痰液NE、PPARγ、elafin表达预测慢性阻塞性肺疾病稳定期患者急性加重的临床研究

Clinical Study on the Expression of NE,PPARγand elafin in Sputum to Predict Acute Exacerbation in Patients with Stable Chronic Obstructive Pulmonary Disease

目的探讨痰液中性粒细胞弹性蛋白酶(neutrophil elastase,NE)、过氧化物酶体增殖物激活受体γ(peroxisome proliferator-activated receptor gamma,PPARγ)、人白细胞弹性蛋白酶抑制因子(elafin)表达预测慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者急性加重的价值。方法选取2019-04/2021-06月作者医院收治的120例COPD稳定期患者进行前瞻性研究,随访6个月,根据6个月内病情是否急性加重分为加重组、非加重组。比较两组一般资料、痰液NE、PPARγ、elafin表达。采用多因素Logistic回归分析探讨急性加重的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)分析痰液NE、PPARγ、elafin表达预测急性加重价值,并采用相对危险度(relative risk,RR)检验分析痰液NE、PPARγ、elafin表达对COPD稳定期患者急性加重病情程度的影响。结果加重组气流受限的肺功能分级、Charlson合并症指数(Charlson comorbidity index,CCI)评分高于非加重组(P均<0.01);加重组痰液NE高于非加重组,PPARγ、elafin低于非加重组(P均<0.01)。气流受限的肺功能分级、CCI评分、NE是急性加重的相关危险因素,PPARγ、elafin是急性加重的相关保护因素。痰液NE、PPARγ、elafin预测急性加重的AUC分别为0.813、0.779、0.722,痰液NE、PPARγ联合elafin预测急性加重的AUC为0.914。NE、PPARγ、elafin高水平者中重度急性加重风险分别是低水平者的3.546、0.438、0.245倍。结论痰液NE、PPARγ、elafin表达与COPD稳定期患者急性加重及急性加重后病情严重程度有关,联合检测可作为预测急性加重的一种方案,为临床治疗提供参考依据。

Objective To investigate the expressions of neutrophil elastase(NE),peroxisome proliferator-activated receptor gamma(PPARγ)and human leukocyte elastase inhibitor(elafin)in sputum in predicting acute weighted value of stable chronic obstructive pulmonary disease(COPD).Methods A prospective study was conducted on 120 patients with stable COPD who were admitted to author′s hospital from April 2019 to June 2021,and the patients were followed up for 6 months.According to the acute exacerbation of the disease within 6 months,the patients were divided into aggravated group and non-aggravated group.The general data,sputum NE,PPARγand elafin expressions were compared between the two groups.The related factors of acute exacerbation were analyzed by the multivariate Logistic regression analysis,and the expression of the sputum NE,PPARγand elafin predicting the value of acute exacerbation were analyzed by receiver operating characteristic(ROC)curve and the area under the curve(AUC),and the effects of sputum NE,PPARγand elafin expressions on the severity of acute exacerbation in patients with stable COPD were analyzed by relative risk(RR).Results The lung function classification and Charlson comorbidity index(CCI)score of airflow limitation in the aggravated group were higher than those in the non-aggravated group(all P<0.01);the sputum NE in the aggravated group was higher than that in the non-aggravated group,while PPARγand elafin were lower than those in the non-aggravated group(all P<0.01).Restricted pulmonary function classification,CCI score and NE were related risk factors for acute exacerbation,and PPARγand elafin were related protective factors for acute exacerbation.The AUC of sputum NE,PPARγand elafin predicting the value of acute exacerbation were0.813,0.779,0.722 respectively;the AUC of sputum NE,PPARγcombined elafin to predict acute exacerbation was 0.914.The risk of moderate to severe acute exacerbation in patients with high levels of NE,PPARγand elafin was 3.546,0.438 and 0.245 times than those with low levels.Conclusion The expressions of NE,PPARγand elafin in sputum are related to acute exacerbation and the severity of post-acute exacerbation in patients with stable COPD.Combined detection can be used as a scheme to predict acute exacerbation and provide a reference for clinical treatment.