血清白细胞介素-6和Ⅱ型肺泡细胞表面抗原对老年慢性阻塞性肺疾病稳定期患者发生中重度气流受限的预测价值

Values of serum interleukin-6 and Kerbs von Lungren 6 antigen to the prediction of moderate to severe airflow limitation in elderly patients with stable chronic obstructive pulmonary disease

目的观察老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者血清白细胞介素-6(interleukin-6,IL-6)、Ⅱ型肺泡细胞表面抗原(Kerbs von Lungren 6antigen,KL-6)水平变化,探讨其对老年COPD稳定期患者发生中重度气流受限的预测价值。方法 135例老年COPD稳定期患者,根据气流受限程度分为轻度组59例和中重度组76例。比较2组年龄、性别、病程、肺功能分级等临床资料;记录2组入院时用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))占预计值百分比(FEV_(1)%pred)、FEV_(1)/FVC及血清IL-6、KL-6水平;多因素logistic回归分析老年COPD稳定期患者发生中重度气流受限的影响因素;绘制ROC曲线,评估血清IL-6、KL-6预测老年COPD稳定期患者发生中重度气流受限的价值。结果中重度组血清IL-6[(29.85±5.07)ng/L]、KL-6[(452.39±57.61)ku/L]水平及肺功能分级Ⅳ级比率(47.37%)均高于轻度组[(24.02±4.31)ng/L、(391.64±43.51)ku/L、20.34%](P<0.05),FVC[(2.04±0.58)L]、FEV_(1)%pred[(44.82±4.57)%]、FEV_(1)/FVC[(66.67±0.48)%]均低于轻度组[(2.38±0.53)L、(48.36±4.29)%、(68.65±0.37)%](P<0.05),年龄、性别比例、病程、1年内急性发作次数与轻度组比较差异均无统计学意义(P>0.05)。血清IL-6(OR=1.314,95%CI:1.163~1.483,P<0.001)、KL-6(OR=1.027,95%CI:1.014~1.040,P<0.001)是老年COPD稳定期患者发生中重度气流受限的影响因素。血清IL-6、KL-6分别以26.70ng/L、412.55ku/L为最佳截断值,单独及联合预测老年COPD稳定期患者发生中重度气流受限的AUC分别为0.815(95%CI:0.744~0.887,P<0.001)、0.802(95%CI:0.729~0.875,P<0.001)、0.830(95%CI:0.761~0.898,P<0.001),灵敏度分别为72.9%、71.2%、83.1%,特异度分别为75.0%、71.1%、67.1%。结论中重度气流受限的老年COPD稳定期患者血清IL-6、KL-6水平升高,血清IL-6、KL-6是老年COPD稳定期患者发生中重度气流受限的影响因素,二者联合预测老年COPD稳定期患者发生中重度气流受限有较高价值。

Objective To observe the changes of interleukin-6(IL-6)and Kerbs von Lungren 6 antigen(KL-6)in patients with stable chronic obstructive pulmonary disease(COPD),and to investigate the values of IL-6 and KL-6 to the prediction of moderate to severe airflow limitation in elderly patients with stable COPD.Methods According to the degree of airflow limitation,135 elderly patients with stable COPD were divided into mild group(n=59)and moderate to severe group(n=76).The clinical data as age,gender,course of disease and pulmonary function degree were compared between two groups.The forced vital capacity(FVC),forced expiratory volume in one second of the predicted value(FEV_(1)%pred),FEV_(1)/FVC,and the levels of serum IL-6 and KL-6 were recorded on admission.Multivariate logistic regression analysis was done to assess the influencing factors of moderate to severe airflow limitation in elderly patients with stable COPD.ROC curve was drawn to evaluate the values of serum IL-6 and KL-6 to the prediction of moderate to severe airflow limitation in elderly patients with stable COPD.Results The levels of IL-6 and KL-6 as well as the percentage of pulmonary function degreeⅣ were higher in moderate to severe group[(29.85±5.07)ng/L,(452.39±57.61)ku/L,47.37%]than those in mild group[(24.02±4.31)ng/L,(391.64±43.51)ku/L,20.34%](P<0.05),FVC and FEV_(1)%pred and FEV_(1)/FVC were lower in moderate to severe group [(2.04±0.58)L,(44.82±4.57)%,(66.67±0.48)%]than those in mild group[(2.38±0.53)L,(48.36±4.29)%,(68.65±0.37)%](P<0.05),and there were no significant differences in the age,gender ratio,disease course,and frequency of acute aggravation within one year between two groups(P>0.05).The serum IL-6(OR=1.314,95%CI:1.163-1.483,P<0.001)and KL-6(OR=1.027,95%CI:1.014-1.040,P<0.001)were the influencing factors of moderate to severe airflow limitation in elderly patients with stable COPD.When the optimal cut-off values of serum IL-6 and KL-6 were 26.70 ng/L and 412.55 ku/L,the AUCs of single and combined detection of them two for predicting moderate to severe airflow limitation were 0.815(95%CI:0.744-0.887,P<0.001),0.802(95%CI:0.729-0.875,P<0.001)and 0.830(95%CI:0.761-0.898,P<0.001),the sensitivities were 72.9%,71.2% and 83.1%,and the specificities were 75.0%,71.1% and 67.1%,respectively.Conclusions The serum IL-6 and KL-6 levels are elevated and are the influencing factors of moderate to severe airflow limitation in elderly patients with stable COPD.The combined detection of them two has a high value to the prediction of moderate to severe airflow limitation.