慢性阻塞性肺疾病患者血清可溶性晚期糖基化终产物受体水平变化及其诊断价值研究

Change and Clinical Significance of Serum sRAGE Level of Patients With COPD

目的分析慢性阻塞性肺疾病(COPD)患者血清可溶性晚期糖基化终产物受体(sRAGE)水平变化及其诊断价值。方法选取2014年11月—2015年10月中国人民解放军第309医院呼吸内科和干部病房诊治的112例COPD住院患者作为COPD组;另按照与COPD患者年龄、性别相匹配的原则选取同期本院体检中心87例体检健康志愿者作为对照组。比较两组受试者一般资料、血液学指标及肺功能指标,分析血清sRAGE水平与血液学指标和肺功能指标的相关性,并评价血清sRAGE水平和肺功能指标对COPD的诊断价值。结果两组受试者性别、年龄、体质指数(BMI)、既往史(高血压、心力衰竭、糖尿病)阳性率比较,差异无统计学意义(P>0.05)。COPD组患者血清C反应蛋白(CRP)水平、白细胞计数(WBC)高于对照组,血清sRAGE水平低于对照组(P<0.05);两组受试者血清糖化血红蛋白(HbA_(1c))、低密度脂蛋白(LDL)及总胆固醇(TC)水平比较,差异无统计学意义(P>0.05)。COPD组患者第一秒用力呼气容积占预计值百分比(FEV_1%)、第一秒用力呼气容积/用力肺活量(FEV_1/FVC)及一氧化碳弥散量占预计值百分比(DLCO%)均低于对照组(P<0.05)。直线相关性分析结果显示,COPD患者血清sRAGE水平与血清CRP(r=0.538)、HbA_(1c)(r=0.541)、LDL(r=0.336)、TC(r=0.427)水平及WBC(r=0.623)呈正相关(P<0.05);对照组受试者血清sRAGE水平与血清CRP(r=1.021)、HbA_(1c)(r=1.025)、LDL(r=1.644)、TC(r=1.355)水平及WBC(r=1.354)无直线相关性(P>0.05);COPD患者血清sRAGE水平与FEV1%(r=0.547)、FEV_1/FVC(r=0.915)、DLCO%(r=0.433)呈正相关(P<0.05)。ROC曲线显示,血清sRAGE水平诊断COPD的曲线下面积(AUC)为0.892、FEV_1%为0.798、FEV_1/FVC为0.911、DLCO%为0.729,血清sRAGE水平诊断COPD的AUC与FEV_1%、FEV_1/FVC、DLCO%比较,差异均无统计学意义(P>0.05)。结论 COPD患者血清sRAGE水平较低,早期检测血清sRAGE水平对COPD的诊断具有一定参考价值。

Objective To analyze the change and clinical significance of serum sRAGE level of patients with COPD.Methods From November 2014 to October 2015, a total of 112 patients with COPD were selected as case group in the Department of Respiratory Medicine and Cadre＇s Ward,the 309 th Hospital of Chinese People＇ s Liberation Army,and a total of 87 healthy volunteers admitted this hospital for physical examination were selected as control group according to matching principle of age and gender. General information,haematological index and lung function index were compared between the two groups,correlation between serum sRAGE level and haematological index, lung function index was analyzed, respectively, and diagnostic value of serum sRAGE level and lung function index on COPD was evaluated,respectively. Results No statistically significant differences of gender,age,BMI or positive rate of past medical history（ including hypertension,heart failure and diabetes） was found between the two groups（ P〉0. 05）. Serum CRP level and WBC of case group were statistically significantly higher than those of control group,serum sRAGE level of case group was statistically significantly lower than that of control group（ P〈0. 05）,while no statistically significant differences of serum level of HbA1c,LDL or TC was found between the two groups（ P〉0. 05）. FEV1%,FEV1/ FVC and DLCO% of case group were statistically significantly lower than those of control group（ P〈0. 05）. Linear correlation analysis showed that,serum sRAGE level of patients with COPD was positively correlated with serum level of CRP（ r = 0. 538）,of HbA1c（ r = 0. 541）,of LDL（ r = 0. 336）,of TC（ r = 0. 427） and WBC（ r = 0. 623）,respectively（ P〉0. 05）; serum sRAGE level of the healthy volunteers was not linearly correlated with serum level of CRP（ r = 1. 021）,of HbA1c（ r = 1. 025）,of LDL（ r = 1. 644）,of TC（ r = 1. 355） or WBC（ r = 1. 354）（ P〈0. 05）; serum sRAGE level of patients with COPD was positively correlated with FEV1%（ r = 0. 547）, FEV1/ FVC（ r =0. 915） and DLCO%（ r = 0. 433）, respectively（ P〈0. 05）. ROC curve showed that, AUC of serum sRAGE level on diagnosis of COPD was 0. 892,that of FEV1% was 0. 798,of FEV1/ FVC was 0. 911,of DLCO% was 0. 729,but there was no statistically significant differences of AUC of serum sRAGE level,of FEV1%,of FEV1/ FVC,of DLCO% on diagnosis of COPD（ P〈0. 05）. Conclusion Serum sRAGE level of patients with COPD is relatively reduced,early detection of serum sRAGE level has certain diagnostic value on COPD.