血清淀粉样蛋白A水平在慢性阻塞性肺疾病急性加重期的变化及其意义

Significance of the changes of the serum amyloid protein A levels in acute exacerbation chronic obstructive pulmonary disease

目的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变化及其意义,为临床诊疗提供参考。方法选取我院接诊的慢性阻塞性肺疾病急性加重期患者70例,将其分为A组(AECOPD I级)38例和B组(AECOPDⅡ/Ⅲ级)32例,选取同期在我院体检的健康人群30例为健康对照组。对比急性加重期患者、稳定期患者以及健康对照组受试者的血清淀粉样蛋白A以及C-反应蛋白(CRP)水平;对比A组和B组患者的血清淀粉样蛋白A和CRP两个指标的敏感度和特异度;分析痰培养结果和血清淀粉样蛋白A和CRP水平的关系。结果稳定期和急性加重期患者的血清淀粉样蛋白A以及CRP水平均显著高于健康对照组(均P<0.05);急性加重期的血清淀粉样蛋白A以及CRP水平均显著高于稳定期(均P<0.05);慢性阻塞性肺疾病患者血清淀粉样蛋白A水平显著高于CRP水平(P<0.05);B组的血清淀粉样蛋白A在区分急性加重期和稳定期的敏感度和特异度为84%、91%,AUC值=0.92,优于CRP的敏感度和特异度(69%、69%,AUC值=0.79);有脓性痰或者痰培养结果阳性患者的血清淀粉样蛋白A水平为(79.36±15.72)mg/L,CRP水平为(24.97±6.52)mg/L,均显著高于没有脓性痰且痰培养结果阴性的患者(均P<0.05)。结论检测血清淀粉样蛋白A对判断慢性阻塞性肺疾病患者病情严重程度有一定的指导意义,同时可以指导临床更有针对性地应用和停用抗生素,值得在临床上进一步推广应用。

Objective To investigate the value of serum amyloid protein A in acute exacerbation chronic obstructive pulmonary disease. Methods 70 patients of acute exacerbation chronic obstructive pulmonary disease（AECOPD） were divided into group A （38 cases of AECOPD I level） and group B （32 cases of AECOPD II/III level）. Selected 30 cases of healthy people as healthy control group in the same period. Compared the level of serum amyloid protein A and C-reactive protein in group of acute exacerbation, group of stable patients and group of healthy. Compared sensitivity and specificity of serum amyloid A and C-reactive protein in group A and group B. Analyzed the relationship between the results of sputum culture and serum amyloid A and C-reactive protein levels. Results The levels of serum amyloid A and C-reactive protein in stable and acute exacerbation were significantly higher than that of the healthy control group （P〈0.05）. Acute exacerbation of serum amyloid A and C-reactive protein levels were significantly higher than that of stable group （all P〈0.05）. The levels of serum amyloid A were significantly higher than C-reactive protein in patients with chronic obstructive pulmonary disease （P〈O.05）. The sensitivity and specificity of serum amyloid protein A in identifying acute exacerbation and stable of group B were 84% and 91% ,AUC value=0.92,were superior than C-reactive protein （69%, 69% ,AUC value=0.79）. The levels of serum amyloid A were （79.36± 15.72）mg/L in patients of purulent sputum or positivity of sputum culture, the levels of C-reactive protein were （24.97±6.52） mg/L. All were significantly higher than that of no purulent sputum and the result of sputum culture negative patients （all P〈0.05 ）. Conclusion The detection of serum amyloid A has certain directive significance to the judgment of patients with chronic obstructive pulmonary disease severity,and can guide clinical targeted application and discontinuation of antibiotics,worthy of further application in clinical practice.