血清AgRP、IL-28A在慢性阻塞性肺疾病合并肺动脉高压中的表达及临床意义

Expression and Clinical Significance of Serum AgRP and IL-28A in Chronic Obstructive Pulmonary Disease Complicated with Pulmonary Hypertension

目的探讨慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者血清刺鼠基因相关蛋白(AgRP)、白细胞介素-28A(IL-28A)的表达及临床意义。方法将2019年1月-2021年1月诊治的COPD合并PH 122例为PH组,依据肺动脉收缩压(PAP)分为轻度组50例、中度组41例、重度组31例。选取同期诊治的单纯COPD 66例为对照组。检测2组血清AgRP、IL-28A水平、动脉血气分析指标[动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))]及炎性因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、IL-6]。血清AgRP、IL-28A与动脉血气指标和炎性因子的相关性采用Pearson相关分析。多因素Logistic回归分析影响COPD合并PH发生的因素。受试者工作特征曲线分析血清AgRP、IL-28A对COPD合并PH的诊断价值。结果PH组PAP、PaCO_(2)、TNF-α、CRP、IL-6、IL-28A高于对照组,而PaO_(2)、AgRP低于对照组(P<0.01)。重度组血清IL-28A、PAP、PaCO_(2)、TNF-α、CRP和IL-6高于中度组和轻度组,而血清AgRP、PaO_(2)水平低于中度组和轻度组(P<0.05)。中度组血清IL-28A、PAP、PaCO_(2)、TNF-α、CRP和IL-6高于轻度组,而血清AgRP、PaO_(2)水平低于轻度组(P<0.05)。血清AgRP与PAP、PaCO_(2)、TNF-α、CRP、IL-6呈负相关,与PaO_(2)呈正相关(P<0.01);血清IL-28A与PAP、PaCO_(2)、TNF-α、CRP、IL-6呈正相关,与PaO_(2)呈负相关(P<0.01)。AgRP、IL-28A是COPD合并PH发生的独立危险因素(P<0.01)。血清AgRP、IL-28A联合检测时曲线下面积大于血清AgRP、IL-28A单独检测(P<0.01)。结论COPD合并PH患者血清AgRP降低,IL-28A升高,二者与COPD合并PH患者疾病严重程度、肺功能及炎性因子有关,且联合检测有助于COPD合并PH的诊断。

Objective To investigate the expression and clinical significance of serum agouti gene-related protein(AgRP)and interleukin-28A(IL-28A)in patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension(PH).Methods A total of 122 patients with COPD and PH diagnosed and treated from January 2019 to January 2021 were selected as PH group,who were divided into mild subgroup(n=50),moderate subgroup(n=41)and severe group(n=31)according to pulmonary artery systolic pressure(PAP).Another 66 patients with simple COPD diagnosed and treated at the same time were selected as the control group.The levels of serum AgRP,IL-28A,arterial blood gas analysis indicators[arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2))]and inflammatory factors[tumor necrosis factor-α(TNF-α),C reactive protein(CRP),interleukin-6(IL-6)]were detected in the two groups.Pearson correlation analysis was used to analyze the correlation between serum AgRP,IL-28A and arterial blood gas analysis indicators and inflammatory factors.Multivariate logistic regression analysis was used to analyze the factors influencing the occurrence of COPD combined with PH.The diagnostic value of serum AgRP and IL-28A in patients with COPD complicated with PH was analyzed by receiver operating characteristic(ROC)curve.Results PAP,PaCO_(2),TNF-α,CRP,IL-6 and IL-28A in PH group were higher than those in control group,while PaO_(2)and AgRP were lower than those in control group(P<0.01).The levels of serum IL-28A,PAP,PaCO_(2),TNF-α,CRP and IL-6 in severe group were higher than those in moderate and mild groups,while the levels of serum AgRP and PaO_(2)were lower than those in moderate and mild groups(P<0.05).Serum levels of IL-28A,PAP,PaCO_(2),TNF-α,CRP and IL-6 in moderate group were higher than those in mild group,while serum levels of AgRP and PaO_(2)in moderate group were lower than those in mild group(P<0.05).Serum AgRP was negatively correlated with PAP,PaCO_(2),TNF-α,CRP and IL-6,and positively correlated with PaO_(2)(P<0.01).Serum IL-28A was positively correlated with PAP,PaCO_(2),TNF-α,CRP and IL-6,and negatively correlated with PaO_(2)(P<0.01).AgRP and IL-28A were independent risk factors for COPD combined with PH(P<0.01).The area under the ROC curve of combined detection of serum AgRP and IL-28A was greater than that of serum AgRP and IL-28A detection alone(P<0.01).Conclusion Serum AgRP decreased and IL-28A increased in patients with COPD combined with PH,both of which were related to the severity of disease,pulmonary function and inflammatory factors in patients with COPD combined with PH.The combined detection of the two is helpful for the diagnosis of COPD combined with PH.