摘要
目的 探讨血清不规则趋化因子(FKN)、血管生成抑制蛋白(vasohibin-1)及D-二聚体在慢性阻塞性肺疾病肺急性加重期(AECOPD)患者中的动态变化及其诊断价值.方法 回顾性选取2020年1月至2022年12月西安交通大学第一附属医院榆林医院收治的106例AECOPD患者为观察组,另选取同期来体检的100名健康志愿者为对照组.比较观察组与对照组患者血清FKN、vasohibin-1、D-二聚体表达水平,并分析观察组患者入院第1天、第3～5天、第7～9天血清FKN、vasohibin-1、D-二聚体表达水平.采取慢性阻塞性肺疾病评定量表(CAT)对患者预后进行评价,取患者中位分值,将CAT评分≥23.43分的患者设为预后不良组(n=21),将＜23.43分的患者设为预后良好组(n=85).建立Logistics回归模型分析影响AECOPD预后不良的因素.建立受试者操作特征(ROC)曲线确定血清FKN、va-sohibin-1、D-二聚体对AECOPD的诊断价值.结果 观察组FKN、vasohibin-1、D-二聚体表达水平分别为(13.57±3.67)μg/L、(641.53±87.47)ng/L、(2.14±0.32)mg/L,均明显高于对照组,差异均有统计学意义(P＜0.05).入院第 7～9 天的 FKN、vasohibin-1、D-二聚体表达水平分别为(9.78±1.57)μg/L、(416.79±57.33)ng/L、(0.95±0.14)mg/L,均明显低于入院第3～5天与入院第1天,差异均有统计学意义(P＜0.05).预后良好组的年龄、FKN、vasohibin-1、D-二聚体水平与预后不良组比较,差异均有统计学意义(P＜0.05).Logistics回归模型分析显示,FKN、vasohibin-1、D-二聚体是AECOPD患者预后不良的独立危险因素(P＜0.05).ROC曲线结果显示,FKN、vasohibin-1、D-二聚体、3者联合的曲线下面积(AUC)分别为0.618、0.674、0.520、0.818.FKN、vasohibin-1、D-二聚体3者联合对AE-COPD 的诊断敏感度、特异度高于3者单一诊断.结论 血清FKN、vasohibin-1及D-二聚体参与AECOPD患者的病情变化过程,可监测这3个指标的动态变化来评估患者病情演变和预后情况,且3者联合检测可以提高对AECOPD患者的判断准确度.
Abstract
Objective To explore the dynamic changes of serum fraetalkine(FKN),angiogenesis inhibitory protein(vasohibin-1)and D-dimer in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 106 patients with AE-COPD admitted to the First Affiliated Hospital of Xian Jiaotong University,Yulin Hospital from January 2020 to December 2022 were retrospective-ly selected as the observation group,and 100 healthy volunteers who underwent physical examination during the same period were selected as the control group.The levels of serum FKN,vasohibin-1 and D-dimer expression in the observation and control group were compared,and the lev-els of serum FKN,vasohibin-1 and D-dimer expression on admission 1 d,3 to 5 d and 7 to 9 d of the observation group were analyzed.The chronic obstructive pulmonary disease rating scale(CAT)was used to evaluate patients with CAT score ≥23.43 were divided into the poor progno-sis group(n=21),and patients with CAT score＜23.43 were divided into the good prognosis group(n=85).Establish multiple Logistic re-gression models to analyze the factors contributing to poor prognosis in AECOPD.Finally,a receiver operating curve(ROC)was established to de-termine the diagnostic value of serum FKN,vasohibin-1,and D-dimer for AECOPD.Results The expression levels of FKN,vasohibin-1,and D-dimer in the observation group were(13.57±3.67)μg/L,(641.53±87.47)ng/L,and(2.14±0.32)mg/L,respectively,which were higher than those in the control group,the differences were statistically significant(P＜0.05).The expression levels of FKN,vasohibin-1,D-dime on admission 9 d of the observation group were(9.78±1.57)μg/L,(416.79±57.33)ng/L,(0.95±0.14)mg/L,respectively,which were lower than those of admission 3 to 5 d and admission 1 d,the differences were statistically significant(P＜0.05).There were statisti-cally significant differences in age,FKN,vasohibin-1 and D-dimer levels between the good prognosis group and the poor prognosis group(P＜0.05).Logistics regression model analysis showed that FKN,vasohibin-1 and D-dimer were independent risk factors for poor prognosis in AE-COPD patients(P＜0.05).The results of ROC curve showed that the area under the curve(AUC)of FKN,vasohibin-1,D-dimer and their combination were 0.618,0.674,0.520 and 0.818,respectively.The sensitivity and specificity of the combination of FKN,vasohibin-1 and D-dimer in the diagnosis of AECOPD were higher than those of the single diagnosis of the three.Conclusion Serum FKN,vasohibin-1,and D-dimer are involved in the process of disease progression in AECOPD patients.The dynamic changes of these three indicators can be monitored to evaluate the patient's disease progression and prognosis.Combined detection of these three indicators can improve the accuracy of judgment in AE-COPD patients.
基金项目
陕西省自然科学基础研究计划项目(2022JQ-906)
NETL
NSTL
万方数据