COPD合并焦虑、抑郁的血清生物标志物研究

Chronic obstructive pulmonary disease with anxiety, depression, serum biomarker research

目的 寻找 COPD 患者合并 焦 虑 抑 郁 可 能 的 生 物 标 记 物。分 析 生 物 标 志 物 在 鉴 别 COPD患者是否合并焦虑抑郁状态的应用价值,多指标联合检测是否能提高其诊断价值。方法 选取 2015年1月1日至8月31日在北京朝阳医院呼吸与危重症医学科门诊就诊以及住院的 COPD 患者, 应用医院焦虑抑郁量表筛选出存在焦虑抑郁状态 COPD 患者37例作为 COPD 合并焦虑抑郁组,另选取不合并焦虑抑郁的 COPD患者40例作为对照组。检测目前国内外报道过的焦虑抑郁患者及健康对照人群间差异有统计学意义的指标：IL-6、肿瘤坏死因子α （TNF-α）、纤维蛋白原 （FIB）和表皮生长因子 （EGF）,对结果进行统计学分析。结果 COPD 合并焦虑抑郁组和对照组间 FIB、EGF、IL-6和 TNF-α差异有统计学意义 （P ＜0.05）,FIB在 COPD 合并焦虑抑郁组显著低于对照组,EGF、IL-6 和 TNF-α在 COPD合并焦虑抑郁组显著高于对照组。FIB、TNF-α、IL-6和 EGF的 ROC曲线下面积 （AUC）分别为0.715、0.688、0.681和0.633,单项指标中以 FIB的 AUC最大,多指标联合应用诊断合并焦虑抑郁的价值优于单项指标。结论 FIB、TNF-α、IL-6和 EGF可作为 COPD 患者合并焦虑抑郁的生物标记物,应用多指标联合检验可提高诊断价值。

Objective To identify possible biomarkers in patients with chronic obstructive pulmonary disease （COPD） complicated with anxiety and depression. To analyze the clinical value of biomarkers in identifying whether COPD patients are associated with anxiety and depression, and then explore whether multi index combined testing can improve their diagnostic value. Methods To select COPD patiensts from department of respiratory and critical care medicine in Beijing Chao-Yang Hospital since January 1,2015 to August 31. Both outpatients and inpatients were recruited. Using hospital anxiety depression scale to screen COPD patients with anxiety or depression status. Thirty seven COPD patients with anxiety or depression were identified, 40 patients without psychological diseases were in control group. Candidate biomarkers were chose according to published papers, including interleukin-6 （IL-6）, tumor necrosis factor alpha （TNF-α）, fibrinogen （FIB）, epidermal growth factor （EGF）. All biomarkers between COPD with and without anxiety or depression were analyzed. Results FIB, EGF, IL-6, TNF-α had significant difference （ P 〈0.05） between COPD patients with or without anxiety or depression. FIB in COPD with anxiety or depression group was significantly lower than in the control group. EGF, IL-6, TNF-α in COPD combined anxiety or depression group were significantly higher than in the control group. FIB, TNF-α, IL-6, EGF area under ROC curve were 0. 715, 0. 688, 0. 681, 0. 715 respectively. Among those FIB was the highest. Combination of four biomarkers were better than any of single one in distinguished the COPD patients with anxiety or depression. Conclusions FIB, TNF-α, IL-6 and EGF could be used as biomarkers in COPD patients with anxiety or depression. Combination of FIB, IL-6, TNF- α and EGF could improve the diagnostic sensitivity, specificity.