血浆组织蛋白酶S和血小板反应蛋白-1对COPD急性加重期患者预后评估的价值  

Values of plasma cathepsin S and thrombospondin-1 in prognosis assessment of patients with acute exacerbation of COPD

作　　者：林石宁 王发辉[1] 石慧芳[1] 张秀峰 LIN Shi-ning;WANG Fa-hui;SHI Hui-fang;ZHANG Xiu-feng(Department of Respiratory Medicine,Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570311,China)

机构地区：[1]海南医学院第二附属医院呼吸内科,海南海口570311

出　　处：《热带医学杂志》2020年第4期516-520,共5页Journal of Tropical Medicine

基　　金：海南省卫生计生行业科研项目(1601032024A2001)。

摘　　要：目的检测慢性阻塞性肺疾病(COPD)急性加重期患者血浆组织蛋白酶(cat)S和血小板反应蛋白(TSP)-1,并分析其在预后评估中的价值。方法选取2015年4月-2016年4月海南医学院第二附属医院就诊的COPD患者109例,其中急性加重期患者49例(急性加重期组),稳定期患者60例(稳定期组)。利用酶联免疫吸附法(ELISA)检测血浆中cat S和TSP-1水平;进行入院急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分;利用血气分析仪检测患者入院氧分压(PO2)、二氧化碳分压(PCO2);利用超声仪检测患者入院肺动脉收缩压,利用彩超仪检测患者入院射血分数;检测患者1 s用力呼气容积(FEV1)、用力肺活量(FVC)。结果与稳定期组比较,急性加重期组患者PO2、射血分数、FEV1、FEV1/FVC显著降低(P<0.05),PCO2、肺动脉收缩压、APACHEⅡ评分显著升高,差异有统计学意义(P<0.05);与稳定期组比较,急性加重期组患者血浆cat S和TSP-1水平显著升高,差异有统计学意义(P<0.05);患者血浆cat S和TSP-1水平联合对COPD急性加重期患者诊断的灵敏度为91.80%,特异度为96.70%,AUC为0.973(95%CI:0.948~0.999,P<0.05);血浆cat S和TSP-1水平分别与急性加重期患者APACHEⅡ评分正相关(r=0.452、0.369,P均<0.05);Kaplan-Meier生存分析表明,cat S高水平患者1年总生存率显著低于cat S低水平者(65.39%vs.91.30%),TSP-1高水平患者1年总生存率显著低于cat S低水平者(66.67%vs.90.91%),差异均有统计学意义(P<0.05)。结论COPD急性加重期患者血浆cat S和TSP-1水平升高,可能与患者不良预后有关。Objective To detect cathepsin S(cat S)and thrombospondin(TSP)-1 in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD),and analyze their application values in prognosis evaluation.Methods109 COPD patients were selected from April 2015 to April 2016 in the Second Affiliated Hospital of Hainan Medical University.Among them,49 in acute exacerbation stage were as acute exacerbation group and 60 in stable stage were as stable group.The levels of cat S and TSP-1 in plasma were detected by enzyme-linked immunosorbent assay(ELISA).Acute physiology and chronic health evaluationⅡ(APACHEⅡ)score of admission was performed.The oxygen partial pressure(PO2)and carbon dioxide partial pressure(PCO2)were measured by blood gas analyzer;pulmonary artery systolic pressure was measured by ultrasonography;ejection fraction was measured by color Doppler ultrasonography,and the forced expiratory volume in one second(FEV1)and forced vital capacity(FVC)were measured.Results Compared with the stable group,PO2,ejection fraction,FEV1 and FEV1/FVC in the acute exacerbation group decreased significantly(P<0.05).PCO2,pulmonary systolic pressure and APACHEⅡscores increased significantly(P<0.05).Compared with the stable group,the levels of cat S and TSP-1 in the acute exacerbation group were significantly higher(P<0.05).The sensitivity,specificity and AUC of the combination of cat S and TSP-1 levels in patients with acute exacerbation of COPD were 91.80%,96.70%and 0.973,respectively.The levels of cat S and TSP-1 in plasma were positively correlated with APACHE II scores in patients with acute exacerbation(r=0.452,0.369,P<0.05).Kaplan-Meier survival analysis showed that the 1-year overall survival rate of patients with high cat S level was significantly lower than that of patients with low cat S level(65.39%vs.91.30%,P<0.05),and the 1-year overall survival rate of patients with high TSP-1 level was significantly lower than that with low cat S level(66.67%vs.90.91%,P<0.05).Conclusion The levels of cat S and TSP-1 in

关 键 词：慢性阻塞性肺疾病急性加重期 血浆组织蛋白酶S 血小板反应蛋白-1 预后 

分 类 号：R563[医药卫生—呼吸系统]