丙种球蛋白作为感染所致的慢性阻塞性肺疾病急性恶化期 预后标志物的可行性

Feasibility of gamma globulin as a marker of the clinical prognosis of acute exacerbation of chronic obstructive pulmonary disease initiated by infection

目的:评估丙种球蛋白成为感染所致的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性恶化期预后的标志物的可行性。方法:回顾性分析从2015年1月至2017年1月武汉市金银潭医院收治的120例COPD急性恶化期患者,依据丙种球蛋白浓度分高水平组(≥6.6 g/dL)与低水平组(<6.6 g/dL),比较两组基本特征、入组研究前状态、入院前治疗情况、慢性阻塞性肺疾病全球创议(GOLD)分级、BODE指数、急性加重的诱因、合并症、一秒用力呼气容积/用力肺活量(forced expiratoryvolumeinonesecond/forcedvitalcapacity,FEV1/FVC),FEV1,FVC,分析丙种球蛋白与患者GOLD的关系,与COPD其他预后因子间的关系,以及与COPD急性恶化早期进展和1年总生存率的关系。结果:低水平组与高水平组在患者基本特征、入组研究前状态及COPD急性加重期诱因上差异无统计学意义。低水平组合并肺心病比例高于高水平组(23.3%vs 5.6%,P=0.011);低水平组FEV1,FEV1/FVC及FVC低于高水平组(均P<0.05)。轻度COPD患者丙种球蛋白浓度高于中、重及极重度[(13.4±2.09) g/dL vs (8.7±2.23) g/dL vs (8.5±1.89) g/dL vs (6.77±1.93) g/dL],差异有统计学意义(P<0.001)。接受糖皮质激素治疗者丙种球蛋白浓度显著低于未接受糖皮质激素治疗者[(7.06±2.47)g/dLvs(8.98±3.03)g/dL,P=0.001],接受家庭氧疗的患者丙种球蛋白浓度低于未接受家庭氧疗者[(7.12±2.27) g/dL vs (8.64±8.11) g/dL,P=0.024]。丙种球蛋白浓度与PaCO2(r=-0.161,P=0.085)及出院后1年内再入院次数(r=-0.263,P=0.005)呈负相关,与FEV1/FVC(r=0.213,P=0.020)及FEV1(r=0.244,P=0.007)呈正相关。低水平组1年总生存率为89.3%,高水平组1年总生存率为94.6%,低水平组1年总生存率低于高水平组(P=0.0037)。结论:血清丙种球蛋白浓度与COPD急性恶化期的FEV1具有良好的相关性,其与COPD患者的严重程度相关,可作为识别COPD急性恶化期高危患者的预后标志物。

Objective： To evaluate the feasibility of using serum globulin electrophoresis as a marker of the prognosis of acute exacerbation of chronic obstructive pulmonary disease（COPD） initiated by infection. Methods： One hundred and twenty patients with acute exacerbation of COPD from January 2015 to January 2017 in Wuhan Jinyintan Hospital were retrospectively collected. The patients was divided into a high concentration group（≥6.6 g/dL） and a low concentration group（6.6 g/dL） according to the level of gamma globulin. The general features, pre-study state, pre-admission treatment, GOLD grade, BODE index, the cause of acute exacerbation, complication, FEV1/FVC, FEV1, and FVC were compared between these two groups. The correlation between Gamma globulin concentration and GOLD grade, other prognostic factor, early progress of acute exacerbation of COPD and 1-year overall survival rate were analyzed and compared. Results： There was no significantly difference between the two groups of correspondent general features, pre study state, and the cause of acute exacerbation. The percentage of pulmonary heart disease of the low concentration group was significantly higher than that in the high concentration group（23.3% vs 5.6%, P=0.011）. The FEV1, FEV1/FVC and FVC of low concentration group was significantly lower than that in the high concentration group（P〈0.05）. The level of gamma globulin of mild COPD was significantly higher than that in the middle, severe, and extreme severe COPD [（13.4±2.09） g/dL vs（8.7±2.23） g/dL vs（8.5±1.89） g/dL vs（6.77±1.93） g/dL, P〈0.001]. The level of gamma globulin of patients received glucocorticoid was significantly lower than patients without glucocorticoid [（7.06±2.47） g/dL vs（8.98± 3.03） g/dL, P=0.001]. The level of gamma globulin of patients received home oxygen therapy was significantly lower that patients without oxygen therapy [（7.12±2.27） g/dL vs（8.64±8.11） g/dL, P=0.024]. The negative correlation was founded between the level of gamma globulin and PaCO2（r=-0.161, P=0.085） and readmission times within 1 year after discharge（r=-0.263, P=0.005）, while positive correlation was founded between the level of gamma globulin and FEV1/FVC（r=0.213, P=0.020） and FEV1（r=0.244, P=0.007）. The 1-year overall survival rate of low concentration group was 89.3%, which was significantly lower that 94.6% in the high concentration group（P=0.0037）. Conclusion： The serum concentration of gamma globulin has a good correlation with FEV1 in acute exacerbation of COPD. The severity of COPD is associated with this simple biomarker, which may help identify high-risk patients with acute exacerbation of COPD.