血浆生长分化因子-15在慢性阻塞性肺疾病严重程度及预后预测中的价值

The value of plasma growth differentiation factor-15 in predicting the severity and prognosis of COPD

目的通过测定慢性阻塞性肺疾病(COPD)患者血浆生长分化因子(GDF-15)的水平,探讨GDF-15在COPD严重程度分级和判断预后中的作用。方法纳入2014年4月~2019年2月我院收治的99例COPD住院患者作为COPD组,按严重程度分为中度组(n=35)、重度组(n=33)、极重度组(n=31),记录各组的基线资料,并对相关指标进行比较。对COPD患者进行14个月随访,记录COPD不良事件。采用Spearman相关分析研究COPD中度、重度、极重度的GDF-15和CRP之间的相关性。并比较GDF-15和CRP区分对照组和COPD组的诊断效能,预测COPD组不良事件。结果与对照组相比,COPD组患者CRP、GDF-15水平明显升高,CRP、GDF-15随COPD严重程度增加而明显升高(均P<0.05),在中度组COPD患者中,血浆中GDF-15与CRP浓度呈正相关(r=0.952,P<0.001),在重度组COPD患者中,血浆中GDF-15与CRP浓度呈正相关(r=0.951,P<0.001),在极重度组COPD患者中,血浆中GDF-15与CRP浓度呈正相关(r=0.973,P<0.001)。ROC曲线表明,血浆CRP、GDF-15对COPD诊断的AUC分别为0.764、0.900,最佳诊断临界值分别为10.45 mg/L、485.50 ng/mL。CRP、GDF-15二者联合诊断的AUC为0.091,血浆CRP、GDF-15对COPD不良事件预测的AUC分别为0.855、0.859,最佳诊断临界值分别为18.45 mg/L、720.95 ng/mL。CRP、GDF-15二者联合诊断的AUC为0.864。结论GDF-15和CRP均有助于判断COPD的严重程度,对预测患者病情的严重程度和预后有着积极的临床意义。

Objective To explore the role of GDF-15 in predicting the severity and prognosis of COPD by determining the level of plasma growth differentiation factor(GDF-15)in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 99 hospitalized patients with COPD in our hospital from April 2014 to February 2019 were included and divided into COPD group,which was divided into moderate group(n=35),severe group(n=33),and extremely severe group(n=31)according to the severity.Baseline data of each group were recorded,and relevant indicators were compared.Patients with COPD were followed up for 14 months and COPD adverse events were recorded.The correlation between moderate,severe and extremely severe GDF-15 and CRP in COPD were analyzed by Spearman correlation analysis.The diagnostic efficacy of GDF-15 and CRP in differentiating healthy group from COPD group and predicting adverse events in COPD group were compared.Results The CRP and GDF-15 in the COPD group were significantly higher than those in the control group.And CRP,GDF-15 increased significantly with the increase of COPD severity(P<0.05).In the moderate group of patients with COPD,GDF-15 in plasma was positively correlated with CRP concentration(r=0.952,P<0.001).In the severe group,GDF-15 and CRP in plasma were positively correlated(r=0.951,P<0.001).In the extremely severe group,GDF-15 in plasma was positively correlated with CRP(r=0.973,P<0.001).ROC curve showed that the AUC of plasma CRP and GDF-15 for the diagnosis of COPD were 0.764 and 0.900, respectively, and the optimal diagnostic thresholds were 10.45 mg/L and 485.50 ng/mL, respectively. The AUC of CRP combined with GDF-15 was 0.091, and the predictive AUC of plasma CRP combined with GDF-15 for adverse events of COPD were 0.855 and 0.859, respectively. The optimal diagnostic thresholds were 18.45 mg/L and 720.95 ng/mL. The AUC of CRP combined with GDF-15 for predicting diagnosis of COPD was 0.864. Conclusion GDF-15 and CRP are both helpful to determine the severity of COPD and have positive clinical significance in predicting the severity and prognosis of patients' disease.