CD163对判断慢性阻塞性肺疾病急性加重的临床价值

Clinical value of CD163 in diagnosis of acute exacerbation of chronic obstructive pulmonary disease

目的探讨血清可溶性清道夫受体CD163在慢性阻塞性肺疾病(COPD)患者血清中的表达及临床意义。方法选取文昌市人民医院100例COPD患者,其中,急性加重期患者45例(急性加重期组),稳定期患者55例(稳定期组);同期选取该院50例健康体检者为对照组。比较3组血清CD163含量的变化,检测肺功能相关指标,分析血清CD163与患者肺功能的相关性,采用受试者操作特征(ROC)曲线分析血清CD163诊断COPD的临床价值。结果 3组血清CD163水平比较,差异有统计学意义(P <0.05);与对照组比较,急性加重期组和稳定期组患者血清CD163水平升高(P<0.05);与稳定期组比较,急性加重期组患者血清CD163水平升高(P <0.05)。3组第1秒用力呼气容积(FEV1)、最大呼气流量(PEF)、第1秒用力呼气容积与用力肺活量比值(FEV1%)及第1秒用力呼气容积占预计值百分比(FEV1%预计值)比较,差异有统计学意义(P <0.05);与对照组比较,急性加重期组和稳定期组患者FEV1、PEF、FEV1%及FEV1%预计值降低(P <0.05);与稳定期组比较,急性加重期组患者FEV1、PEF、FEV1%及FEV1%预计值降低(P<0.05)。Spearman相关性分析结果显示,急性加重期组患者血清CD163水平与FEV1%及FEV1预计值呈负相关(rs=-0.833和-0.805,均P=0.000);稳定期组患者血清CD163水平与FEV1%及FEV1%预计值呈负相关(rs=-0.714和-0.643,均P=0.000);血清CD163诊断COPD急性加重期的曲线下面积为0.821(95%CI:0.629,0.976),诊断敏感性为0.928,特异性为0.803;其诊断COPD稳定期的曲线下面积为0.784(95%CI:0.436,0.761),诊断敏感性为0.872,特异性为0.741。结论 CD163在COPD患者血清中呈高表达,其表达与患者肺功能密切相关,或将成为COPD临床诊断的一项新指标。

Objective To investigate the expression and clinical significance of soluble scavenger receptor CD163 in serum of patients with chronic obstructive pulmonary disease(COPD). Methods Totally 100 patients with chronic obstructive pulmonary disease, including 45 patients with acute exacerbation and 55 patients with stable disease, in addition, 50 cases of healthy people as control group. The changes of serum soluble scavenger receptor CD163 in the acute exacerbation group, stable phase group and control group were compared. Three groups of lung function related indicators were measured, and the correlation between serum soluble scavenger receptor CD163 and lung function was analyzed. The clinical value of serum soluble scavenger receptor CD163 in the diagnosis of chronic obstructive pulmonary disease was analyzed by ROC curve. Results The differences of serum soluble scavenger receptor CD163 levels in the three groups were statistically significant(P < 0.05). Compared with the control group, the levels of receptor CD163 in the acute exacerbation group and the stable phase group were increased(P < 0.05). Compared with the stable group, the serum soluble scavenger receptor CD163 level was increased in the acute exacerbation group(P < 0.05). The differences between the three groups of FEV1, PEF, FEV1% and FEV1%pred were statistically significant(P < 0.05). Compared with the control group, the FEV1, PEF, FEV1% and FEV1%pred measurements were decreased in the acute exacerbation group and the stable phase group(P < 0.05). Compared with the stable phase group, the patients in the acute exacerbation group were FEV1, PEF, and FEV1% and FEV1%pred measurements were reduced(P < 0.05). Sperman correlation analysis showed that serum CD163 levels were negatively correlated with FEV1% and FEV1%pred in patients with acute exacerbation(rs =-0.833 and-0.805, all P = 0.000);the serum CD163 levels in stable patients FEV1% and FEV1%pred were negatively correlated(rs =-0.714 and-0.643, all P = 0.000);the area under the curve of serum CD163 for the diagnosis of acute exacerbation of chronic obstructive pulmonary disease was 0.821(95% CI: 0.629, 0.976), diagnostic sensitivity was 0.928, specificity was 0.803;the area under the curve for the diagnosis of chronic obstructive pulmonary disease was 0.784(95% CI: 0.436, 0.761), diagnostic sensitivity was 0.872, specificity was 0.741. Conclusions The soluble scavenger receptor CD163 is highly expressed in the serum of patients with chronic obstructive pulmonary disease, and it’s expression is closely related to the lung function of patients. Perhaps, it will become a clinical test for chronic obstructive pulmonary disease.