血清25(OH)D、Lp(a)和CTnI水平对慢性阻塞性肺疾病急性加重患者合并冠心病患者早期诊断的临床研究  

Clinical study of early diagnosis of serum 25 (OH) D, Lp (a) and CTnI in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with coronary heart disease

作　　者：徐莉[1] 徐晓[1] XU Li;XU Xiao(Respiratory Depatment,Suzhou Affiliated Hospital of Nanjing Medical University,Suzhou,Jiangsu 215002,China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院本部呼吸与危重症医学科

出　　处：《临床肺科杂志》2020年第1期3-7,共5页Journal of Clinical Pulmonary Medicine

基　　金：苏州市卫生和计划生育委员会临床重点病种课题(No LCX201712)

摘　　要：目的探讨血清25羟基维生素D[25(OH)D]、脂蛋白(a)[Lp(a)]和肌钙蛋白I(CTnI)对慢性阻塞性肺疾病急性加重(AECOPD)合并冠心病(CHD)患者早期诊断的临床研究。方法本文统计了二组病例和正常对照组的性别、年龄、病程、体重指数(BMI)、吸烟和饮酒情况。化学发光免疫分析和化学法测定了218例AECOPD合并CHD、136例AECOPD患者和100例正常对照组血清25(OH)D、Lp(a)和CTnI水平,并进行了对比性分析。计算稳态型IR指数(HOMA-IR),受试者工作特征(ROC)曲线评估AECOPD合并CHD患者早期诊断的临床价值。结果218例AECOPD合并CHD和136例AECOPD的发生发展与BMI、吸烟和饮酒密切相关。AECOPD合并CHD和AECOPD患者血清25(OH)D水平较之100例正常对照组明显降低(P均<0.01);血清Lp(a)和CTnI水平明显增高(P均<0.01);AECOPD合并CHD较之AECOPD患者血清25(OH)D水平亦明显降低(P<0.01);血清Lp(a)和CTnI水平亦明显增高(P<0.01);AECOPD合并CHD和AECOPD HOMA-IR水平均明显增高(P均<0.01)。ROC曲线显示:血清25(OH)D、Lp(a)和CTnI水平的临界值分别为20.96ng/mL、295.78mg/dL和0.050 ng/mL,AUC分别为0.771、0.813和0.752,敏感度分别为78.6%、82.4%和76.3%,特异度分别为82.3%、88.5%和79.6%。结论AECOPD的发生发展与BMI、吸烟、饮酒和HOMA-IR密切相关。血清25(OH)D、Lp(a)和CTnI是AECOPD合并CHD早期诊断的有价值指标。Objective To explore the clinical study of early diagnosis of serum 25(OH)D,Lp(a)and CTnI in patients with AECOPD complicated with CHD.Methods Their sex,age,course,BMI,smoke and drink were statistically analyzed in the two groups and compared with the control group.The levels of serum 25(OH)D,Lp(a)and CTnI were determined in 218 patients with AECOPD complicated with CHD,136 patients with AECOPD and 100 healthy people by biochemistry and chemluminsence immunoassay.The HOMA-IR level was calculated.The clinical value of early diagnosis was predicted in patients with AECOPD complicated with CHD by ROC curve.Results In 218 patients with AECOPD complicated with CHD and 136 patients with AECOPD,the development of disease was closely related with BMI,smoke and drink.The serum 25(OH)D level in patients with AECOPD complicated with CHD and patients with AECOPD was obviously lower than that in the control group(P<0.01),and the levels of serum Lp(a)and CTnI were obviously higher(P<0.01).The serum 25(OH)D level in patients with AECOPD complicated with CHD was obviously lower than that in patients with AECOPD(P<0.01),and the levels of serum Lp(a)and CTnI were obviously higher(P<0.01).The HOMA-IR level increased obviously in patients with AECOPD complicated with CHD and patients with AECOPD(P<0.01).ROC curve showed the cut-off value of 25(OH)D,Lp(a)and CTn I was 20.96 ng/m L,295.78 mg/d L and 0.050 ng/m L respectively,AUC was 0.771,0.813 and 0.752 respectively,sensitivity was 78.6%、82.4%and 76.3%,and specificity was 82.3%、88.5%and79.6%respectively.Conclusion The development of AECOPD is closely related with BMI,smoke,drink and HOMA-IR.The levels of 5(OH)D,Lp(a)and CTn I are valuable indexes for early diagnosis of AECOPD complicated with CHD.

关 键 词：慢阻肺急性加重合并冠心病(AECOPD合并CHD) 血清25羟基维生素D[25(OH)D] 脂蛋白(a)[Lp(a)] 肌钙蛋白I(CTnI) 受试者工作特征(ROC)曲线 

分 类 号：R54[医药卫生—心血管疾病]