慢性阻塞性肺疾病急性加重期血清IL-6、PCT及NSE水平联合检测对患者继发轻度认知障碍的预测价值

Predictive Value of Combined Detection of Serum IL-6,PCT and NSE Levels in Patients with Chronic Obstructive Pulmonary Disease During Acute Exacerbation

目的探讨血清白介素-6(IL-6)、降钙素原(PCT)及神经元特异性烯醇化酶(NSE)水平联合检测对COPD急性加重期(AECOPD)患者继发轻度认知障碍(MCI)的预测价值。方法方便选取该院于2018年1月—2019年9月收治的AECOPD患者90例作为研究对象。采用MoCA评估患者认知功能变化,将继发MCI患者设为实验组(n=23),未继发MCI患者为对照组(n=67)。对比两组IL-6、PCT及NSE的水平差异;采用急性生理与慢性健康评分(APACHEⅡ)对病情进行评估;采用Spearman相关性分析MoCA与血清IL-6、PCT及NSE水平的相关性;采用ROC曲线分析血清IL-6、PCT及NSE水平对慢性阻塞性肺疾病急性加重期继发轻度认知障碍的预测价值。结果实验组的IL-6水平为(20.45±1.88)pg/mL,高于对照组的(8.65±1.39)pg/mL,差异有统计学意义(t=31.970,P<0.001);实验组PCT水平为(1.33±0.94)ng/mL,高于对照组的(0.75±0.43)ng/mL,差异有统计学意义(t=4.002,P<0.001);实验组的NSE水平为(18.75±7.78)ng/mL,高于对照组的(14.74±4.24)ng/mL,差异有统计学意义(t=3.101,P<0.01);实验组的APACHEⅡ分数为(18.45±3.73)分,高于对照组的(10.23±1.11)分,差异有统计学意义(t=16.210,P<0.001)。AECOPD患者MoCA评分与影响因素的相关性分析结果显示:IL-6、PCT及NSE与AECOPD患者的MoCA评分呈负相关;IL-6、PCT及NSE的ROC曲线下面积分别为0.85、0.78、0.71,均具有较好的敏感度、特异度及准确性;3个因子联合检测的曲线下面积为0.80,敏感度、特异度及准确性最高。结论AECOPD患者血清中IL-6、PCT及NSE水平升高与继发认知障碍有关,血清中IL-6、PCT及NSE水平联合检测对AECOPD患者继发MCI有较好的预测价值。

Objective To investigate the combined detection of serum interleukin-6(IL-6),procalcitonin(PCT)and neuron-specific enolase(NSE)levels for the secondary recognition of patients with acute exacerbation of COPD(AECOPD)predictive value of MCI.Methods Prospectively selected 90 cases of AECOPD patients admitted to the hospital from January 2018 to September 2019 as the study object.MoCA was used to evaluate the changes of patients'cognitive function.Patients with secondary MCI were set as the experimental group(n=23),and patients without secondary MCI were used as the control group(n=67).Compare the levels of IL-6,PCT and NSE between the two groups;use acute physiology and chronic health score(APACHEⅡ)to evaluate the condition;use Spearman correlation to analyze the correlation between MoCA and serum IL-6,PCT and NSE levels;The ROC curve was used to analyze the predictive value of serum IL-6,PCT and NSE levels for mild cognitive impairment secondary to acute exacerbation of chronic obstructive pulmonary disease.Results The IL-6 level in the experimental group was(20.45±1.88)pg/mL,which was higher than that in the control group(8.65±1.39)pg/mL,the difference was statistically significant(t=31.970,P<0.001);the experimental group PCT The level was(1.33±0.94)ng/mL,which was higher than that of the control group(0.75±0.43)ng/mL,the difference was statistically significant(t=4.002,P<0.001);the NSE level of the experimental group was(18.75±7.78)ng/mL,higher than that of the control group(14.74±4.24)ng/mL,the difference was statistically significant(t=3.101,P<0.01);the APACHEⅡscore of the experimental group was(18.45±3.73)points,higher than the score of(10.23±1.11)in the control group was statistically significant(t=16.210,P<0.001).The correlation analysis results of MoCA score and influencing factors in AECOPD patients showed that IL-6,PCT and NSE were negatively correlated with MoCA score in AECOPD patients;the area under the ROC curve of IL-6,PCT and NSE were 0.85,0.78 and 0.71,all had better sensitivity,specificity and accuracy;the area under the curve of the three factors combined detection was 0.80,with the highest sensitivity,specificity and accuracy.Conclusion The elevated serum levels of IL-6,PCT and NSE in AECOPD patients are related to secondary cognitive impairment.The combined detection of serum levels of IL-6,PCT and NSE has a good predictive value for secondary MCI in AECOPD patients.