补体C1q/肿瘤坏死因子相关蛋白与慢阻肺伴肺栓塞患者肺功能的相关性及对临床结局预测价值

Correlation between C1q tumor necrosis factor related protein and lung function in patients with chronic obstructive pulmonary obstruction with pulmonary embolism and its prediction of clinical outcome

目的 探讨血清C1q肿瘤坏死因子相关蛋白(C1q tumor necrosis factor related protein,CTRP)4、9与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺栓塞(pulmonary embolism,PE)患者肺功能的相关性及对临床结局的预测效果。方法 选择2016年6月至2017年12月期间收治的单纯性COPD患者98例作为非肺栓塞组,88例COPD合并PE患者作为肺栓塞组,同期体检的健康人群80例作为对照组。采用ELISA法检测研究对象血清CTRP-4、CTRP-9水平,捷斯特肺功能仪测定肺功能,比较各组间血清CTRP-4、CTRP-9水平、肺功能指标差异,分析血清因子与肺功能的关系。肺栓塞患者常规治疗后随访2年,根据临床结局分为死亡组、生存组,Logistic回归分析影响死亡的危险因素,采用ROC曲线分析血清CTRP-4、CTRP-9预测临床结局的效果。结果 肺栓塞组血清CTRP-4、CTRP-9水平高于非肺栓塞组、对照组(P<0.05),而FEV1%pred水平低于非肺栓塞组、对照组(P<0.05);CTRP-4、CTRP-9与FEV1%pred呈负相关(r=-0.681,-0.693,P均<0.01);随访期间,失访4例,死亡24例(28.57%),存活60例(71.43%);Logistic回归分析显示CTRP-4、CTRP-9、FEV1%pred、肺功能分级均为COPD合并PE患者死亡的独立危险因素(P<0.05);CTRP-4预测死亡的灵敏度为87.50%,特异度为71.67%,ROC曲线下面积为0.766(95%CI 0.704-0.847);CTRP-9预测死亡的灵敏度为83.33%,特异度为78.33%,ROC曲线下面积为0.832(95%CI 0.767-0.904)。结论 COPD合并PE患者血清CTRP-4、CTRP-9高表达,其水平与肺功能呈正相关,是导致患者死亡的独立危险因素,预测临床结局效果良好,具有一定的应用价值。

Objective To explore the correlation between serum C1q tumor necrosis factor related protein(CTRP)4,9and chronic obstructive pulmonary disease(COPD)with pulmonary embolism(PE)and its predictive effect of clinical outcome.Methods 98cases of simple COPD patients admitted from June 2016and December 2017were chosen as the non-pulmonary embolism group,88cases of COPD and PE patients as the pulmonary embolism group,and 80healthy people as control group.The serum CTRP-4and CTRP-9levels of the subjects were detected by ELISA,and the lung function was measured by the Jester pulmonary function instrument.To compare the differences in serum CTRP-4,CTRP-9levels and lung function indexes between three groups,analyze the relationship between CTRP-4,CTRP-9levels and lung function.Non-pulmonary embolism group were followed up for 2years after conventional treatment and were divided into death group and survival group according to the clinical outcome.Logistic regression analysis was used to analyze the risk factors affecting death.ROC curve was used to analyze the effect of serum CTRP-4and CTRP-9in predicting clinical outcome.Results The serum CTRP-4and CTRP-9level of pulmonary embolism group was significantly higher than that of non-pulmonary embolism group and control group,while the FEV1%pred level was significantly lower than that of non-pulmonary embolism group and control group(P<0.05).Pearson correlation analysis was used to show CTRP-4and CTRP-9negative correlation with FEV1%pred,respectively(r=-0.681,-0.693,P<0.01).During the follow-up period,4cases were lost to follow-up,24cases died(28.57%),and 60cases survived(71.43%).Univariate and Logistic regression analysis showed that CTRP-4,CTRP-9,FEV1%pred,and lung function classification are independent risk factors for death in COPD and PE patients(P<0.05).The sensitivity of CTRP-4in predicting death was 87.50%,the specificity was 71.67%,the area under the ROC curve was 0.766(95%CI0.704-0.847);the sensitivity of CTRP-9in predicting death was 83.33%,the specificity was 78.33%,ROC The area under the curve is 0.832(95%CI 0.767-0.904).Conclusion The high expression of CTRP-4and CTRP-9in serum of patients with COPD and PE is positively correlated with lung function,and is an independent risk factor leading to patient death.It is effective in predicting clinical outcome and has certain application value.