慢性阻塞性肺疾病急性加重期血浆纤维蛋白原的变化及临床意义

Changes of plasma fibrinogen level in patients with acute exacerbation of chronic obstructive pulmonary disease and its clinical significance

目的探讨血浆Fib作为慢性阻塞性肺疾病(COPD)急性加重期生物标志物的临床应用价值。方法选取2019年5月至2020年5月就诊于杭州市余杭区第一人民医院呼吸内科的COPD患者90例,根据诊断标准将COPD患者分为稳定组和急性加重组,每组45例;选取同期本院体检的健康体检者30例作为健康对照组。所有受试者均予肺功能检查[第一秒用力呼气容积占预计值百分比(FEV1%)和第一秒用力呼气容积占用力肺活量百分比(FEV1/FVC)]、改良版的医学研究委员会问卷(mMRC)评分、COPD评估测试(CAT)评分、BODE指数、6 min步行试验(6MWT)等评估;另检测血浆PaO2、PaCO2、IL-6、IL-8、WBC、CRP及Fib,并分析各组检测指标的差异;同时分析急性加重组患者血浆Fib水平与肺功能指标、PaO2、PaCO2、BODE指数、炎症因子的相关性。结果急性加重组患者FEV1%、FEV1/FVC、6MWT步行距离均低于健康对照组和稳定组,而mMRC评分、BODE指数、CAT评分、IL-6、IL-8、WBC、CRP、Fib数值均高于稳定组和健康对照组,差异均有统计学意义(均P<0.05)。稳定组患者FEV1%、FEV1/FVC、6MWT步行距离均低于健康对照组,而mMRC评分、BODE指数、CAT评分、IL-6、IL-8、WBC、CRP、Fib均高于健康对照组,差异均有统计学意义(均P<0.05)。急性加重组患者PaO2低于稳定组,而PaCO2高于稳定组,差异均有统计学意义(均P<0.05)。急性加重组患者血浆Fib水平与PaCO2、BODE指数、CRP、WBC、IL-6、IL-8均呈正相关(r=0.498、0.443、0.654、0.409、0.611、0.389,均P<0.01),但与PaO2、FEV1%、FEV1/FVC均呈负相关(r=-0.396、-0.415、-0.639,均P<0.01)。结论血浆Fib可作为一种潜在生物标志物,指导COPD急性加重的早期诊断及治疗。

Objective To investigate the clinical value of plasma fibrinogen(Fib)as a biomarker for acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 90 COPD patients,including 45 stable cases and 45 acute exacerbation cases,were enrolled from May 2019 to May 2020,and 30 healthy subjects served as controls.The pulmonary function,CAT score,BODE Index,6MWT and mMRC score,serum levels of IL-6,IL-8,WBC,CRP,PaO2,PaCO2 and plasma Fib were obtained for all participants.Spearman rank correlation was used to analyze the correlation.Results The levels of plasma Fib,IL-6,IL-8,WBC count,CRP,CAT score,BODE Index,mMRC score in acute exacerbation group were significantly higher than those in the stable group and the healthy control group(all P<0.05),while the FEV1%,FEV1/FVC and 6MWT were significantly lower than those in stable group and healthy control group(all P<0.05).The FEV1%,FEV1/FVC and 6MWT values of the stable group were lower than those of the healthy control group,while the mMRC score,BODE index,CAT score,IL-6,IL-8,WBC count,CRP and Fib values were higher than those of the healthy control group(all P<0.05).The levels of PaO2 in acute exacerbation group was significantly lower than in the stable group,while PaCO2 was significantly higher than in the stable group(P<0.01).The plasma Fib levels were positively correlated with the PaCO2,BODE index,CRP,WBC,IL-6,IL-8(r=0.498,0.443,0.654,0.409,0.611,0.389,all P<0.01),while negatively correlated with PaO2,FEV1%,FEV1/FVC(r=-0.396,-0.415,-0.639,all P<0.01)in AECOPD patients.Conclusion Plasma Fib can be used as a potential biomarker to guide the early diagnosis and treatment in COPD patients with acute exacerbation.