血清PGRN、HIF-1α和HCAR对慢性阻塞性肺疾病再次急性加重的临床评估意义

Application of serum PGRN,HIF-1αand HCAR in evaluating acute re-exacerbation of chronic obstructive pulmonary disease

目的探讨血清颗粒蛋白前体(PGRN)、缺氧诱导因子(HIF)-1α、超敏C反应蛋白(hsCRP)与白蛋白(ALB)比值(HCAR)在慢性阻塞性肺疾病急性加重(AECOPD)患者中的表达及预测再次急性加重的价值。方法选取2021年1月—2022年6月于徐州市贾汪区人民医院治疗的AECOPD患者共60例作为AECOPD组,选取同期体检健康者30例为健康对照组。采集外周血2 ml,检测血清PGRN、HIF-1α水平;收集AECOPE组入院时人口学资料、动脉血气分析、血常规结果、hsCRP和ALB,计算HCAR。出院后定期随访。根据180 d内再次急性加重情况,将研究对象划分为再次急性加重组和无再次急性加重组。单因素logistic回归分析各指标与再次急性加重的关系。通过绘制受试者工作特征曲线(ROC),分析血清PGRN、HIF-1α、HCAR预测患者再次急性加重的临床价值。结果AECOPD组血清PGRN浓度、HIF-1α浓度、HCAR较健康对照组显著升高,差异有统计学意义(P<0.05)。AECOPD患者中呼吸衰竭组血清PGRN浓度、HIF-1α浓度、HCAR较无呼吸衰竭组显著增高,差异有统计学意义(P<0.05)。单因素logistic回归分析提示血清PGRN和HIF-1α是AECOPD再次急性加重的危险因素。ROC曲线分析发现,血清PGRN联合HIF-1α的曲线下面积(AUC)为0.84,显著高于血清HIF-1α的AUC(0.68,P<0.05),但是相比于血清PGRN的AUC(0.71),差异无统计学意义(P>0.05)。结论血清PGRN、HIF-1α浓度、HCAR能反映AECOPD患者病情的严重程度,血清PGRN联合HIF-1α对预测AECOPD再次急性加重具有较高的特异性。

Objective To investigate the expression of serum progranulin(PGRN),hypoxia inducible factor-1(HIF)-1αand hypersensitive C-reactive protein/albumin ratio(HCAR)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and their value in predicting acute re-exacerbation.Methods A total of AECOPD 60 patients who were treated in the People's Hospital of Jiawang from January 2021 to June 2022 were selected as an experimental group.Meanwhile,30 healthy subjects who underwent physical examination were selected as a control group.Then,their peripheral blood samples(2 ml per person)were collected,and the levels of serum PGRN and HIF-1αwere measured.The demographic data and arterial blood gas analysis and blood routine results were collected,while the levels of hypersensitive C-reactive protein(hsCRP)and albumin(ALB)were recorded to calculate HCAR.After discharge,all the subjects were regularly followed-up.Based on the presence of acute re-exacerbation within 180 days,they were divided into two groups:an acute re-exacerbation group and a non-acute re-exacerbation group.The correlation between each variable and acute re-exacerbation was determined through univariate logistic regression analysis.A receiver operating characteristic curve(ROC)was plotted to evaluate the value of PGRN and HIF-1αin predicting acute re-exacerbation.Results The concentrations of serum PGRN and HIF-1αand HCAR in the AECOPD group was obviously higher than those in the control group(P<0.05).The concentrations of serum PGRN and HIF-1αand HCAR in AECOPD patients with respiratory failure were obviously higher than those without respiratory failure(P<0.05).Univariate logistic regression analysis suggested that serum PGRN and HIF-1αwere the risk factors of AECOPD acute re-exacerbation.The ROC analysis showed that the area under the curve of serum PGRN combined with HIF-1αwas 0.84,which was statistically higher than that of serum HIF-1α(0.68,P<0.05),but without statistical difference compared with serum PGRN,with an AUC of 0.71.Conclusions Serum PGRN,HIF-1αand HCAR can reflect the severity of AECOPD patients.The combined use of serum PGRN and HIF-1αhas higher specificity in predicting acute re-exacerbation in AECOPD patients.