稳定期慢性阻塞性肺疾病频繁急性加重的影响因素及其与血清SFRP1、PGRN水平的相关性

Influencing factors of frequent acute exacerbations of stable chronic obstructive pulmonary disease and its correlation with serum SFRP1 and PGRN levels

目的:探究稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)频繁急性加重的影响因素及其与血清分泌型卷曲相关蛋白1(secreted frizzled-related protein 1,SFRP1)、颗粒蛋白前体(progranulin,PGRN)水平的相关性。方法:选取2020年4月至2021年2月于汕头市大峰医院呼吸内科就诊的稳定期COPD患者为研究对象,根据患者既往12个月内症状急性加重的情况,将其分为频繁急性加重组和非频繁急性加重组。采集所有患者一般资料,进行肺功能检查、常规生化指标及血清SFRP1、PGRN水平测定,并行改良英国医学研究委员会呼吸困难量表(modified Medical Research Council Dyspnea Scale,mMRC)、临床慢性阻塞性肺病问卷(Clinical COPD Questionnaire,CCQ)、Charlson合并症指数(Charlson Comorbidity Index,CCI)、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评估。采用logistic回归模型分析相关指标与COPD频繁急性加重的关系。结果:共入组160例,其中频繁急性加重组为92例,非频繁急性加重组68例。与非频繁急性加重组相比,频繁急性加重组的体重指数(body mass index,BMI)、第1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))、FEV_(1)/用力肺活量(forced vital capacity,F VC)及血清肾小球滤过率(glomerular filtration rate,GFR)、血红蛋白(haemoglobin,Hb)水平均明显更低(P<0.05),血清总免疫球蛋白E(immunoglobulin E,IgE)、SFRP1、PGRN水平及慢性阻塞性肺病评估测试(COPD assessment test,CAT)、HAMA评分则均明显更高(P<0.05)。Logistic回归分析显示:BMI[优势比(odds ratio,OR)=0.973]、FEV_(1)(OR=0.963)、GFR(OR=0.865)、血清总IgE(OR=3.473)、SFRP1(OR=2.081)、PGRN(OR=2.612)及CAT评分(OR=1.101)、HAMA评分(OR=1.134)均为稳定期COPD频繁急性加重的独立影响因素(P<0.05)。结论:相比非频繁急性加重患者,COPD频繁急性加重患者存在BMI较低、肺功能较差等特点,且血清SFRP1、PGRN水平与频繁急性加重具有明显相关性。

Objective:To explore the influencing factors of frequent acute exacerbations of chronic obstructive pulmonary disease(COPD)in stable phase and its correlation with serum secreted frizzled-related protein 1(SFRP1)and progranulin(PGRN)levels.Methods:Patients with stable COPD who were treated in the Department of Respiratory Medicine of Shantou Dafeng Hospital from April 2020 to February 2021 were selected as the research subjects.According to the patients’acute exacerbation of symptoms in the past 12 months,they were divided into a frequent acute recombination group and a non-frequent acute recombination group.The patients’general data were collected and pulmonary function was examined.The routine biochemical indexes,serum SFRP1 and PGRN were measured,and the modified medical research council(mMRC),clinical COPD questionnaire(CCQ),Charlson comorbidity index(CCI),Hamilton anxiety scale(HAMA)were assessed.The relationship between the correlation index and the frequent acute exacerbation of COPD was analyzed by logistic regression model.Results:A total of 160 cases were enrolled,of which 92 cases were in the frequent acute recombination group and 68 cases were in the non-frequent acute recombination group.Compared with the non-frequent acute recombination group,body mass index(BMI),forced expiratory volume in one second(FEV_(1)),FEV_(1)/forced vital capacity(FVC),serum glomerular filtration rate(GFR),and haemoglobin(Hb)levels of the frequent acute recombination group were significantly lower(P<0.05),while levels of serum total immunoglobulin E(IgE),SFRP1,and PGRN and scores of COPD assessment test(CAT)and HAMA were significantly higher(P<0.05).Logistic regression analysis showed that BMI[odds ratio(OR)=0.973],FEV_(1)(OR=0.963),GFR(OR=0.865),serum total IgE(OR=3.473),SFRP1(OR=2.081),PGRN(OR=2.612)and scores of CAT(OR=1.101)and HAMA(OR=1.134)are independent influencing factors(P<0.05).Conclusion:COPD patients with frequent acute exacerbations had lower BMI and poorer pulmonary function than those with non-frequent acute exacerbations,and the serum levels of SFRP1 and PGRN were significantly correlated with frequent acute exacerbations.