慢性阻塞性肺疾病急性加重期心肌损伤血清标志物检测及意义  

Detection and Significance of Serum Markers of Myocardial Injury in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

作　　者：陈泽莲 吴群华 Chen Zelian;Wu Qunhua(Department of Respiratory and Critical Care Medicine,Zigong First People’s Hospital,Zigong 643000,China)

机构地区：[1]自贡市第一人民医院呼吸与危重症医学科,自贡643000

出　　处：《成都医学院学报》2024年第2期303-306,314,共5页Journal of Chengdu Medical College

基　　金：2021年自贡市医学科学院医疗卫生自有资金引导基金项目(No:2021ZCYKY11)。

摘　　要：目的 探讨血清25羟维生素D[25(OH)D]、淀粉样蛋白A(SAA)、B型脑钠肽(BNP)对慢性阻塞性肺疾病急性加重(AECOPD)患者早期心肌损伤的评估价值。方法 选取自贡市第一人民医院2020年1月至2023年6月收治的500例AECOPD患者,按心型脂肪酸结合蛋白(H-FABP)水平分为心肌损伤组(试验A组,H-FABP>7μg/L,n=98)和心肌正常组(试验B组,H-FABP≤7μg/L,n=402),纳入同期在我院进行健康体检的100例正常人为对照组。比较研究对象的一般资料以及血清25(OH)D、SAA、BNP、H-FABP水平,分析血清25(OH)D、SAA、BNP与H-FABP相关性,采用受试者工作特征(ROC)曲线分析血清25(OH)D、SAA、BNP水平对AECOPD患者早期心肌损伤的评估价值。结果 3组性别、年龄、体重指数、收缩压、舒张压比较差异无统计学意义(P>0.05)。试验A组、试验B组、对照组血清25(OH)D呈递增趋势(P<0.05),血清SAA、BNP、H-FABP呈递减趋势(P<0.05)。血清25(OH)D与H-FABP呈负相关(P<0.05),血清SAA、BNP与H-FABP均呈正相关(P<0.05)。ROC曲线分析显示,血清25(OH)D、SAA、BNP水平及联合检测对AECOPD患者早期心肌损伤均有预测效能(P<0.05),AUC分别为0.784、0.742、0.855、0.853,其中BNP敏感度、特异性分别为95.30%、79.30%。结论 AECOPD患者早期心肌损伤时,血清25(OH)D降低,血清SAA、BNP升高,且上述3项指标均与H-FABP具有一定相关性,检测血清25(OH)D、SAA、BNP水平对AECOPD患者早期心肌损伤发生具有评估价值,其中BNP评估价值较高。Objective To investigate the value of serum 25-hydroxy vitamin D[25(OH)D],amyloid A(SAA)and B-type natriuretic peptide(BNP)levels in predicting early myocardial injury in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 500 patients with AECOPD admitted to Zigong First People's Hospital from January 2020 to June 2023 were selected.And according to their serum level of heart fatty acid-binding protein(H-FABP),they were divided into myocardial injury group(experimental group A,H-FABP>7μg/L,n=98)and normal myocardium group(experimental group B,H-FABP≤7μg/L,n=402).And 100 healthy subjects who underwent physical examination in the hospital during the same period were enrolled as control group.The general data,serum 25(OH)D,SAA,BNP and H-FABP levels of the subjects were compared.The correlation between serum 25(OH)D,SAA and BNP levels and serum H-FABP level was analyzed.Receiver operating characteristic(ROC)curve was used to analyze the value of serum 25(OH)D,SAA and BNP levels in predicting early myocardial injury in patients with AECOPD.Results There was no significant difference in gender ratio,age,body mass index,systolic blood pressure and diastolic blood pressure among the three groups(P>0.05).Serum 25(OH)D in experimental group A,experimental group B and control group showed an increasing trend(P<0.05),while serum SAA,BNP and H-FABP showed decreasing trends(P<0.05).Serum 25(OH)D was negatively correlated with serum H-FABP(P<0.05),while serum SAA and BNP were positively correlated with serum H-FABP(P<0.05).ROC curve analysis revealed that serum 25(OH)D,SAA,BNP levels and their combined detection were effective in predicting early myocardial injury in patients with AECOPD(P<0.05),and their AUC were 0.784,0.742,0.855,and 0.853,respectively.And among them,BNP had the highest predictive efficiency,with a sensitivity and specificity of 95.30%and 79.30%,respectively.Conclusion Serum 25(OH)D level is decreased and serum SAA and BNP levels are increased in AECOPD pa

关 键 词：慢性阻塞性肺疾病急性加重 25羟维生素D 淀粉样蛋白A B型脑钠肽 心肌损伤 

分 类 号：R446.1[医药卫生—诊断学]