COPD合并肺部真菌感染患者血清学及肺功能参数分析

Analysis of serological indexes and pulmonary function parameters in patients with COPD combined with pulmonary fungal infection

目的分析慢性阻塞性肺病(COPD)合并肺部真菌感染(PFI)患者血清学指标与肺功能之间的关系。方法选择2017年1月-2019年6月河北医科大学第一医院收治的98例COPD合并PFI患者为PFI组,以同期收治的50例COPD合并肺部细菌感染患者为细菌组,50例COPD未合并感染患者为未感染组。检测各组患者血清白蛋白(ALB)、白细胞(WBC)计数、C反应蛋白(CRP)、降钙素原(PCT)和1,3-β-D葡聚糖水平;检测第1秒用力呼气容积(FEV1)、用力肺活量(FVC)和FEV1/FVC。受试者工作特征曲线(ROC)分析血清1,3-β-D葡聚糖对COPD患者PFI的诊断价值;Pearson相关性分析血清学指标与COPD合并PFI患者肺功能之间的相关性。结果 98例COPD合并PFI患者共分离出113株病原菌,分离菌株以假丝酵母菌属为主,占76.99%;PFI组和细菌组患者的WBC、CRP和PCT水平均高于非感染组(P<0.05),FEV1、FVC和FEV1/FVC均低于非感染组(P<0.05);PFI组患者的1,3-β-D葡聚糖水平高于细菌组和非感染组(P<0.05);ROC分析显示,血清1,3-β-D葡聚糖诊断COPD患者PFI的AUC为0.897;相关性分析显示,COPD合并PFI患者的FEV1、FVC和FEV1/FVC均与血清CRP、PCT和1,3-β-D葡聚糖水平呈负相关性(P<0.05)。结论血清1,3-β-D葡聚糖水平对COPD患者PFI的发生具有较高的诊断价值,联合检测PCT、CRP可用于COPD患者肺功能的评估。

OBJECTIVE To analyze the relationship between serological indexes and pulmonary function in patients with chronic obstructive pulmonary disease(COPD) combined with pulmonary fungal infection(PFI). METHODS A total of 98 patients with COPD and PFI who were admitted to the first hospital of Hebei Medical University from Jan. 2017 to Jun. 2019 were enrolled as the PFI group. Fifty patients with COPD and pulmonary bacterial infection(PBI) who were admitted during the same period were enrolled as the bacterial group. Fifty patients only with COPD were enrolled as the non-infection group. The levels of serum albumin(ALB), white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT) and 1,3-β-D glucan, Forced expiratory volume in 1 second(FEV1), forced vital capacity(FVC) and FEV1/FVC in each group were detected. Receiver operating characteristic curves(ROCs) were applied to analyze the diagnostic value of serum 1,3-β-D glucan for PFI in COPD patients. Pearson correlation analysis was applied to analyze the correlation between serological indexes and pulmonary function in patients with COPD and PFI. RESULTS Totally 113 strains of pathogens were isolated from the 98 COPD patients complicated with PFI, among which Candida spp was dominant, accounting for 76.99%. The levels of WBC, CRP and PCT of the PFI group and the bacterial group were significantly higher than those of the non-infection group(P<0.05);the FEV1, FVC and FEV1/FVC of the PFI group and the bacterial group were significantly lower than those of the non-infection group(P<0.05). The 1,3-β-D glucan level of the PFI group was significantly higher than that of the bacterial group and the non-infection group(P<0.05). ROC analysis showed that the AUC of the serum 1,3-β-D glucan was 0.897 in diagnosis of PFI of the COPD patients. Correlation analysis indicated that the FEV1, FVC and FEV1/FVC of the COPD patients complicated with PFI were negatively correlated with the serum CRP, PCT and 1,3-β-D glucan(P<0.05).CONCLUSION Serum 1,3-β-D may have relatively higher diagnostic value for PFI in COPD patients. The combined detection of PCT and CRP can be applied to evaluate pulmonary function in COPD patients.