急性期COPD患者肺泡灌洗液病原菌分布及血清锁链素、CC16、CRP/ALB分析

Analysis of the distribution of pathogens in alveolar lavage fluid and the serum desmosine,CC16 and CRP/ALB ratio in patients with acute chronic obstructive pulmonary disease

目的探究急性期慢性阻塞性肺疾病(COPD)患者肺泡灌洗液病原菌分布,并分析血清锁链素、Clara细胞蛋白(CC16)、C反应蛋白/白蛋白(CRP/ALB)比值。方法选取本院2017年10月-2020年10月收治的急性期COPD患者256例(急性期COPD组),同期收治的缓解期COPD患者158例(缓解期COPD组),以及同期在本院体检的健康者260例(对照组)。使用全自动细菌鉴定仪对COPD患者的肺泡灌洗液进行病原菌的分离及鉴定,利用全自动生化分析仪检测血清锁链素、CC16、CRP/ALB值。绘制受试者工作特征(ROC)曲线,评估上述三指标诊断急性期COPD的价值。结果 256例急性期COPD患者肺泡灌洗液中细菌或真菌培养阳性138例,阳性率53.91%。共检出173株菌株,其中G-菌占72.25%,G+菌占24.27%。对照组、缓解期COPD组、急性期COPD组血清锁链素分别为(0.62±0.15)μg/L、(18.64±5.16)μg/L、(26.57±7.94)μg/L;CRP/ALB比值分别为(0.18±0.06)×10^(-3)、(0.18±0.06)×10^(-3)、(1.59±0.35)×10^(-3);CC16水平分别为(4.59±1.05)ng/ml、(1.31±0.38)ng/ml、(0.75±0.21)ng/ml。与对照组相比,缓解期COPD组和急性期COPD组血清锁链素、CRP/ALB比值增高(均P<0.05),用力肺活量(FVC)、第一秒用力呼气容积用力肺活量(FEV1)、FEV1/FVC、血清CC16水平降低(均P<0.05);与缓解期COPD组相比,急性期COPD组血清锁链素、CRP/ALB值增高(均P<0.05),CC16水平降低(P<0.05)。血清锁链素、CC16、CRP/ALB值诊断急性期COPD的ROC曲线下面积(AUC)分别为0.839、0.844和0.878,相应的敏感度分别为71.70%、77.50%和76.30%,特异性分别为87.70%、82.90%和87.70%;三者联合诊断急性期COPD的AUC为0.962,敏感度和特异性分别为91.30%和90.60%。结论急性期COPD患者肺泡灌洗液中的病原菌以G-菌为主,患者血清锁链素水平、CRP/ALB值升高,CC16水平降低,对疾病的诊断具有参考价值,且三者联合诊断的价值更高。

Objective To explore the distribution of pathogens in the alveolar lavage fluid of patients with acute chronic obstructive pulmonary disease(COPD) and to analyze the serum desmosine and Clara cell protein(CC16) levels and the C-reactive protein/albumin(CRP/ALB) ratio in those patients. Methods Subjects were a total of 256 patients with acute COPD seen at this hospital from October 2017 to October 2020;158 patients with stable COPD seen at this hospital during the same period served as patients with stable COPD, and 260 healthy people who underwent a physical examination at this hospital during the same period served as the control group. Strains in alveolar lavage fluid were identified by an automated bacterial identification system, and levels of serum desmosine and CC16 and the CRP/ALB ratio were determined by an automated biochemical analyzer. The receiver operating characteristic(ROC) curve was used to evaluate using levels of serum serotonin and CC16 and the CRP/ALB ratio to identify acute COPD. Results Of 256 patients with acute COPD, 138 had alveolar lavage fluid that tested positive for bacteria or fungi(positivity: 53.91%). A total of 173 strains were detected, and most(72.25%) were strains of Gram-negative bacteria. Strains of Gram-positive bacteria were also detected(24.27%). Serum desmosine was 0.62±0.15 μg/L in the control group, 18.64±5.16 μg/L in patients with stable COPD, and 26.57±7.94 μg/L in patients with acute COPD. The ratio of CRP/ALB was 0.18±0.06×10^(-3) in the control group, 0.18±0.06×10^(-3) in patients with stable COPD, and 1.59±0.35×10^(-3) in patients with acute COPD. The CC16 level was 4.59±1.05 ng/ml in the control group, 1.31±0.38 ng/ml in patients with stable COPD, 0.75±0.21 ng/ml in patients with acute COPD. Compared to the control group, patients with stable COPD and patients with acute COPD had higher serum desmosine and a higher CRP/ALB ratio(P<0.05), a lower forced vital capacity(FVC), a lower forced expiratory volume in the first second(FEV1), a lower FEV1/FVC, and a lower serum CC16 level(P<0.05). Compared to patients with stable COPD, patients with acute COPD had higher serum desmosine and a higher CRP/ALB ratio(P<0.05) and a lower CC16 level(P<0.05). The area under the ROC curve(AUC) for serum desmosine in the identification of acute COPD was 0.839, that for the CC16 level was 0.844, and that for the CRP/ALB ratio was 0.878. Serum desmosine had a sensitivity of 71.70% and a specificity of 87.70%, the CC16 level had a sensitivity of 77.50% and a specificity of 82.90%, and the CRP/ALB ratio had a sensitivity of 76.30% and a specificity of 87.70%. The AUC for all three indices for the identification of acute COPD was 0.962, and all three indices had a sensitivity of 91.30% and a specificity of 90.60%. Conclusion The pathogens in the alveolar lavage fluid of patients with acute COPD were mainly Gram-negative bacteria, followed by Gram-positive bacteria. The serum level of desmosine and the CRP/ALB ratio are higher i patients with acute COPD while the level of CC16 is lower. A combination of serum desmosine, the CC16 level, and the CRP/ALB ratio have a higher diagnostic value in terms of identifying acute COPD.