05)。相关分析显示AECOPD患者血清IL-38水平与C反应蛋白及纤维蛋白原呈负相关(r=-0.38、-0.29,均P<0.05)。二分类Logistic回归分析显示血清IL-38水平较低是AECOPD合并肺栓塞的危险因素(OR=0.78,95%CI:0.61~0.94,P<0.05)。ROC曲线分析显示,IL-38评估AECOPD合并肺栓塞的ROC曲线下面积为0.74(95% CI:0.63~0.84,P<0.05),最佳截断值为52.1 ng/L,敏感度为0.709,特异度为0.692。结论IL-38可能通过抑制炎症反应改善AECOPD患者的易栓状态,血清IL-38水平对AECOPD合并肺栓塞有一定的预测意义。Objective To investigate the correlation between serum interleukin-38 (IL-38) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with pulmonary embolism (PE).Methods The 94 patients with AECOPD admitted to Tianjin Chest Hospital from August 2015 to April 2018 were suspected of PE.They were divided into two groups based on CT pulmonary angiography (CTPA) and color Doppler ultrasound of lower extremity veins: 39 cases in PE group and 55 cases in Non-PE group.The general data and laboratory examination results of these subjects were recorded.Serum IL-38 was measured by double antibody enzyme-linked immunosorbent assays (ELISA).The between-group differences of above parameters were analyzed.Pearson correlation or Spearman rank correlation was used to analyze the association of IL-38 with each variable in AECOPD patients.Binary Logistic regressions were conducted to determine the risk factors of AECOPD with PE.ROC curve was used to assess the value of serum IL-38 in predicting AECOPD with PE.Results The serum level of IL-38 was lower in PE group than in Non-PE group [46.3 (33.1,58.1) vs 61.5 (46.6,72.5) ng/L,P<0.05].Correlation analysis showed that serum IL-38 levels were negatively correlated with C reactive protein and fibrinogen in patients with AECOPD (r=-0.38,-0.29,all P<0.05).Binary Logistic regressions showed that lower serum IL-38 level was a risk factor of AECOPD with PE (OR=0.78,95%CI: 0.61-0.94,P<0.05).The area under the ROC curve was 0.74 (95% CI: 0.63-0.84,P<0.05).When cutoff value of serum IL-38 was 52.1ng/L,the sensitivity was 70.9% and the specificity was 69.2% respectively.ConclusionIL-38 could relieve the hypercoagulability by inhibiting inflammation in patients with AECOPD and could act as a predictor of AECOPD with PE.

关 键 词：肺疾病 慢性阻塞性 白细胞介素38 肺栓塞 

分 类 号：R563[医药卫生—呼吸系统]