血浆解聚素-金属蛋白酶8可辅助诊断老年慢性阻塞性肺疾病患者的病情严重程度

Plasma adisintegrin and metalloprotease 8 assists diagnosis of disease severity in elderly patients with chronic obstructive pulmonary disease

目的:探讨血浆解聚素-金属蛋白酶8(ADAM8)水平在老年慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)诊断和病情评估中的价值。方法:收集229例老年COPD患者的临床资料,其中稳定期记为COPD组(98例),急性加重期记为AECOPD组(131例),参照2019年修订的《慢性阻塞性肺疾病全球创议》指南,根据患者病情的综合评估情况分为A、B、C、D组。同时选取无慢性呼吸系统疾病的老年健康体检者40例为对照组。比较各组的基线资料、动脉血气、肺功能指标以及血浆ADAM8水平,分析血浆ADAM8与各指标的相关性以及对COPD急性加重的诊断价值。结果:血浆ADAM8水平在对照组、COPD组、AECOPD组,以及A、B、C、D组中均依次升高,任意2组间比较,差异有统计学意义(P均<0.05)。血浆ADAM8水平与白细胞计数、中性粒细胞与淋巴细胞比值、红细胞分布宽度、纤维蛋白原、D-二聚体以及PaCO_(2)呈显著正相关(P=0.000),与嗜酸性粒细胞计数、PaO_(2)、第1秒用力呼气量/用力肺活量(FEV_(1)/FVC)及第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)呈显著负相关(P=0.000)。血浆ADAM8水平诊断AECOPD的最佳临界值为114.47 ng/mL,曲线下面积为0.881,敏感度为77.00%,特异性为88.90%,约登指数为0.659,95%置信区间为0.834~0.929。结论:老年COPD患者血浆中ADAM8水平明显升高,是评估COPD严重程度以及急性加重期的辅助指标。

Objective:To explore the value of adisintegrin and metalloprotease 8(ADAM8)level in the diagnosis and condition assessment of elderly chronic obstructive pulmonary disease(COPD)during acute exacerbation.Methods:The clinical data of 229 elderly COPD patients were collected,and they were divided into stable COPD group(98 cases)and acute exacerbation COPD(AECOPD)group(131 cases).Referring to the global initiative for chronic obstructive lung disease guideline revised in 2019,the patients were divided into groups A,B,C and D according to the comprehensive evaluation of the patient's condition.At the same time,40 elderly healthy subjects without chronic respiratory diseases were selected as the control group.The baseline data,arterial blood gas,pulmonary function indexes and plasma ADAM8 levels were compared among the groups,and the correlation between plasma ADAM8 and each index and its diagnostic value for AECOPD were analyzed.Results:Plasma ADAM8 levels were increased in the control group,COPD group,AECOPD group,and groups A,B,C and D in turn,and the difference was statistically significant between any two groups(all P<0.05).Plasma ADAM8 level was significantly positively correlated with white blood cell count,neutrophil-to-lymphocyte ratio,red blood cell distribution width,fibrinogen,D-dimer and PaCO_(2)(P=0.000),and significantly negatively correlated with eosinophil count,PaO_(2),forced expiratory volume in 1 second/forced vital capacity(FEV_(1)/FVC)and forced expiratory volume in 1 second as a percentage of predicted value(FEV_(1)%pred)(P=0.000).The optimal cut-off value of plasma ADAM8 level for the diagnosis of AECOPD was 114.47 ng/mL,the area under curve was 0.881,the sensitivity was 77.00%,the specificity was 88.90%,the Youden index was 0.659,and the 95%confidence interval was 0.834-0.929.Conclusion:The plasma level of ADAM8 in elderly COPD patients is significantly increased,which is an auxiliary indicator for evaluating the severity of COPD and AECOPD.