CysC、α1⁃MG及β2⁃MG在慢性阻塞性肺疾病患者的检测价值及与缺氧所致肾损伤的相关性

The detection and significance of CysC、α1⁃MG、β2⁃MG of early kidney injure in patients with chronic obstructive pulmonary disease

目的探讨血清胱抑素C(CysC)、α1微球蛋白(α1⁃MG)及β2微球蛋白(β2⁃MG)在慢性阻塞性肺疾病(COPD)中的检测价值及与缺氧所致早期肾损伤的相关性。方法选择2013年1月至2016年8月本院就诊的206例COPD患者,依据氧分压(SPO2)分为轻度缺氧组64例、中度缺氧组86例、重度缺氧组56例三组,另选取50例健康者作为对照组,检测4组CysC、α1⁃MG、β2⁃MG、肌酐(Scr)、尿素氮(BUN)水平,并利用ROC曲线分析CysC、α1⁃MG及β2⁃MG对COPD及COPD合并肾损伤的诊断价值,通过Pearson检验分析CysC、BUN、α1⁃MG、β2⁃MG与Scr的相关性。结果①对照组比较,COPD组CysC、α1⁃MG、β2⁃MG水平均明显升高,COPD组Scr、BUN水平与对照组差异无统计学意义(P>0.05);②Cys⁃C水平在轻度组、中度组、重度组均显著高于对照组(P<0.05);α1⁃MG、β2⁃MG水平在中度组、重度组均显著高于对照组(P<0.05);与轻度组比较,重度组CysC、α1⁃MG、β2⁃MG水平较高(P<0.05);与中度组比较,重度组CysC水平较高(P<0.05);③α1⁃MG、β2⁃MG及Cys C均与Scr呈正相关(均P<0.05)。④ROC曲线示,CysC、α1⁃MG、β2⁃MG及联合检测预测COPD的曲线下面积为0.810、0.743、0.812、0.915、0.936,最佳阈值为1.74 mg/L、12.22 mg/L、2.34 mg/L,敏感度分别为0.806、0.726、0.794、0.903,特异度为0.795、0.705、0.782、0.903;CysC、α1⁃MG、β2⁃MG及联合检测的曲线下面积分别为0.864、0.832、0.812,最佳阈值分别为1.62 mg/L、12.08 mg/L、2.58 mg/L,敏感度分别为0.824、0.816、0.808、0.914,特异度分别为0.786、0.774、0.762、0.903。结论联合检测CysC、α1⁃MG、β2⁃MG对于预测COPD患者疾病程度和预防缺氧所致肾损伤并发症的发生具有良好价值。

Objective To investigate the detection value of serum cystatin C(CysC),α1 microglobulin(α1⁃MG)andβ2 microglobulin(β2⁃MG)in chronic obstructive pulmonary disease(COPD)and correlation of the early stage of hypoxia kidney injury.Methods A total of 206 elderly patients with COPD from January 2013 to August 2016 in our hospital were selected as the study object.Based on the blood gas analysis,they were divided into COPD with mild,moderate and severe hypoxia groups.A total of 50 healthy people were selected as control group.The CysC,α1⁃MG,β2⁃MG,Scr levels were detected and compared for analysis.The ROC curve was used to analyze the diagnostic value of CysC,α1⁃MG andβ2⁃MG on COPD and COPD combined with renal injury.Pearson correlation analysis was used to analyze the correlation between CysC,BUN,α1⁃MG andβ2⁃MG and Scr.Results①Compared with control group,CysC,α1⁃MG,β2⁃MG levels in COPD group significantly increased,and the Scr levels had no statistical significance on the difference with the control group(P>0.05).②CysC level in mild,moderate and severe hypoxia group were significantly higher than that in control group,and the differences had no statistical significance(P<0.05);α1⁃MG,β2⁃MG levels in moderate and severe hypoxia group were significantly higher than that in control group(P<0.05).Compared with group mild hypoxia group,CysC,α1⁃MG,β2⁃MG levels in severe hypoxia group were higher(P<0.05);compared with moderate hypoxia group,CysC level in severe hypoxia group were higher(P<0.05);③α1⁃MG,β2⁃MG and CysC were negatively correlated with Scr(all P<0.05).④The ROC curve shows that the area under the curve for predicting COPD by CysC,α1⁃MG,β2⁃MG,and combined detection were 0.810,0.743,0.812,0.915,0.936 respectively;and the optimal thresholds were 1.74 mg/L,12.22 mg/L,2.34 mg/L respectively;sensitivity were 0.806,0.726,0.794,0.903 respectively;specificity were 0.795,0.705,0.782,0.903 respectively.The AUC of CysC,α1⁃MG,β2⁃MG and the combined detection were 0.864,0.832,and 0.812 respectively;and the optimal thresholds were 1.62 mg/L,12.08 mg/L,and 2.58 mg/L respectively;and the sensitivity were 0.824,0.816,0.808,and 0.914 respectively;with specificities were0.786,0.774,0.762,and 0.903 respectively.Conclusions The combined detection of CysC,α1⁃MG,β2⁃MG is of great value in predicting the degree of disease in patients with COPD and preventing the occurrence of renal injury complications caused by hypoxia.