血清胆红素在慢性阻塞性肺疾病中的临床意义

Clinical significance of serum bilirubin in chronic obstructive pulmonary disease

目的分析血清胆红素与慢性阻塞性肺疾病(COPD)及慢性阻塞性肺疾病急性加重期(AECOPD)之间的关系并探讨其临床意义。方法纳入2017年1月至2018年11月于南京医科大学第一附属医院呼吸与危重症医学科住院的AECOPD患者210例(AECOPD组),同时期于该院被诊断为COPD稳定期的患者108例(COPD组)和进行体检的健康者118名(健康对照组)进行回顾性分析。检测比较3组血清胆红素、炎症指标水平的差异。收集AECOPD患者相关资料并研究胆红素、C-反应蛋白(CRP)与各因素间的相关性。探索胆红素的临床意义。结果AECOPD组患者总胆红素(TBIL)、直接胆红素、间接胆红素水平最低,健康对照组最高,差异均有统计学意义(P值均<0.001)。AECOPD组患者中性粒细胞计数(NE)、中性粒细胞百分比(NE%)、CRP水平最高,其次为COPD组,差异均有统计学意义(P值均<0.05)。相关性分析显示AECOPD患者TBIL与CRP呈负相关(r=-0.225,P<0.01)。间接胆红素与NE%、CRP、动脉血二氧化碳分压呈负相关(r=-0.145、-0.333、-0.160,P值均<0.05),与氧合指数呈正相关(r=0.136,P=0.049)。CRP与NE、NE%、慢性阻塞性肺疾病评估测试评分、住院天数呈正相关(r=0.347、0.313、0.145、0.185,P值均<0.05),与氧合指数呈负相关(r=-0.146,P=0.035)。多因素Logistic回归分析显示TBIL是COPD及AECOPD的独立保护因素。受试者工作特征曲线显示性别、吸烟状况、吸烟指数、TBIL、CRP、NE%多因素诊断COPD的曲线下面积为0.888(95%CI:0.845~0.932,P<0.001),TBIL单独诊断COPD的曲线下面积为0.663(95%CI:0.593~0.734,P<0.001)。TBIL、慢性阻塞性肺疾病评估测试评分、NE%多因素诊断AECOPD的曲线下面积为0.975(95%CI:0.961~0.989,P<0.001),TBIL单独诊断AECOPD的曲线下面积为0.672(95%CI:0.611~0.732,P<0.001)。结论正常生理范围内的血清胆红素水平在COPD患者中降低,在AECOPD患者中更低,与炎症指标相关,可能是COPD及AECOPD的独立保护因素,具有一定的临床价值。

Objective To analyze the relationship between serum bilirubin in serum and chronic obstructive pulmonary disease(COPD)or acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and to study the clinical significance of serum bilirubin.Methods A total of 210 patients with AECOPD hospitalized in Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University from January 2017 to November 2018(AECOPD group),108 patients with stable COPD diagnosed in the hospital during the same period(COPD group)and 118 healthy subjects who underwent physical examination(healthy control group)were enrolled into this study.The levels of serum bilirubin and inflammatory indexes in the three groups were detected and compared.The correlation data of patients with AECOPD were collected and the correlation between the factors and the level of serum bilirubin was studied.The diagnostic value of serum bilirubin was explored.Results The levels of total bilirubin(TBIL),direct bilirubin and indirect bilirubin were the lowest in the AECOPD group and the highest in the healthy control group(all P<0.001).The levels of neutrophil count(NE),neutrophil percentage(NE%)and C-reactive protein(CRP)were the highest in AECOPD group,followed by COPD group(all P<0.05).Correlation analysis showed that there was a negative correlation between TBIL and CRP in patients with AECOPD(r=-0.225,P<0.01).IBIL was negatively correlated with NE%,CRP and partial pressure of carbon dioxide in artery(r=-0.145,-0.333,-0.160,all P<0.05),but positively correlated with oxygenation index(r=0.136,P=0.049).CRP was positively correlated with NE,NE%,CAT score and hospitalization days(r=0.347,0.313,0.145,0.185,all P<0.05),but negatively correlated with oxygenation index(r=-0.146,P=0.035).Multivariate Logistic regression analysis indicated that TBIL was an independent protective factor for COPD and AECOPD.The area under ROC curve of sex,smoking status,smoking index,TBIL,CRP and NE%for the diagnosis of COPD was 0.888(95%CI:0.845-0.932,P<0.001).The area under ROC curve of TBIL for the diagnosis of COPD was 0.663(95%CI:0.593-0.734,P<0.001).The area under the ROC curve of TBIL,CAT score and NE%for the diagnosis of AECOPD was 0.975(95%CI:0.961-0.989,P<0.001).The area under ROC curve of TBIL for the diagnosis of AECOPD was 0.672(95%CI:0.611-0.732,P<0.001).Conclusions The level of serum bilirubin in physiological range is lower in patients with COPD and even lower in patients with AECOPD.It is related to inflammatory indexes and may be an independent protective factor of COPD and AECOPD,which has a certain clinical value.