老年COPD稳定期病人经鼻高流量湿化氧疗血清颗粒蛋白前体表达水平及意义  

Expression level and significance of serum progranulin in elderly patients with chronic obstructive pulmonary disease treated by high-flow nasal cannula oxygen therapy

作　　者：秦克 李同林 华俊萍 江美芳 QIN Ke;LI Tong-lin;HUA Jun-ping;JIANG Mei-fang(Department of Respiratory and Critical Care Medicine,363 Hospital,Chengdu 610041,China)

机构地区：[1]三六三医院呼吸与危重症医学科,四川省成都市610041

出　　处：《实用老年医学》2023年第12期1215-1218,共4页Practical Geriatrics

基　　金：成都市医学科研课题项目(2021189)。

摘　　要：目的研究稳定期COPD病人经鼻高流量湿化氧疗(HFNC)治疗效果,并探讨治疗前后血清颗粒蛋白前体(PGRN)表达水平及意义。方法选择2019年6月至2021年6月于我院就诊的中重度稳定期COPD病人96例,随机分为A组和B组。A组病人应用HFNC,B组病人使用双水平正压通气(BiPAP)呼吸机,2组病人同时进行祛痰、解痉平喘和抗炎治疗。比较2组治疗前后PGRN、IL-8、IL-6和TNF-α水平及血气指标变化;分析血清PGRN与炎性因子的相关性;采用ROC曲线分析血清PGRN差值对老年COPD病人首次急性加重的预测价值。结果治疗后,2组血清PGRN、IL-8、IL-6、TNF-α水平和PaCO_(2)均较治疗前明显降低,PaO_(2)水平明显升高,且A组改善更明显,差异均有统计学意义(P<0.05)。相关分析显示,治疗前后血清PGRN差值和IL-8、IL-6、TNF-α差值均呈正相关(r=0.724、0.421、0.322,P<0.05)。随访发现,A组和B组首次急性加重时间差异有统计学意义(24个月比15个月,P<0.05)。ROC曲线分析显示,血清PGRN差值预测COPD病人首次急性加重的AUC为0.717(95%CI:0.619~0.812),截断值为49.2μg/L,以此截断值将A组病人划分为高波动组和低波动组,2组首次急性加重中位时间分别为27个月和21个月(P<0.05)。结论HFNC对稳定期COPD病人有较好疗效,治疗过程中血清PGRN水平变化与病人首次急性加重存在关联。Objective To explore the efficacy of high-flow nasal cannula oxygen therapy(HFNC)in the elderly patients with stable chronic obstructive pulmonary disease(COPD),as well as the expression level of serum progranulin(PGRN)and its significance.Methods A total of 96 elderly patients with moderate to severe stable COPD who were admitted to our hospital from June 2019 to June 2021 were selected and randomly divided into group A and group B.Group A was treated with HFNC,and group B was treated with bilevel positive airway pressure(BiPAP)ventilators.All the patients received expectorant,spasmolytic,anti-asthmatic and anti-inflammatory treatment at the same time.The levels of serum PGRN,interleukin-8(IL-8),IL-6,tumor necrosis factor(TNF)-αand the blood gas parameters before and after treatment were detected and compared between the two groups.The correlations between PGRN and inflammatory factors were analyzed.Receiver operating characteristic curve(ROC)was drawn to analyze the value of PGRN in predicting the first acute exacerbation in the elderly patients with stable COPD.Results After treatment,the levels of serum PGRN,IL-8,IL-6,TNF-αand partial pressure of arterial carbon dioxide(PaCO_(2))in two groups were significantly lower and partial pressure of arterial oxygen(PaO_(2))was significantly higher than those before treatment,especially in group A(P<0.05).The difference in serum PGRN before and after treatment was positively correlated with the difference in IL-8,IL-6 and TNF-αin COPD patients(r=0.724,0.421,0.322,P<0.05).The time of first acute exacerbation was statistically different between group A and group B(24 months vs 15 months,P<0.05).ROC analysis showed that the area under the curve(AUC)of difference of PGRN in predicting the first acute exacerbation in COPD patients was 0.717(95%CI:0.619-0.812)and the cut-off value was 49.2μg/L.According to the cut-off value,group A was divided into high-oscillation group and low-oscillation group,with a time of the first acute exacerbation of 27 months and 21 months,resp

关 键 词：慢性阻塞性肺疾病 经鼻高流量加温湿化氧疗 血清颗粒蛋白前体 首次急性加重 

分 类 号：R563[医药卫生—呼吸系统]