血清可溶性人基质裂解素2和降钙素原水平的变化在AECOPD患者中的病情评估

Index changes of serumal soluble human stromelysin-2 and procalcitonin assess the patients of AECOPD

目的探讨血清可溶性人基质裂解素2(sST2)与慢性阻塞性肺疾病急性加重期(AECOPD)患者病情严重程度的关系及临床意义。方法检测120例(Ⅰ级30例、Ⅱ级30例、Ⅲ级30例和Ⅳ级30例)AECOPD患者治疗前后的血清sST2、降钙素原(PCT)、C反应蛋白(CRP)水平,并分析血清sST2、PCT、CRP水平与CAT评分、6 min步行距离(6 minutes walk distance,6MWD)之间的相关性。另选择30例体检正常人员作为对照组。结果 (1)AECOPD组治疗前血清sST2、PCT、CRP水平显著高于治疗后和对照组(P值均<0.05),且在一定程度上随着病情严重程度的增加而增加;(2)COPD严重程度分级与血清sST2、CRP、PCT水平存在相关性(r=0.588,r=0.447,r=0.305,P值均小于0.01),Ⅰ级、Ⅱ级COPD患者血清sST2水平明显低于Ⅲ级、Ⅳ级患者(t=9.600,P<0.01);(3)血清sST2水平与患者CAT量表呈正相关(r=0.363,P<0.01),随着血清sST2水平的升高,CAT量表数值也升高;与6MWD呈负相关(r=-0.434,P<0.01),随着血清sST2水平的升高,6MWD距离下降。结论Ⅲ级、Ⅳ级AECOPD患者血清sST2水平高于Ⅰ级、Ⅱ级AECOPD患者,随病情好转,血清sST2水平降低显著。血清sST2水平可以在一定程度上反映AECOPD患者病情严重程度,对AECOPD患者病情评估具有临床价值。

Objective To analyse the severity of disease and the evaluation of serum quality of life value of serumal soluble human stromelysin-2 and procalcitonin in the patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods The serumal soluble human stromelysin-2, procalcitonin, C reactive protein were detected in 120 hospitalized AECOPD patients before and after the treatment, and to study the correlation above indexes with severity of COPD, COPD assessment test（CAT） and 6 minutes walk distance （6MWD）. Results Compared with after the treatment patients and healthy control group, serumal levels of the soluble human stromelysin-2, procalcitoniu, C-reactive protein were significantly elevated in the patient with AECOPD before the treatment （ P 〈 0.05 ）. To some extent, the levels of these indicators were increasing with the increase in the severity of the disease. The severity classification of COPD were positively correlated with serum sST2, C RP and PCT levels （ r = 0.588, r = 0.132, r = 0.305, P〈0.01 ） , serum sST2 level of the combined Class I and I1 COPD patients was significantly lower than the combined Class HI and IV COPD patients （t = 9.600, P〈0.01）. The serumal sST2 was positively correlated with CAT （r=0.363, P〈0.01） , and was negatively correlated with 6MWD （r=-0.434, P〈0.01）. Conclusions The serumal sST2 levels in HI, IV level AECOPD patients were higher than Ⅰ , Ⅱstage AECOPD patients, and with the condition improved, serumal sST2 decreased significantly. Serumal sST2 can reflect the severity of AECOPD patients in some extent, and has certain clinical value to evaluate the condition of AECOPD patients.