联合检测FeNO、血清sTREM-1、CyPA表达水平在评估COPD患者预后中的价值

Value of combined detection of serum levels of FeNO, sTREM-1 and CyPA in evaluating prognosis of COPD patients

目的探讨联合检测呼出气一氧化氮(FeNO)、血清可溶性髓样细胞触发受体-1(sTREM-1)、亲环素A(CyPA)表达水平在评估慢性阻塞性肺疾病(COPD)患者预后中的价值。方法随机选择2017年1月-2018年12月在本院诊治的COPD稳定期患者80例,同时选择同时段在本院门诊体检的健康志愿者60例。对比两组研究对象的FeNO、sTREM-1、CyPA水平以及与肺功能、CAT评分之间的相关性。结果COPD组患者的sTREM-1、CyPA水平均显著高于健康组,FeNO水平较对照组低,差异均有统计学意义(P<0.05);COPD组患者的IL-16、IL-18、TNF-α的水平显著高于健康组,差异有意义(P<0.05),不同级别GOLD分级患者的FeNO、sTREM-1、CyPA水平之间差异有意义(P<0.05),随着肺功能的下降,sTREM-1、CyPA水平逐渐升高,FeNO水平逐渐下降;随着GOLD分级的升高患者的CAT评分逐渐升高;sTREM-1、CyPA水平与COPD呈正相关,FeNO水平与COPD呈负相关(P<0.05),sTREM-1、CyPA水平与CAT呈正相关,FeNO水平与CAT呈负相关(P<0.05)。使用ROC曲线评价FeNO、sTREM-1、CyPA水平对COPD的诊断价值,结果表明FeNO、sTREM-1、CyPA单独检测的曲线下面积分别为0.794、0.765、0.753,三者联合检测的曲线下面积为0.902,诊断价值较高,敏感度、特异度分别为89.84%、71.54%。结论sTREM-1、CyPA水平与COPD的发生发展有较大关系,并且与病情严重程度呈相关性。FeNO值可用来评估COPD患者的气道损伤情况,并且可反映病情程度,三者联合检测可提高COPD的敏感度、特异度,对病情的评估有重要意义,在临床上可广泛使用。

Objective To explore the value of combined detection of serum FeNO,sTREM-1 and CyPA levels in evaluating the prognosis of COPD patients.Methods 80 patients with stable COPD from January 2017 to December 2018 were randomly selected.At the same time,60 healthy volunteers who were in the outpatient clinic at the same time were selected.All subjects were tested for FeNO,sTREM-1,CyPA levels,lung function,and CAT scores.The relationship between FeNO,sTREM-1,CyPA levels and lung function and CAT scores was compared between the two groups.Results The levels of sTREM-1 and CyPA in the COPD group were significantly higher than those in the healthy group,and the level of FeNO in the COPD group was lower than that in the control group(P<0.05).The levels of IL-6,IL-8 and TNF-alpha in the COPD group were significantly higher than those in the healthy group(P<0.05).The levels of FeNO,sTREM-1 and CyPA in patients with different grades of GOLD were significantly different(P<0.05).With the decline of pulmonary function,the levels of sTREM-1 and CyPA gradually increased,and the level of FeNO gradually decreased.With the increase of GOLD grade,the CAT scores of patients gradually increased.The levels of sTREM-1 and CyPA were positively correlated with COPD,FeNO was negatively correlated with COPD(P<0.05),sTREM-1 and CyPA were positively correlated with CAT,and FeNO was negatively correlated with CAT(P<0.05).The ROC curve was used to evaluate the diagnostic value of FeNO,sTREM-1 and CyPA levels for COPD.The results showed that the areas under the curves detected by FeNO,sTREM-1 and CyPA alone were 0.794,0.765 and 0.753,respectively.The area under the curves detected by the combination of the three methods was 0.902,and the diagnostic value was higher.The sensitivity and specificity were 89.84%and 71.54%,respectively.Conclusion The levels of sTREM-1 and CyPA are closely related to the occurrence and development of COPD and the severity of COPD.FeNO value can be used to evaluate the airway injury of COPD patients,and it can reflect the severity of the disease.The combined detection of the three can improve the sensitivity and specificity of COPD,which is of great significance for the evaluation of the disease and can be widely used in clinic.