慢性阻塞性肺疾病患者血清NR4A1表达及临床意义

Expression and clinical significance of serum NR4A1 in chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者血清NR4A1表达及临床意义。方法选取COPD急性加重期患者52例(急性加重期组)、稳定期患者55例(稳定期组)、健康体检者50例(对照组)。对比各组NR4A1、第一秒用力呼气容积(FEV1)、第一秒用力呼气容积占预计值百分比(FEV1%pred)、第一秒用力呼气容积与用力肺活量比值(FEV1/FVC)、最大呼气流量(PEF)、COPD评估测试呼吸问卷(CAT)评分、呼吸困难指数(mMRC)评分、白介素6(IL-6)、C反应蛋白(CRP)差异;Pearson相关分析NR4A1与各指标的相关性;绘制受试者工作特征(ROC)曲线分析血清NR4A1对COPD的诊断价值。结果相较于对照组,稳定期组和急性加重期组NR4A1、FEV1%pred、FEV1/FVC、PEF、FEV1显著降低(P<0.05),而CRP、IL-6显著增高(P<0.05);急性加重期组NR4A1、FEV1%pred、FEV1/FVC、PEF显著低于稳定期组(P<0.05),而CRP、IL-6、mMRC评分、CAT评分显著高于稳定期组(P<0.05)。急性加重期组和稳定期组血清NR4A1水平均与FEV1、FEV1%pred、FEV1/FVC、PEF呈正相关(P<0.05),并与CRP、IL-6、mMRC评分、CAT评分呈负相关(P<0.05)。NR4A1诊断COPD稳定期的AUC为0.785(95%CI:0.437~0.762),敏感性为87.2%,特异性为74.2%。NR4A1诊断COPD急性加重期的AUC为0.822(95%CI:0.629~0.977),敏感性为92.7%,特异性为80.4%。结论 COPD患者血清NR4A1表达降低,其表达与肺功能及炎症指标密切相关,是COPD的潜在生物标志物。

Objective To evaluate the expression and clinical significance of serum NR4 A1 in chronic obstructive pulmonary disease(COPD). Methods 52 patients with acute exacerbation of COPD(the AECOPD group), 55 patients with stable COPD( the stable group) and 50 cases of healthy people(the control group) were selected as study objects. The levels of NR4 A1, forced expiratory volume in one second(FEV1), forced expiratory volume in one second/predicted value ratio(FEV1%pred), forced expiratory volume in one second/forced vital capacity( FEV1/FVC),peak expiratory flow( PEF),COPD assessment test( CAT),modified Medical Research Council( m MRC),interleukin-6( IL-6) and C-reactive protein( CRP) were compared among the three groups. The correlation between NR4 A1 and various indexes was analyzed by Pearson method. The value of serum NR4 A1 in the diagnosis of COPD was analyzed by receiver operating characteristic( ROC) curve. Results Compared with the control group,the levels of NR4 A1,FEV1% pred,FEV1/FVC,PEF and FEV1 were significantly decreased( P <0. 05),and the levels of CRP,IL-6,m MRC score and CAT score were significantly increased in the AECOPD group and the stable group( P < 0. 05). The levels of NR4 A1,FEV1% pred,FEV1/FVC and PEF in the AECOPD group were significantly lower than those in the stable group( P < 0. 05),and the levels of CRP and IL-6 were significantly higher in the AECOPD group than in the stable group( P < 0. 05). The NR4 A1 expression in the AECOPD group and the stable group was positively correlated with FEV1,FEV1% pred,FEV1/FVC and PEF( P < 0. 05),and negatively correlated with CRP,IL-6,m MRC score and CAT score( P < 0. 05). The AUC of NR4 A1 for the diagnosis stable COPD was 0. 785( 95% CI: 0. 437 ~ 0. 762),the sensitivity was 87. 2%,and the specificity was 74. 2%. The AUC of NR4 A1 for the diagnosis AECOPD was 0. 822( 95% CI: 0. 629 ~ 0. 977),the sensitivity was 92. 7%,and the specificity was 80. 4%. Conclusion The expression of serum NR4 A1 in COPD patients is decreased,its expression is closely related to lung function and inflammation indicators,and it is a potential biomarker for COPD.