慢性阻塞性肺疾病患者抗内皮细胞抗体持续检测的意义

Significance of continuous surveillance of anti-endothelial cell antibody in patients with chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(简称慢阻肺)患者1年内持续检测抗内皮细胞抗体(AECA)的意义。方法选取2019年10月至2020年2月在贵州省人民医院就诊的慢阻肺急性加重期患者36例,稳定期患者93例,同时段选取30例健康人作为正常对照组。其中稳定期组以AECA中位数(386.17 pg/mL)为界限,将>386.17 pg/mL纳入较高组,<386.17 pg/mL纳入较低组,依据该分组标准,该中位数(AECA=386.17 pg/mL)省略掉,AECA较高组及较低组样本量各占46例。对各组进行AECA的检测和肺功能检查,统计既往1年内急性加重次数及进行mMRC评分,同时对以上内容均进行动态随访。结果三组间AECA水平比较:慢阻肺急性加重期组高于稳定期组、正常对照组,稳定期组高于正常对照组,差异均有统计学意义(均P<0.05)。慢阻肺稳定期组随访前后相关指标的整体比较:随访后AECA水平均高于基线,12个月后随访高于6个月后随访;12个月后随访的第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%pred)以及FEV1与用力肺活量(FVC)的比值(FEV1/FVC)均低于基线,其中FEV1/FVC、FEV1%pred还低于6个月后随访;随访12个月后随访的急性加重次数、mMRC评分较6个月后随访高,差异均有统计学意义(均P<0.05)。AECA较高组及较低组随访后相关指标的比较:AECA较高组12个月后随访的AECA、急性加重次数、mMRC评分均高于同期的较低组,6个月后随访的急性加重次数、mMRC评分高于同期的较低组;AECA较高组12个月后随访的FEV1、FEV1%pred、FEV1/FVC低于同期的AECA较低组,6个月后随访的FEV1、FEV1%pred低于同期的较低组,差异均有统计学意义(均P<0.05)。结论AECA表达异常可能参与了慢阻肺肺功能的持续减退、既往1年急性加重次数、mMRC评分增高,因此可能和其持续进展相关。

Objective To explore the significance of continuous surveillance of anti-endothelial cell antibody(AECA)in patients with chronic obstructive pulmonary disease(COPD)in one year.Methods Thirty-six patients with acute exacerbation of COPD and 93 patients with stable COPD were selected from Guizhou Provincial People’s Hospital from October 2019 to February 2020,thirty healthy people in the same period were selected as normal control group.In the stable phase group,>386.17 pg/mL was included in the higher group,and<386.17 pg/mL was included in the lower group according to the AECA median(386.17 pg/mL).According to the grouping criteria,the patient with the AECA median was omitted,the sample size of AECA higher group and lower group accounted for 46 cases,respectively.AECA test,lung function examination,the number of acute exacerbations in the past 1 year and MMRC score were performed for each group;At the same time,all the above contents were followed up dynamically.Results 1.Comparison of AECA levels among the three groups:the acute exacerbation COPD group was higher than the stable phase group and the normal control group,and the stable phase group was higher than the normal control group,with statistical significance(all P<0.05).2.Overall comparison of related indicators before and after follow-up in COPD stable period group:AECA level was higher than baseline after follow-up,and the follow-up after 12 months was higher than that after 6 months;After 12 months,forced expiratory volume in one second(FEV1),the ratio of FEV1 to forced vital capacity(FVC),and FEV1%pred were all lower than baseline,and the first two indexes were lower than those after 6 months follow-up.The number of acute exacerbations and mMRC score after 12 months were higher than that after 6 months follow-up,with statistical significance(all P<0.05).3.Comparison of related indicators after follow-up between the higher and lower AECA groups:Follow-up after 12 months showed that AECA,the number of acute exacerbations and mMRC score in the higher AECA group were all higher than those in the lower AECA group at the same period,and the number of acute exacerbations and MMRC score in the higher AECA group were higher than those in the lower AECA group at 6-month follow-up.The FEV1,FEV1%pred and FEV1/FVC of the higher AECA group followed up after 12 months were lower than those of the lower AECA group at the same period,and the FEV1 and FEV1%pred of the higher AECA group followed up after6 months were lower than those of the lower AECA group at the same period,and all the differences were statistically significant(all P<0.05).Conclusion Abnormality of AECA expression in COPD may be associated with continued decline in lung function,number of acute exacerbations in the previous 1 year,and increased mMRC score,and therefore may be associated with continued progression.