三种外周血生化指标在支气管哮喘急性发作期患者中的表达研究

Study on expressions of three peripheral blood biochemical indicators in patients with acute exacerbation of bronchial asthma

目的探讨外周血血栓素B2(TXB2)、CC趋化因子受体7(CCR7)及可溶性协同刺激分子B7同系物2(sB7-H2)在支气管哮喘(BA)急性发作期患者中的表达及与肺功能的相关性。方法149例BA患者,根据病情分期分为急性发作组(n=92)和缓解期组(n=57),比较两组临床资料、肺功能及外周血TXB2、CCR7及sB7-H2表达水平,根据急性发作严重程度将患者分为轻、中、重度组,比较不同严重程度患者外周血TXB2、CCR7及sB7-H2水平及肺功能,分析外周血TXB2、CCR7及sB7-H2水平与肺功能指标的关系。结果急性发作组肺功能指标第一秒用力呼气容量(FEV_(1))、用力肺活量(FVC)、用力呼气量占用力肺活量比值(FEV_(1)/FVC)均低于缓解期组,外周血TXB2、CCR7及sB7-H2水平高于缓解期组(P<0.05);轻度患者外周血TXB2、CCR7及sB7-H2水平低于中、重度患者(P<0.05),中度患者外周血TXB2、CCR7及sB7-H2水平低于重度患者(P<0.05);轻度患者FEV_(1)、FVC高于中、重度患者(P<0.05),FEV_(1)/FVC高于重度患者(P<0.05);中度患者FEV_(1)、FVC高于重度患者(P<0.05),FEV_(1)/FVC与轻度、重度患者比较,差异均无统计学意义(P>0.05);BA急性发作期患者外周血TXB2、CCR7、sB7-H2水平与FEV_(1)、FVC、FEV_(1)/FVC均呈负相关(P<0.05)。外周血TXB2、CCR7、sB7-H2单独及联合诊断BA急性发作的AUC分别为0.807、0.805、0.742、0.806,敏感度为75.00%、80.40%、81.52%、83.71%,特异度为70.22%、71.91%、66.70%、63.19%。结论BA急性发作期患者外周血TXB2、CCR7及sB7-H2水平随病情进展均显著升高,且与肺功能呈显著负相关,可作为临床BA急性发作期辅助性检测指标。

Objective To investigate the expressions of peripheral blood thromboxane B2(TXB2),CC chemokine receptor 7(CCR7)and soluble B7 homologue 2(sB7-H2)in patients with acute exacerbation of bronchial asthma(BA)and their correlation with pulmonary function.Methods One hundred and forty-nine patients with BA were divided into an acute exacerbation group(n=92)and remission group(n=57)according to the disease staging.The clinical data,pulmonary function and expression levels of peripheral blood TXB2,CCR7 and sB7-H2 were compared between the two groups.The patients were further classified into mild,moderate and severe groups according to the severity of acute exacerbation.The levels of peripheral blood TXB2,CCR7 and sB7-H2 and pulmonary function were compared among patients with different severities.The relationship between the levels of peripheral blood TXB2,CCR7 and sB7-H2 and the pulmonary function indicators was analyzed.Results The pulmonary function indicators such as forced expiratory volume in the 1stsecond(FEV_(1)),forced vital capacity(FVC)and ratio of forced expiratory volume to forced vital capacity(FEV_(1)/FVC)in the acute exacerbation group were lower than those in the remission group(P<0.05).The levels of peripheral blood TXB2,CCR7 and sB7-H2 were higher than those in the remission group(P<0.05).The levels of TXB2,CCR7 and sB7-H2 in peripheral blood of mild patients were significantly lower than those of moderate patients and severe patients(P<0.05),and the above levels of moderate patients were significantly lower than those of severe patients(P<0.05).The FEV_(1)and FVC of mild patients were significantly higher than those of moderate patients and severe patients(P<0.05),and FEV_(1)/FVC was higher than that in severe patients(P<0.05).FEV_(1)and FVC of moderate patients were significantly higher than those of severe patients(P<0.05),but there was no statistical significance in FEV_(1)/FVC compared with that of mild patients and severe patients(P>0.05).The levels of peripheral blood TXB2,CCR7 and sB7-H2 in patients with acute exacerbation of BA were negatively correlated with FEV_(1),FVC and FEV_(1)/FVC(P<0.05).ROC curve analysis showed that the AUCs of peripheral blood TXB2,CCR7,sB7-H2 alone and in combination for diagnosis of acute exacerbation of BA were 0.807,0.805,0.742 and 0.806 respectively.The sensitivities were 75.00%,80.40%,81.52%and 83.71%,respectively.The specificities were 70.22%,71.91%,66.70%and 63.19%,respectively.Conclusions The levels of peripheral blood TXB2,CCR7 and sB7-H2 in patients with acute exacerbation of BA are increased significantly with the progression of the disease.The increases are significantly negatively correlated with pulmonary function.Therefore,they can be used as auxiliary indicators of acute exacerbation of BA in clinical practice.