血清suPAR、PAI-1对慢性阻塞性肺疾病合并支气管扩张的诊断价值

The Diagnostic Value of Serum suPAR and PAI-1 in Chronic Obstructive Pulmonary Disease with Bronchiectasis

目的研究血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)、纤溶酶原激活物抑制剂-1(PAI-1)对慢性阻塞性肺疾病(COPD)合并支气管扩张的诊断价值。方法在2019年10月至2021年4月,共纳入265例稳定期中重度COPD患者作为研究对象,根据支气管扩张程度将他们分为无支扩组(n=135)和COPD合并支扩组(n=130)。另外纳入100例无肺部疾病或无法控制的慢性疾病志愿者作为对照组。酶联免疫吸附检测血清suPAR、PAI-1和血清炎症因子水平,使用肺功能仪检测肺通气和弥散功能。结果COPD患者血清suPAR、PAI-1水平均高于对照组(P<0.05),且COPD合并支扩组血清suPAR、PAI-1水平较无支扩组升高更明显(P<0.05)。血清suPAR与第1秒用力呼气容积占预计值百分比(FEV1%pre)、第1秒用力呼气容积/用力肺活量(FEV1/FVC)、一氧化碳弥散量占预计值百分比(DLCO%pre)呈负相关性(P<0.05),与残气量/肺总量、高分辨率计算机断层扫描(HRCT)评分、血清白细胞介素(IL)-6水平呈正相关(P<0.05)。血清PAI-1与FEV1/FVC、DLCO%pre呈负相关性(P<0.05),与HRCT评分、血清IL-6水平呈正相关性(P<0.05)。经受试者工作特征曲线分析,联合检测血清suPAR和PAI-1用于诊断COPD患者发生支气管扩张的曲线下面积为0.828(0.778~0.878)。结论血清suPAR、PAI-1在COPD合并支气管扩张的患者中显著上升,且与患者肺功能恶化和机体炎症状态有关。血清suPAR、PAI-1联合诊断COPD发生支气管扩张的效能显著。

Objective To study the diagnostic value of serum soluble urokinase-type plasminogen activator receptor(suPAR)and plasminogen activator inhibitor-1(PAI-1)for chronic obstructive pulmonary disease(COPD)with bronchiectasis.Methods From October,2019 to April,2021,a total of 265 stable patients with moderate to severe COPD were included as the study subjects.According to the degrees of bronchiectasis,these patients were divided into the non-branch expansion group(n=135)and COPD combined branch expansion group(n=130).100 volunteers with no lung disease or uncontrollable chronic diseases were also included as the control group.Enzyme-linked immunosorbent assay was conducted to detect levels of serum suPAR,PAI-1 and inflammatory factors.The pulmonary ventilation and diffusion function were measured by pulmonary function instrument.Results Levels of serum suPAR and PAI-1 in COPD patients were higher than those in the control group(P<0.05),and levels of serum suPAI and PAI-1 in the COPD patients with branch expansion group were higher than those in the non-branch expansion group(P<0.05).Also,serum suPAR and forced expiratory volume in the first second accounted for the percentage of predicted value(FEV1%pre),forced expiratory volume in the first second/forced vital capacity(FEV1/FVC),and carbon monoxide diffused volume accounted for the percentage of predicted value(DLCO%pre)showed a negative correlation(P<0.05).Serum suPAR was positively correlated with residual air volume/total lung volume,high-resolution computed tomography(HRCT)score,and interleukin(IL)-6(P<0.05).Serum PAI-1 was negatively correlated with FEV1/FVC,and DLCO%pre(P<0.05).Serum PAI-1 was positively correlated with HRCT score and IL-6(P<0.05).According to the receiver operating characteristics curve analysis,the area under the curve of serum suPAR and PAI-1 for the combined diagnosis of bronchiectasis in COPD patients was 0.828(0.778-0.878).Conclusion Serum suPAR and PAI-1 are significantly increased in COPD patients with bronchiectasis,and these markers are related to lung function and inflammation indicators.The combination of serum suPAR and PAI-1 is effective in diagnosing COPD bronchiectasis.