慢性阻塞性肺疾病不同阶段血浆微纤丝相关蛋白4水平变化及其临床意义

Change and Clinical Significance of Plasma MFAP4 Level in Different Stages of Chronic Obstructive Pulmonary Disease

目的分析慢性阻塞性肺疾病(COPD)不同阶段血浆微纤丝相关蛋白4(MFAP4)水平变化及其临床意义。方法选取2016年4月—2017年4月在阜阳市人民医院门诊就诊的COPD稳定期患者50例作为A组,呼吸科收治的慢性阻塞性肺疾病急性加重(AECOPD)患者30例作为B组;另选取同期体检健康者30例作为对照组。比较对照组与A组受试者入院时肺功能指标〔包括第1秒用力呼气容积占预计值百分比(FEV1%perd)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)〕、6分钟步行距离(6MWD)、改良版英国医学研究会呼吸困难量表(mMRC)评分及血浆MFAP4水平,B组患者入院时及治疗1个月后肺功能指标、mMRC评分、血浆MFAP4水平及炎性反应指标〔包括白细胞计数(WBC)、C反应蛋白(CRP)〕。血浆MFAP4水平与COPD稳定期患者入院时FEV1%pred、6MWD及同期FEV1%pred的相关性分析采用Pearson相关分析。结果(1)A组患者入院时FEV1%pred、FEV1/FVC低于对照组,6MWD短于对照组,mMRC评分和血浆MFAP4水平高于对照组(P<0.05)。(2)Pearson相关分析结果显示,血浆MFAP4水平与COPD稳定期患者入院时FEV1%pred(r=-0.948)、6MWD(r=-0.744)及同期FEV1%pred(r=-0.949)呈负相关(P<0.05)。(3)B组患者入院时及治疗1个月后FEV1/FVC比较,差异无统计学意义(P>0.05);治疗1个月后B组患者FEV1%pred和血浆MFAP4水平高于入院时,mMRC评分及WBC、CRP低于入院时(P<0.05)。结论COPD稳定期患者血浆MFAP4水平升高,而AECOPD患者血浆MFAP4水平较COPD稳定期降低;血浆MFAP4水平与COPD稳定期患者疾病严重程度有关,可作为评估COPD稳定期严重程度的新指标。

Objective To analyze the change and clinical significance of plasma MFAP4 level in different stages of chronic obstructive pulmonary disease(COPD).Methods From April 2016 to April 2017,a total of 50 outpatients with stable COPD were selected as A group and 30 patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)were selected as B group in the Department of Respiratory Medicine,in the People's Hospital of Fuyang;meanwhile 30 healthy volunteers admitted to this hospital for physical examination were selected as control group.Index of pulmonary function(including FEV1%pred and FEV1/FVC),6-minute walking distance,mMRC score and plasma MFAP4 level were compared between control group and A group;in B group,index of pulmonary function,mMRC score,plasma MFAP4 level and inflammatory reaction indicators(including WBC and CRP)were compared at admission and 1 month after treatment.Pearson correlation analysis was used to analyze the correlations of plasma MFAP4 level with FEV1%pred and 6-minute walking distance in A group at admission,with FEV1%pred in A group during corresponding period.Results(1)FEV1%pred and FEV1/FVC in A group were statistically significantly lower than those in control group,6-minute walking distance in A group was statistically significantly shoter than that in control group,while mMRC score and plasma MFAP4 level in A group were statistically significantly higher than those in control group(P<0.05).(2)Pearson correlation analysis results showed that,plasma MFAP4 level was negatively correlated with FEV1%pred(r=-0.948)and 6-minute walking distance(r=-0.744)in A group at admission,and negatively correlated with FEV1%pred(r=-0.949)in A group during corresponding period(P<0.05).(3)There was no statistically significant difference in FEV1/FVC in group B at admission and 1 month after treatment(P>0.05);compared to those at admission,FEV1%pred and plasma MFAP4 level 1 month after treatment were statistically significantly higher,while mMRC score,WBC and CRP 1 month after treatment were statistically significantly lower(P<0.05).Conclusion Plasma MFAP4 level is significantly elevated in patients with stable COPD,but it is significantly decreased in patients with AECOPD compared to that at stable stage;plasma MFAP4 level is significantly correlated with the severity of stable COPD,which may as a new index to evaluate the severity of stable COPD.