白细胞介素-6和涎液化糖链抗原-6及载脂蛋白a水平预测老年慢性阻塞性肺疾病急性加重期患者近期预后的价值  

Values of interleukin-6, Krebs von den Lungen-6 and apolipoprotein a to the prediction of short-term prognosis of elderly patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：加娜依•阿乃西 加孜那•托哈依 Jianayi ANAIXI;Jiazina TUOHAYI(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830054,China)

机构地区：[1]新疆医科大学第一附属医院呼吸与危重症医学科,新疆维吾尔自治区乌鲁木齐830054

出　　处：《中华实用诊断与治疗杂志》2021年第10期1038-1042,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：新疆维吾尔自治区自然科学基金项目(2018D01C015)。

摘　　要：目的观察老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)患者血清白细胞介素-6(interleukin-6, IL-6)、涎液化糖链抗原-6(Krebs von den Lungen-6, KL-6)及载脂蛋白a(apolipoprotein a, APOA)表达情况,探讨其预测AECOPD患者近期预后的价值。方法 93例老年AECOPD患者均接受规范化治疗,分别于入院时及出院前1 d检测血清IL-6、KL-6及APOA水平,出院后随访1年,根据随访期间是否再次出现急性加重分为预后良好组58例和预后不良组35例;比较2组入院时临床资料及血清IL-6、KL-6、APOA水平。采用多因素logistic回归分析老年AECOPD患者出院后发生近期预后不良的影响因素,采用Spearman相关性分析老年AECOPD患者血清IL-6、KL-6、APOA水平之间的相关性;绘制ROC曲线,评估入院时血清IL-6、KL-6、APOA水平对老年AECOPD患者发生近期预后不良的预测效能。结果 93例老年AECOPD患者中,35例再次出现急性加重,发生率为37.63%;93例患者出院前1 d血清IL-6[11.94(11.04,13.56)pg/L]、KL-6[40.09(38.52,41.77)u/mL]水平均低于入院时[15.64(13.25,16.90)pg/L、47.57(43.17,51.34)u/mL](P<0.05),APOA水平[1.90(1.74,2.05)g/L]高于入院时[1.54(1.21,1.85)g/L](P<0.05);预后不良组入院时血清IL-6[17.17(15.79,19.15)pg/L]、KL-6[53.39(48.81,54.55)u/mL]水平均高于预后良好组[14.10(12.24,15.96)pg/L、44.54(40.98,48.54)u/mL](P<0.05),APOA水平[1.21(1.01,1.40)g/L]低于预后良好组[1.76(1.51,1.98)g/L](P<0.05);血清IL-6(OR=2.601,95%CI:1.257~5.382,P=0.010)、KL-6(OR=1.692,95%CI:1.319~2.171,P<0.001)、APOA水平(OR=0.007,95%CI:<0.001~0.094,P<0.001)是老年AECOPD患者出院后发生近期预后不良的影响因素;当入院时血清IL-6、KL-6、APOA水平最佳截断值分别为15.333 pg/L、46.759 u/mL、1.640 g/L时,单独及联合检测预测AECOPD患者出院后发生近期预后不良的AUC分别为0.861(95%CI:0.789~0.932,P<0.001)、0.893(95%CI:0.828~0.957,P<0.001)、0.850(95%CI:0.772~0.927Objective To observe the expressions of serum interleukin(IL)-6, Krebs von den Lungen-6(KL-6) and apolipoprotein a(APOA) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD), and to explore their values to the prediction of short-term prognosis. Methods All 93 elderly patients with AECOPD received standardized treatment, and were detected the levels of IL-6, KL-6 and APOA on admission and oneday before discharge.All patients were followed up for one year after discharge and were divided into 58 patients with good prognosis(good prognosis group)and 35 patients with poor prognosis(poor prognosis group)according to whether acute exacerbation occurred again during the follow-up period.The clinical data and the levels of IL-6,KL-6 and APOA on admission were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of poor short-term prognosis in elderly AECOPD patients after discharge.Spearman correlation was used to analyze the correlations among IL-6,KL-6 and APOA in elderly AECOPD patients.ROC curve was drawn to evaluate the efficiencies of IL-6,KL-6 and APOA levels on admission on predicting the poor short-term prognosis of elderly AECOPD patients.Results Among 93 elderly patients with AECOPD,35 patients developed acute exacerbation,accounting for37.63%.The levels of serum IL-6 and KL-6 were lower one day before discharge [11.94(11.04,13.56)pg/L,40.09(38.52,41.77)u/mL]than those on admission [15.64(13.25,16.90)pg/L,47.57(43.17,51.34)u/mL](P<0.05),and APOA level was higher one day before discharge [1.90(1.74,2.05)g/L]than that on admission[1.54(1.21,1.85)g/L](P<0.05).The levels of serum IL-6 and KL-6 were higher in poor prognosis group[17.17(15.79,19.15)pg/L,53.39(48.81,54.55)u/mL]than those in good prognosis group[14.10(12.24,15.96)pg/L,44.54(40.98,48.54)u/mL](P<0.05),and the level of APOA was lower in poor prognosis group[1.21(1.01,1.40)g/L]than that in good prognosis group[1.76(1.51,1.98)g/L]on admission(P<0.05).IL-6(OR=2.601,

关 键 词：慢性阻塞性肺疾病 急性加重期 白细胞介素-6 涎液化糖链抗原-6 载脂蛋白A 

分 类 号：R563.9[医药卫生—呼吸系统]