外周血人类软骨糖蛋白39联合嗜酸性粒细胞对慢性阻塞性肺疾病急性加重再入院风险预评估作用分析

Effect of human chondroglycoprotein 39 combined with eosinophils in peripheral blood on risk assessment of readmissions with acute exacerbation of chronic obstructive pulmonary disease

目的 探讨外周血人类软骨糖蛋白39(YKL-40)联合嗜酸性粒细胞(EOS)对慢性阻塞性肺疾病急性加重(AECOPD)再入院风险的预评估作用。方法 选取重庆医科大学附属第二医院呼吸与危重症医学科自2019年4月至2022年7月收治的141例AECOPD患者为研究对象。根据1年内是否因急性加重再入院将患者分为非再入院组(n=86)与再入院组(n=55)。记录并比较两组患者的一般资料、实验室检查及治疗情况。采用Spearman检验法分析YKL-40与患者一般资料、改良医学研究委员会呼吸困难量表(mMRC)评分间的相关性。采用多因素Logistic回归法分析AECOPD患者再入院的危险因素。结果 再入院组患者起病年龄小于非再入院组、mMRC评分≥2分比例高于非再入院组,差异均有统计学意义(P<0.05)。再入院组患者嗜酸性粒细胞比例(EOS%)、YKL-40、低于-950 HU低密度衰减区体积比(%LAA-950)、气管壁厚度均高于非再入院组,第1秒最大呼气量(FEV1)低于非再入院组,差异均有统计学意义(P<0.05)。Spearman相关性分析结果显示,YKL-40水平与患者年龄、吸烟指数、mMRC评分、管壁厚度、住院时间均呈正相关性(r=0.276、0.253、0.297、0.723、0.325,P<0.05),与FEV1、第1秒最大呼气量/用力肺活量均呈负相关性(r=-0.345、-0.257,P<0.05)。多因素Logistic回归分析结果显示,EOS%、YKL-40及管壁厚度均为AECOPD患者再入院的危险因素(P<0.05)。结论 AECOPD再入院患者起病年龄更早,呼吸困难更明显,气道重塑及肺气肿更严重。外周血高水平YKL-40联合EOS%有助于AECOPD患者再入院患者的甄选。

Objective To investigate the pre-assessment effect of cartilage glycoprotein 39(YKL-40)combined with eosinophils(EOS)in peripheral blood on readmission risk of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 141 patients with AECOPD admitted to the department of respiratory and critical care medicine of the Second Clinical Hospital of Chongqing Medical University from April 2019 to July 2022 were selected as the study subjects.Patients were divided into non-readmission group(n=86)and readmission group(n=55)according to whether they were readmitted for acute aggravation within 1 year.General data, laboratory examination and treatment were recorded and compared between the two groups.Spearman test was used to analyze the correlation between YKL-40 and patients′ general data and modified medical research council dyspnea scale(mMRC).Multivariate Logistic regression was used to analyze the risk factors of readmission in AECOPD patients.Results The onset age of patients in readmission group was younger than that in non-readmission group, and the proportion of mMRC score≥2 points was higher than that in non-readmission group, with statistical significance(P<0.05).The ratio of eosinophils(EOS%),the percent of low attenuation areas<950 HU(%LAA-950),the thickness of airway wall in readmission group were higher than those in non-readmission group, and forced expiratory volume in 1 second(FEV1)was lower than those in non-readmission group, with statistical significance(P<0.05).Spearman correlation analysis showed that YKL-40 level was positively correlated with patient age, smoking index, mMRC,tube wall thickness and length of hospital stay(r=0.276,0.253,0.297,0.723,0.325,P<0.05).It was negatively correlated with FEV1 and forced expiratory volume in 1 second/forced vital capacity(r=-0.345,-0.257,P<0.05).Multivariate Logistic regression analysis showed that EOS%,YKL-40 and tube wall thickness were all risk factors for readmission in AECOPD patients(P<0.05).Conclusion Readmission patients with AECOPD had earlier onset, more pronounced dyspnea, and more severe airway remodeling and emphysema.High levels of YKL-40 in peripheral blood combined with EOS% are helpful for the selection of readmitted patients with AECOPD.