血清鸢尾素和热休克蛋白27及D-二聚体水平对慢性阻塞性肺疾病急性加重期合并肺栓塞的鉴别价值及其与预后的关系探讨  

Discrimination value of serum irisin,HSP-27 and D-D in acute exacerbation of chronic obstructive pulmonary disease with pulmonary embolism and their relationship with prognosis

作　　者：李娜[1] 朱宏霞[2] 朱丹 尚颖 LI Na;ZHU Hongxia;ZHU Dan;SHANG Ying(Department of Respiratory Medicine,the Second Affiliated Hospital of Dalian Medical University,Dalian,Liaoning,116023,China;Department of General Medicine,Cardiovascular Hospital of the Second Affiliated Hospital of Dalian Medical University,Dalian Ruikang Cardiovascular Hospital)

机构地区：[1]大连医科大学附属第二医院呼吸内科,辽宁大连116023 [2]大连医科大学附属第二医院心血管病医院(大连瑞康心血管病医院)综合内科

出　　处：《临床急诊杂志》2022年第5期337-342,347,共7页Journal of Clinical Emergency

基　　金：2017年辽宁省自然科学基金指导计划(No:2017061036)。

摘　　要：目的:观察并探讨血清鸢尾素、热休克蛋白27(HSP27)和D-二聚体(D-D)水平在慢性阻塞性肺疾病急性加重期(AECOPD)合并肺栓塞(PE)中的变化意义及临床价值。方法:选取大连医科大学附属第二医院呼吸内科2018年1月-2020年12月期间住院的AECOPD患者共500例,其中未合并PE的AECOPD患者(AECOPD组)420例,AECOPD合并PE患者(AECOPD+PE组)80例,对AECOPD合并PE患者根据PE严重指数评分和危险分级,分为高、中、低危3个组;以截止末次随访患者是否死亡,将AECOPD合并PE患者分为存活组和死亡组;另选取体检中心的健康体检者80例为对照组。记录其性别、年龄、BMI、吸烟史及研究指标的数据,检测所有研究对象血清鸢尾素、HSP27、D-D水平,并进行对比分析。结果:AECOPD+PE组血清HSP27和D-D水平高于AECOPD组和对照组,且AECOPD组也高于对照组(P<0.05),而AECOPD+PE组血清鸢尾素水平低于AECOPD组和对照组,且AECOPD组也低于对照组(P<0.05);Spearman相关性分析显示,AECOPD合并PE患者血清HSP27和D-D水平与PE危险程度呈显著正相关,而血清鸢尾素水平与PE危险程度呈显著负相关(P<0.05)。受试者工作特征曲线分析发现血清鸢尾素、HSP27和D-D单独应用及联合应用鉴别AECOPD合并PE的受试者工作特征曲线下面积分别为0.774、0.716、0.721、0.804。Logistic回归分析结果显示:血清鸢尾素水平是预后的重要保护因素,而HSP27和D-D水平是预后的重要危险因素(P<0.05)。结论:血清HSP27、D-D水平在AECOPD尤其是合并PE患者中升高,而血清鸢尾素水平则降低,且与PE危险程度有相关性,具有一定的鉴别价值,联合检测3个血清指标可能有助于及时判断患者的病情严重程度及评估预后。Objective:To observe and explore the changes of serum irisin,heat shock protein 27(HSP27)and D-dimer(D-D)levels in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with pulmonary embolism(PE)significance and clinical value.Methods:A total of 500 AECOPD patients who were hospitalized in the Department of Respiratory Medicine in The Second Affiliated Hospital of Dalian Medical University from January 2018 to December 2020 were selected,including 420 AECOPD patients without PE(AECOPD group)and 80 AECOPD patients with PE(AECOPD+PE group).Patients with AECOPD combined with PE were divided into high,medium and low risk groups according to the PE severity index score and risk classification.Patients with AECOPD combined with PE were divided into survival group and death group according to whether the patients died at the last follow-up up to discharge.80 healthy subjects from the hospital’s physical examination center were selected as the control group.Basic information such as gender,age,body mass index(BMI),smoking history and research indicators were recorded,and serum irisin,HSP27 and D-D of all subjects were detected and compared and analyzed.Results:The serum HSP27 and D-D in the AECOPD+PE group were higher than those in the AECOPD group and the control group,and the AECOPD group was also higher than the control group(P<0.05),while the serum irisin in the AECOPD+PE group was lower than that in the AECOPD group and the control group,and the AECOPD group was also lower than the control group(P<0.05).Spearman correlation analysis showed that serum HSP27 and D-D in AECOPD patients with PE were significantly positively correlated with the risk of PE,the degree of irisin was significantly negatively correlated(P<0.05).ROC curve analysis found that the AUC of serum irisin,HSP27 and D-D single and combined application were 0.774,0.716,0.721,0.804 respectively.Logistic regression analysis showed that serum irisin level was an important protective factor for prognosis,while HSP27 and D-D leve

关 键 词：慢性阻塞性肺疾病急性加重期 肺栓塞 鸢尾素 热休克蛋白27 D-二聚体 鉴别 预后 

分 类 号：R563.5[医药卫生—呼吸系统]