慢性阻塞性肺疾病急性加重期患者血清生长分化因子15和白细胞介素6的表达水平及临床意义

Expression levels and clinical significance of serum growth differentiation factor 15 and interleukin 6 in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者血清生长分化因子15(GDF-15)和白细胞介素6(IL-6)的表达水平及临床意义。方法选择慢性阻塞性肺疾病(COPD)稳定期患者40例(稳定组),急性加重期患者80例(加重组),其中急性加重期1级或2级40例(加重1组),急性加重期3级或4级40例(加重2组);另选40例健康体检者为对照组。采用酶联免疫吸附试验检测各组受试者血清GDF-15、IL-6水平;分析血清GDF-15、IL-6水平与第一秒用力呼气容积占预计值百分比(FEV1%pred)的相关性;采用受试者工作特征(ROC)曲线评估GDF-15、IL-6诊断AECOPD的价值。结果加重1组、加重2组血清GDF-15、IL-6水平均高于稳定组和对照组,且加重2组高于加重1组(P<0.05)。加重1组、加重2组血清GDF-15水平均与IL-6水平呈正相关,AECOPD患者GDF-15水平和IL-6水平均与FEV1%pred呈负相关(均P<0.05)。GDF-15诊断AECOPD的ROC曲线下面积为0.833,灵敏度、特异度和准确率分别为0.838、0.700和0.792;IL-6诊断AECOPD的曲线下面积为0.682,灵敏度、特异度和准确率分别为0.713、0.575和0.716。结论血清GDF-15、IL-6水平与AECOPD的病情严重程度相关,GDF-15对AECOPD具有较高的诊断价值。

Objective To investigate the expression levels and clinical significance of serum growth differentiation factor 15(GDF-15) and interleukin 6(IL-6) in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods Forty patients with stable chronic obstructive pulmonary disease(COPD) were enrolled as stable group,80 patients with AECOPD as exacerbation group,including 40 cases of acute exacerbation of grade Ⅰ or Ⅱ(exacerbation 1 group),and 40 cases of acute exacerbation of grade Ⅲ or Ⅳ(exacerbation 2 group);another 40 healthy check-up individuals were enrolled as control group.Enzyme-linked immunosorbent assay was used to detect serum GDF-15 and IL-6 levels among subjects of each group;the correlation of serum GDF-15 or IL-6 level with the percentage of predicted forced expiratory volume in one second(FEV 1% pred) was analyzed;receiver operating characteristic(ROC) curve was employed to assess the efficiency of GDF-15 or IL-6 for diagnosing AECOPD. Results The serum levels of GDF-15 and IL-6 in the exacerbation 1 group and exacerbation 2 group were higher than those in the stable group and control group,and the exacerbation 2 group had higher levels than the exacerbation 1 group( P <0.05).Among the exacerbation 1 group and exacerbation 2 group,serum GDF-15 level positively correlated with IL-6 level,and GDF-15 and IL-6 levels negatively correlated with FEV 1% pred among AECOPD patients(all P <0.05).The area under ROC curve of GDF-15 for diagnosing AECOPD was 0.833,the sensitivity,specificity and accuracy were 0.838,0.700 and 0.792,respectively;the area under the curve of IL-6 for diagnosing AECOPD was 0.682,and the sensitivity,specificity and accuracy were 0.713,0.575 and 0.716 ,respectively. Conclusion Serum GDF-15 and IL-6 levels are associated with the severity of AECOPD,GDF-15 has a higher diagnostic efficiency for AECOPD.