探讨血清淀粉样蛋白A在慢性阻塞性肺疾病急性加重期的临床应用

Probing clinical application of serum amyloid A in acute exacerbation of chronic obstructive pulmonary disease

目的探讨血清淀粉样蛋白A（serum amyloid A，SAA）在慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）的临床应用。方法随机抽取中一重度慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者120例（GOLDⅡ～Ⅳ级），其中AECOPDⅠ级、AECOPDⅡ／Ⅲ级患者各60例（依据2004年ATS／ERS指南：Ⅰ级，不需住院治疗；Ⅱ级，需住院治疗；Ⅲ级，存在呼吸衰竭。并以此标准作为判断住院与否的金标准）。AECOPDⅠ级患者在急性加重期、稳定期测SAA、C反应蛋白（CRP）水平；AECOPDⅡ／Ⅲ级患者在急性加重期、恢复期、稳定期测SAA、CRP水平，且住院后做3次痰涂片及培养；并随机抽取同期我院体检的健康对照者20名，测SAA、CRP水平。结果AECOPD患者SAA水平明显高于CRP水平，差异有统计学意义（P〈0．05）。根据接收者工作特征（ROC）曲线分析，SAA、CRP均不能很好地将AECOPDI级同COPD稳定期区分开，因为其ROC曲线下面积（AUC）分别为0．70、0．63；SAA与CRP相比能更好地将AECOPDⅡ／Ⅲ级同COPD稳定期区分开，因为其AUC值分别为0．91、0．78。有脓痰及痰培养阳性者SAA、CRP水平明显升高。SAA、CRP水平均升高时，静滴抗生素5d左右症状明显好转者，出院后继续口服抗生素3d组和住院静滴抗生素10～14d组，6个月随访的再住院次数、急性加重次数在两组间差异无统计学意义。CRP正常、SAA升高时，用与不用抗生素组预后差异无统计学意义。结论在AECOPD中SAA是较CRP更敏感的一个炎症标志物，且SAA联合CRP有利于指导抗生素的应用。

Objective To probe clinical application of serum amyloid A（SAA） in acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods Patients with chronic obstructive pulmonary disease（COPD） were randomly drawn off （GOLD Ⅱ-Ⅳ level） , including 60 patients of AECOPD Ⅰ level and 60 patients AECOPDⅡ/Ⅲ （according to 2004 year ATS/ERS guide：level Ⅰ ,treated at home,level Ⅱ , requires hospitalisation; level Ⅲ, leads to respiratory failure. The criteria are regarded golden criteria to decide wether patients require hospitalisation）. The concentrations of SAA and CRP in the serum （were measured in patients with level Ⅰ AECOPD both acute exacerbation and stable stage and in twenty healthy volunteers;they were also measured in patients with AECOPD of level Ⅱ/Ⅲ among aeute exacerbation, stage of recovery, stable stage, and sputum smear and cluture were done three times after hospitalisation. Results The concentration of SAA was significantly higher than that of CRP in patients with AECOPD（ P 〈 0.05）. According to the receiver operating characteristic （ROC） curves analysis principle, both SAA and CRP modestly distinguished level Ⅰ AECOPD from stable COPD,as ROC analysis generated AUC values of 0.70 for SAA and 0.63 for CRP;SAA was significantly better at differentiating level Ⅱ /Ⅲ AECOPD from stable COPD with an AUC value of 0.91 versus CRP with an AUC value of 0.78 （P 〈0.05）. The concentrations of SAA and CRP in the serum were significantly higher when sputum was purulent or bacteria were found. When SAA and CRP were both higher than normal level,one group used ivtravenous antibiotic about five days and symptom was significantly improved, then altered oral antibiotic using three days and the other group used ivtravenous antibiotic about 10-14 days in hospital. Times of hospitalisation and acute exacerbation were not significantly different between two groups after six months＇ follow-up visit. Wether using antibiotic was not significantly different by six months＇ follow-up visit when SAA was high and CRP was normal. Conclusions SAA is a more sensitive inflammation marker than CRP in AECOPD, and SAA combinating CRP can profit to direct application of antibiotic.