慢性阻塞性肺疾病合并肺气肿患者血清不规则趋化因子变化及临床意义

Changes and clinical significance of serum CX3CL1/FKN in patients with COPD and emphysema

目的分析慢性阻塞性肺疾病(COPD)合并肺气肿患者血清不规则趋化因子(CX3CL1/FKN)变化及临床意义。方法我院收治的106例COPD患者,按是否合并肺气肿分为COPD合并肺气肿组(n=46)和COPD组(n=60),选取同期我院体检的40例健康者作为对照组;随访28 d,根据预后将COPD合并肺气肿组分为存活组(n=40)和死亡组(n=6),检测血清CX3CL1/FKN、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平和肺功能肺活量(FVC)、第一秒钟用力呼气容积占预计值的百分比(FEV1%)、第一秒钟用力呼气容积占肺活量的百分比(FEV1/FVC%),分析血清CX3CL1/FKN、IL-6、TNF-α、CRP水平与肺功能的相关性,并采用ROC曲线分析其水平对COPD合并肺气肿预后的评估价值。结果COPD合并肺气肿组治疗前后血清CX3CL1/FKN、IL-6、TNF-α、CRP水平高于COPD组,FEV1、FVC、FEV1/FVC低于COPD组(P<0.05);血清CX3CL1/FKN、IL-6、TNF-α、CRP水平与FEV1、FVC、PEV1/FVC呈负相关(P<0.05);生存组血清CX3CL1/FKN、IL-6、TNF-α、CRP水平低于死亡组(P<0.05);血清CX3CL1/FKN、IL-6、TNF-α、CRP水平是影响COPD合并肺气肿患者预后的危险因素(P<0.05);血清CX3CL1/FKN、IL-6、TNF-α、CRP水平联合预测COPD合并肺气肿患者预后的敏感度及特异度均高于单独预测(P<0.05)。结论COPD合并肺气肿患者血清CX3CL1/FKN、IL-6、TNF-α、CRP水平呈高表达,可能是引起肺功能下降的因素,且对预后评估价值较高。

Objective Objective To analyze the changes and clinical significance of serum fractalkine(CX3CL1/FKN)in patients with chronic obstructive pulmonary disease(COPD)and emphysema.Methods One hundred and six patients with COPD in our hospital were divided into COPD with emphysema group(n=46)and COPD group(n=60).Meanwhile,40 healthy subjects were selected as a control group.According to the results of 28-day follow-up,patients in the COPD with emphysema group were further divided into survival group(n=40)and death group(n=6).Levels of serum CX3CL1/FKN,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)as well as lung function indexes such as forced vital capacity(FVC),forced expiratory volume in 1 second as percent predicted values(FEV1%)and forced expiratory volume in the first second as percentage of forced vital capacity(FEV1/FVC%)were detected.The correlation of serum CX3CL1/FKN,IL-6,TNF-αand CRP with lung function was analyzed.ROC curve analysis was used to evaluate the prognostic value of above indexes for COPD with emphysema.Results The levels of serum CX3CL1/FKN,IL-6,TNF-αand CRP were higher while FEV1%,FVC and FEV1/FVC%were lower in the COPD with emphysema group than those in the COPD group(P<0.05).Spearman correlation analysis showed that serum CX3CL1/FKN,IL-6,TNF-αand CRP levels were negatively correlated with FEV1%,FVC and FEV1/FVC%(P<0.05).The levels of serum CX3CL1/FKN,IL-6,TNF-αand CRP were lower in the survival group than those in the death group(P<0.05).Multivariate logistic regression analysis showed that serum CX3CL1/FKN,IL-6,TNF-α,and CRP levels were risk factors affecting the prognosis of patients with COPD and emphysema(P<0.05).ROC curve analysis showed that the sensitivity and specificity of serum CX3CL1/FKN,IL-6,TNF-α,and CRP in combination were higher than those of each index for prognosis of patients with COPD and emphysema(P<0.05).Conclusion Patients with COPD and emphysema have high levels of serum CX3CL1/FKN,IL-6,TNF-αand CRP,which are factors causing the decline of lung function.Therefore,these indexes have a high prognostic value.