诱导痰葡萄糖水平与慢性阻塞性肺疾病预后及病情严重程度的关系

The relationship between induced sputum glucose level and the prognosis and severity of the chronic obstructive pulmonary disease

目的评估诱导痰葡萄糖水平对稳定期慢性阻塞性肺疾病(COPD)患者预后及病情严重程度的意义,为临床早期识别、干预高危患者提供依据。方法选取2019年1~4月在金华市人民医院呼吸内科门诊就诊或出院后随访的稳定期COPD患者200例作为研究对象,检测其诱导痰葡萄糖水平,以检测值的中位数746.5μmol/L为界将所有患者分为诱导痰葡萄糖高水平组和低水平组,对所有患者随访12个月,统计随访期间的急性加重发生率、住院时间、死亡率、肺功能分级和CAT评分,最终共有183例患者完成随诊。采用ROC曲线研究诱导痰葡萄糖水平预测COPD急性加重和死亡风险的最佳值及相应灵敏度和特异度。结果诱导痰葡萄糖高水平组COPD患者的急性加重发生率、死亡率显著高于低水平组,住院时间长于低水平组(P<0.05),肺功能低于低水平组,CAT评分高于低水平组(P<0.05)。诱导痰葡萄糖水平预测COPD急性加重风险的ROC曲线下面积为0.880(95%可信区间:0.832,0.928),最佳截断值为701.0μmol/L时,灵敏度为72.1%,特异度为87.6%,Youden指数为0.60。诱导痰葡萄糖水平预测COPD死亡风险的ROC曲线下面积为0.976(95%可信区间:0.952,1.000),最佳截断值为831.8μmol/L时,灵敏度为94.1%,特异度为84.3%,Youden指数为0.84。结论诱导痰葡萄糖水平可作为生物学指标,用于评估稳定期COPD患者预后及病情严重程度。

Objective to evaluate the significance of induced sputum glucose level in assessing the prognosis and severity of patients with stable chronic obstructive pulmonary disease(COPD),and to provide evidence for early clinical identification and intervention of high-risk patients.Methods A total of 200 patients with stable COPD who attended the Department of Respiratory Medicine of Jinhua People's Hospital or were followed up after discharge from January to April 2019 were selected as the research objects.The induced sputum glucose levels were detected.Taking the median of 746.5μmol/L of the detected value as the boundary,all patients were divided into high-level induced sputum glucose group and low-level induced sputum glucose group.All patients were followed up for 12 months.The incidence of acute exacerbations,hospitalized time,mortality,the lung function level and the CAT score during the follow-up period were counted.In the end,a total of 183 patients completed the follow-up.The ROC curve was used to study the optimal value of induced sputum glucose level to predict the risk of acute exacerbation and death of COPD,as well as the corresponding sensitivity and specificity.Results The incidence of acute exacerbation and mortality of COPD patients in the high-level induced sputum glucose group were significantly higher than those in the low-level induced sputum glucose group,the hospitalized time was longer than that in the low-level induced sputum glucose group(P<0.05).The lung function was lower than that in the low-level group,and the CAT score was higher than that in the low-level group(P<0.05).The area under the ROC curve for the induced sputum glucose level to predict the risk of acute exacerbation of COPD was 0.880(95%confidence interval:0.832,0.928),the best cut-off value was 701.0μmol/L,with the sensitivity of 72.1%,the specificity of 87.6%,and Youden index of 0.60.The area under the ROC curve for the induced sputum glucose level to predict the risk of death from COPD was 0.976(95%confidence interval:0.952,1.000),the best cut-off value was 831.8μmol/L,with the sensitivity of 94.1%,the specificity of 84.3%,and Youden index of 0.84.Conclusion The induced sputum glucose level can be used as a biological indicator to evaluate the prognosis and severity of COPD patients in a stable phase.