骨膜蛋白在老年慢性阻塞性肺疾病患者中的变化及与血嗜酸粒细胞和肺功能的相关性

Periostin level changes in elderly patients with chronic obstructive pulmonary disease and their correlation with blood eosinophils and lung function

目的观察血清骨膜蛋白在老年慢性阻塞性肺疾病(简称慢阻肺)患者中的变化及血清骨膜蛋白和血嗜酸粒细胞(EOS)、肺功能的相关性,探讨血清骨膜蛋白能否成为观察慢阻肺患者病情变化的指标。方法病例对照研究,纳入2018年12月至2021年5月老年慢阻肺住院患者128例为慢阻肺组,健康体检者60例为对照组,检测所有研究对象血清骨膜蛋白、血EOS、嗜酸粒细胞百分比(EOS%)和肺功能,以及慢阻肺组治疗后血清骨膜蛋白,比较慢阻肺组与对照组血清骨膜蛋白、血EOS、EOS%、肺功能第1秒用力呼气容积占预计值的百分比(FEV1%pred)的差异及慢阻肺组治疗前后骨膜蛋白的变化。将慢阻肺组患者进一步分为轻度组、中度组及重度组,比较各组间指标的差异,多元线性回归分析血清骨膜蛋白与血EOS、FEV1%pred的相关性,二元Logistic回归分析血清骨膜蛋白与慢阻肺发生的相关性,多元有序Logistic回归分析血清骨膜蛋白与慢阻肺严重程度的相关性。结果慢阻肺患者血清骨膜蛋白和血EOS、EOS%高于对照组,FEV1%pred低于对照组(均P<0.05),慢阻肺组经治疗症状改善后血清骨膜蛋白较治疗前降低[(103.47±9.58)mg/L比(105.20±9.45)mg/L],差异有统计学意义(t=2.830、P=0.005)。中度组和重度组血清骨膜蛋白、血EOS、EOS%均高于轻度组,且重度组高于中度组;FEVlpred%在中、重度组低于轻度组,重度组低于中度组(均P<0.05)。多元线性回归分析结果显示,骨膜蛋白与血EOS呈正相关(β=33.728、P=0.002),与FEV1%pred呈负相关(β=-0.208、P=0.001)。Logistic回归分析结果显示,高水平血清骨膜蛋白是慢阻肺的危险因素(OR=1.079、95%CI:1.019~1.143、P=0.009),且是慢阻肺严重程度的危险因素(OR=1.097、95%CI:1.0151.186、P=0.020)。结论血清骨膜蛋白水平升高增加慢阻肺发生和严重程度加重的风险,且血清骨膜蛋白与血嗜酸粒细胞和肺功能相关,骨膜蛋白有望成为慢阻肺的生物标志物之一。

Objective To examine changes in serum periostin in elderly patients with chronic obstructive pulmonary disease(COPD)and their correlation with blood eosinophils(EOS)and lung function,and to explore whether serum periostin can be used as a biomarker for COPD.Methods Case-control study,a total of 128 hospitalized elderly patients with COPD were enrolled in the COPD group,and 6o healthy elderly adults receiving physical check-ups were included in the control group between December 2018 and May 2021.Serum periostin,blood EOS,eosinophil percentage(EOS%)and lung function were measured for all participants.In addition,serum periostin in the COPD group was also measured after treatment.Differences in serum periostin,EOS,EOS%and the predicted percentage value of forced expiratory volume in one second(FEV1%pred)as a measure for lung function were compared between the COPD group and the control group,and differences in serum periostin in the COPD group before and after treatment were also compared.Patients in the COPD group were further divided into a mild subgroup,a moderate subgroup and a severe subgroup,and differences in values of the parameters were compared between the subgroups.Multiple linear regression was used to analyze the correlation of serum periostin with blood EOS and FEV1%pred;the correlation between periostin and COPD was analyzed by binary Logistic regression;the correlation between periostin and COPD severity was analyzed by ordered multinomial Logistic regression.Results Serum periostin,EOS and EOS%in the COPD group were higher than in the control group.FEV1%pred was lower than in the control group(all P<0.05),and post-treatment serum periostin in the COPD group was lower than pre-treatment levels[(103.47±9.58)mg/L vs.(105.20±9.45)mg/L,t=2.830,P=0.005].Serum periostin,EOS and EOS%in the moderate and severe subgroups were higher than in the mild subgroup,and their levels in the severe subgroup were higher than in the moderate subgroup.FEV1%pred in the moderate and severe subgroups was lower than in the mild subgroup,while FEV1%pred in the severe subgroup was lower than in the moderate subgroup(all P<0.05).Multiple linear regression analysis showed that serum periostin was positively correlated with blood EOS(β=33.728,P=0.002)and negatively correlated with FEV1%pred(β=-0.208,P=O.001).Logistic regression analysis showed that high serum periostin was a risk factor for COPD(OR=1.079,95%CI:1.019-1.143,P=0.009)and also a risk factor for the severity of COPD(OR=1.097,95%CI:1.015-1.186.P=0.020).Conclusions High serum periostin increases the risk of occurrence and aggravation of COPD,serum periostin correlates with blood EOS and lung function and has the potential to become one of the biomarkers for COPD.