一氧化氮、白细胞介素6在慢性阻塞性肺疾病中的变化及临床意义

Changes and clinical significance of nitric oxide and interleukin-6 in patients with vhronic obstructive pulmonary disease

目的探讨呼出气一氧化氮(FeNO)、白细胞介素6(IL-6)在慢性阻塞性肺疾病(COPD)中的变化及临床意义。方法选择2018年1月至2021年6月许昌市人民医院收治的COPD患者83例为研究对象,同期选取本院健康体检者90例为对照组。收集所有受试对象一般资料,对所有受试对象进行FeNO检测和肺功能检测,包括第1秒用力呼气容积/预计值(FEV_(1)%pred)、用力肺活量(FVC)、第1秒呼气容积与用力肺活量比值(FEV_(1)/FVC)。酶联免疫吸附试验(ELISA)检测血清中IL-6水平。对患者出院后1年进行随访,根据患者是否发生急性加重,将患者分为急性加重发生组46例,急性加重未发生组37例。Pearson相关性分析FeNO、IL-6与患者肺功能的关系;ROC曲线分析FeNO、IL-6对COPD患者急性加重发生的预测价值。结果与对照组比较,COPD组FeNO、血清IL-6水平均显著升高,肺功能指标FEV_(1)%pred、FEV_(1)/FVC显著降低(P<0.05);FeNO、IL-6水平与COPD患者肺功能指标FEV_(1)%pred、FEV_(1)/FVC均呈负相关(r=-0.513、-0.478,-0.524、-0.495,P<0.05);与急性加重未发生组比较,急性加重发生组EOS%、NEU、CAT评分、FeNO、IL-6水平显著升高,FEV_(1)%pred、FEV_(1)/FVC显著降低(P<0.05);ROC曲线结果显示,FeNO、IL-6预测COPD患者发生急性加重的曲线下面积(AUC)分别为0.734、0.720,敏感度分别为84.8%、65.2%,特异性分别为67.6%、75.7%,截断值分别为28.80 bbp、113.44 pg/mL,95%CI分别为0.616-0.853、0.609-0.831。结论FeNO、IL-6在COPD患者中水平升高,并与患者肺功能下降有关,可能是预测COPD急性加重的生物标志物。

Objective To investigate the changes and clinical significance of fractional exhaled nitrie oxide(FeNO)and interleukin-6(IL-6)in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 83 patients with COPD admitted to our hospital from January 2018 to June 2021 were selected as the study subjects,and 90 healthy people in our hospital were selected as the control group in the same period.The general data of all subjects were selected,and FeNO and pulmonary function tests were performed on all subjects,including forced expiratory volume in 1 second/predicted value(FEV_(1)%pred),forced vital capacity(FVC),and ratio of expiratory volume in 1 second to forced vital capacity(FEV_(1)/FVC).The level of IL-6 in serum was detected by enzyme-linked immunosorbent assay(ELISA).The patients were followed up for 1 year after discharge.According to whether the patients had acute exacerbation,the patients were divided into acute exacerbation group with 46 cases and no acute exacerbation group with 37 cases.Pearson correlation analysis was used to analyze the relationship between FeNO and IL-6 and the lung function of patients;ROC curve analysis was used to analyze the predictive value of FeNO and IL-6 for the occurrence of acute exacerbation in COPD patients.Results Compared with the control group,the levels of FeNO and serum IL-6 in the COPD group were significantly increased,and the pulmonary function indexes FEV_(1)%pred and FEV_(1)/FVC were significantly decreased(P<0.05);FeNO and IL-6 levels were all negatively correlated with pulmonary function indexes FEV_(1)%pred and FEV_(1)/FVC in COPD patients(r=-0.513,-0.478;-0.524,-0.495;P<0.05);Compared with the group without acute exacerbation,the levels of EOS%,NEU,CAT,FeNO and IL-6 in the acute exacerbation group were significantly increased,and the FEV_(1)%pred and FEV_(1)/FVC were significantly decreased(P<0.05).The areas under the curve(AUC)of FeNO and IL-6 for predicting acute exacerbation in COPD patients were 0.734 and 0.720,the sensitivities of 84.8%and 65.2%,the specificities of 67.6%and 75.7%,the cut-off values were 28.80 BBP and 113.44pg/mL,and 95%CI were 0.616-0.853 and 0.609-0.831,respectively.Conclusion The levels of FeNO and IL-6 were increased in patients with COPD,and they were associated with the decline of pulmonary function and may be biomarkers to predicting acute exacerbation of COPD.