慢性阻塞性肺疾病急性加重期患者血清PGRN水平变化及其意义  

Changes and clinical significance of serum PGRN level in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：王新梅 栾念旭[2] 张妍 王玉香 WANG Xinmei;LUAN Nianxu;ZHANG Yan;WANG Yuxiang(Ninth People′s Hospital of Qingdao,Qingdao 266002,China)

机构地区：[1]青岛市第九人民医院,山东青岛266002 [2]青岛市市立医院 [3]青岛市李沧区中心医院

出　　处：《山东医药》2019年第19期23-26,共4页Shandong Medical Journal

基　　金：山东省科技发展计划项目(2016GSF119023)

摘　　要：目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者血清颗粒蛋白前体(PGRN)水平变化及其临床意义。方法选择AECOPD患者97例(AECOPD组),其中肺功能分级Ⅰ级21例、Ⅱ级30例、Ⅲ级27例、Ⅳ级19例。同期另选稳定期COPD患者60例(SCOPD组)和体检健康者60例(对照组)。采集所有研究对象清晨空腹肘静脉血,采用ELISA法检测血清PGRN;在安静环境下采用Masterscope肺功能仪检测第1秒用力呼气容积(FEV1)、用力肺活量(FVC),计算FEV1/FVC。比较三组血清PGRN水平和FEV1、FVC、FEV1/FVC变化,以及AECOPD不同肺功能分级者上述指标变化。采用Pearson相关分析法分析AECOPD患者血清PGRN水平与FEV1、FVC、FEV1/FVC的关系。AECOPD患者入院28d内死亡20例、存活77例,比较存活者与死亡者血清PGRN水平变化。采用受试者工作特征(ROC)曲线评估血清PGRN对AECOPD患者死亡的预测价值。结果AECOPD组、SCOPD组、对照组血清PGRN水平逐渐降低,FEV1、FVC、FEV1/FVC逐渐升高,两两比较P均<0.05。随着肺功能分级增加,AECOPD患者血清PGRN水平逐渐升高,FEV1、FVC、FEV1/FVC逐渐降低(P均<0.05)。Pearson相关分析显示,AECOPD患者血清PGRN水平与FEV1、FVC、FEV1/FVC均呈负相关关系(r分别为-0.672、-0.716、-0.758,P均<0.05)。AECOPD患者入院28d内存活者血清PGRN水平明显低于死亡者(P<0.01)。血清PGRN水平预测AECOPD患者死亡的ROC曲线下面积为0.891(95%CI:0.838~0.945),最佳截断值为196.37ng/mL,此时血清PGRN水平预测AECOPD患者死亡的敏感性为89%、特异性为83%、准确性为87%。结论AECOPD血清PGRN水平明显升高,其水平升高与肺功能降低呈明显负相关关系;血清PGRN水平有可能作为预测AECOPD患者预后的指标之一。ObjectiveTo explore the level of serum progranulin (PGRN) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its clinical significance. Methods Ninety-seven patients with AECOPD (AECOPD group) were selected, and there were 21 cases in grade Ⅰ, 30 cases in grade Ⅱ, 27 cases in grade Ⅲ, and 19 cases in grade Ⅳ according to the classification of pulmonary function. During the same period, 60 stable COPD patients (SCOPD group) and 60 healthy persons (control group) were selected. Fasting elbow venous blood was collected from all subjects in the morning, the serum PGRN was detected by ELISA. The forced expiratory volume in the first second (FEV 1) and forced vital capacity (FVC) were measured by Masterscope pulmonary function instrument in quiet environment, and FEV 1/FVC was calculated. The changes of serum PGRN level and FEV 1, FVC and FEV 1/FVC in the three groups were compared, and the changes of the above indexes in the AECOPD patients with different pulmonary function grades were compared. Pearson correlation analysis was used to analyze the relationships between serum PGRN level and FEV 1, FVC, and FEV 1/FVC in patients with AECOPD. Twenty AECOPD patients died and 77 survived within 28 days of admission, the serum levels of PGRN in survivors and dead patients were compared, the predictive value ratio of serum PGRN to AECOPD mortality was evaluated by receiver operating characteristic curve (ROC). Results Serum PGRN levels in the AECOPD group, SCOPD group, and control group decreased gradually, while FEV 1, FVC and FEV 1/FVC increased gradually, with statistically significant difference (all P<0.05). With the increase of pulmonary function grading, the serum PGRN levels in AECOPD patients increased gradually, while FEV 1, FVC and FEV 1/FVC decreased gradually (all P< 0.05 ). Pearson correlation analysis showed that the serum PGRN levels in AECOPD patients were negatively correlated with FEV 1, FVC and FEV 1/FVC (r=-0.672,-0.716, and -0.758, respectively;all P<0.05).

关 键 词：慢性阻塞性肺疾病急性加重期 颗粒蛋白前体 肺功能 受试者工作特征曲线 

分 类 号：R563[医药卫生—呼吸系统]