血浆磷脂、白三烯B4联合B型脑钠肽诊断慢性阻塞性肺疾病急性加重期患者的临床价值研究

Clinical Value of Plasma Phospholipid,Leukotriene B4 and Type B Brain Natriuretic Peptide in the Diagnosis of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的探讨血浆胆碱酯酶(ChE)、白三烯B4(LTB4)联合B型脑钠肽(BNP)诊断慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床价值。方法研究对象均选自2016年7月至2018年1月我院呼吸科收治的90例慢性阻塞性肺疾病(COPD)患者,根据病情严重程度分为AECOPD组45例和慢性阻塞性肺疾病缓解期(SCOPD)组45例。选取同期健康志愿者50例作为对照组。比较三组受试者间的血清ChE、LTB4和BNP水平,并进行Spearson、Logistic及诊断价值分析。结果 AECOPD组和SCOPD组的血清ChE水平显著低于对照组,LTB4和BNP水平显著高于对照组(P <0. 05);AECOPD组血清ChE水平显著低于SCOPD组,LTB4和BNP水平显著高于SCOPD组(P <0. 05)。经过Spearson相关性分析,ChE与AECOPD患者肺功能指标FEV%pre值呈正相关,LTB4和BNP与FEV%pre值均呈负相关(P <0. 05)。经Logistic回归分析,ChE、LTB4和BNP均是AECOPD发病的独立危险因素。相比于ChE、LTB4和BNP单独检测,三项指标联合检测的灵敏度(92. 3%)、特异性(94. 7%)、准确度(93. 3%)及AUC值(0. 903)明显升高(P <0. 05)。结论 ChE、LTB4和BNP与COPD患者的病情严重程度有密切关系,联合应用可以作为AECOPD诊断、病情进展和预后判断的辅助手段。

Objective To investigate the clinical value of plasma cholinesterase(ChE),leukotriene B4 (LTB4)and type B brain natriuretic peptide (BNPs)in the diagnosis of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods All the studied patients were divided into the AECOPD group (n=45)and chronic obstructive pulmonary disease (SCOPD)group (n=45)according to the severity of the disease.50 healthy volunteers were also selected as the control group.The serum levels of ChE,LTB4 and BNP were compared among the three groups,and Spearman test ,logistic regression and the diagnostic value were conducted and analyzed. Results The serum levels of ChE in AECOPD group and SCOPD group were significantly lower than that in the control group,while LTB4 and BNP were significantly higher than those in the control group( P <0.05).The level of ChE in the AECOPD group was significantly lower than that in the SCOPD group,while LTB4 and BNP were significantly higher than those in the SCOPD group ( P < 0.05).Through Spearman correlation analysis,there was a positive correlation between the level of ChE and the pulmonary function index (FEV%pre)in patients with AECOPD,and there was a negative correlation between the levels of LTB4,BNP and FEV%pre ( P <0.05).Through logistic regression analysis,ChE,LTB4 and BNP were independent risk factors of AECOPD.The sensitivity (92.3%),specificity (94.7%),accuracy (93.3%)and AUC (0.903)values of the combination test of the three indexes were the highest ( P < 0.05),compared with that of ChE,LTB4 or BNP single test( P <0.05). Conclusion There is a close relationship between ChE,LTB4,BNP and the disease severity of COPD patients.The combined application of these three markers can be used as an auxiliary means for the diagnosis,progression and prognosis of AECOPD.