哮喘合并慢性阻塞性肺疾病患者急性加重期血清ECP、IL-13水平及其临床意义

Expression and clinical significance of serum ECP and IL-13 in acute exacerbation of asthma patients with chronic obstructive pulmonary disease

目的检测哮喘合并慢性阻塞性肺疾病(COPD)患者血清嗜酸性粒细胞阳离子蛋白(ECP)、白细胞介素-13(IL-13)水平,探讨其对患者急性加重期的诊断价值。方法回顾性研究2019年8月—2020年8月邢台市人民医院收治的哮喘急性发作期(哮喘组)、COPD急性加重期(COPD组)、哮喘合并COPD急性加重期(合并组)患者,每组80例,另取同期该院健康体检者80例为对照组。采用酶联免疫吸附试验检测受试者血清ECP、IL-13水平,全自动血细胞分析仪检测嗜酸性粒细胞(EOS)水平。所有研究对象行肺功能通气检查,计算第1秒用力呼气容积占用力肺活量百分比(FEV_(1)/FVC)、第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)。采用Pearson法分析合并组患者血清ECP、IL-13、EOS水平与肺功能指标的相关性。绘制受试者工作特征(ROC)曲线评价ECP、IL-13水平对哮喘合并COPD急性加重期患者的诊断价值。结果与对照组比较,哮喘组、COPD组、合并组血清ECP、IL-13、EOS、水平升高(P<0.05);哮喘组与COPD组血清ECP、IL-13、EOS水平比较,差异均无统计学意义(P>0.05);与哮喘组、COPD组比较,合并组血清ECP、IL-13、EOS水平升高(P<0.05)。与对照组比较,哮喘组、COPD组、合并组FEV_(1)%pred、FEV_(1)/FVC水平降低(P<0.05);哮喘组与COPD组FEV_(1)%pred、FEV_(1)/FVC水平比较,差异均无统计学意义(P>0.05);与哮喘组、COPD组比较,合并组患者FEV_(1)%pred、FEV_(1)/FVC水平降低(P<0.05)。Pearson相关性分析结果显示,合并组患者血清ECP与IL-13、EOS水平呈正相关(r=0.487和0.563,均P=0.000),与肺功能指标FEV_(1)%pred、FEV_(1)/FVC呈负相关(r=-0.487和-0.504,P=0.000和0.003);血清IL-13水平与EOS呈正相关(r=0.670,P=0.010),与肺功能指标FEV_(1)%pred、FEV_(1)/FVC呈负相关(r=-0.469和-0.650,P=0.000和0.006);EOS与肺功能指标FEV_(1)%pred、FEV_(1)/FVC呈负相关(r=-0.502和-0.512,P=0.001和0.004)。血清ECP、IL-13联合诊断哮喘合并COPD急性加重期患者的AUC为0.937,大于两者单独诊断的AUC,其敏感性和特异性分别为89.3%和85.6%。结论血清ECP、IL-13异常高表达与哮喘合并COPD急性加重发生、发展关系密切,可以反映哮喘合并COPD患者肺功能损伤程度,且两者联合检测对哮喘合并COPD急性加重期患者具有较高的诊断价值。

Objective To detect the level of serum eosinophil cationic protein(ECP)and interleukin-13(IL-13)in patients of asthma-COPD overlap syndrome,and to explore its diagnostic value for acute exacerbation of Asthma with COPD.Methods A retrospective study was conducted on 80 patients with acute attack of asthma,acute exacerbation of COPD and asthma combined with acute exacerbation of COPD admitted to the Respiratory Department of our hospital from August 2019 to August 2020,and another 80 patients with physical examination were selected as the control.The levels of serum ECP and IL-13 was measured with enzyme-linked immunosorbent assay(ELISA),the level of EOS was determined with automatic blood cell analyzer.Pulmonary function ventilation was performed in all subjects,and the percentage of forced expiratory volume in forced vital capacity in the first second(FEV_(1)/FVC)and the percentage of forced expiratory volume in predicted value in the first second(FEV_(1)%pred)were calculated.Pearson correlation was used to analyze the correlation between serum ECP,IL-13,eosinophil(EOS)and lung function indexes FEV_(1)%Pred and FEV_(1)/FVC in patients with asthma combined with acute exacerbation of COPD.The diagnostic value of the levels of ECP and IL-13 in patients with acute exacerbation of asthma-COPD overlap syndrome was evaluated by ROC curve.Results Compared with the control group,serum levels of ECP,IL-13,and EOS were increased(P<0.05),and FEV_(1)%pred and FEV_(1)/FVC levels were decreased(P<0.05)in the acute attack of asthma group,acute exacerbation of COPD group and asthma-COPD overlap syndrome group;compared with patients in the acute attack of asthma group,serum ECP,IL-13,EOS,FEV_(1)%pred,FEV_(1)/FVC levels in the acute exacerbation of COPD group were not statistically significant(P>0.05),and serum ECP,IL-13,and EOS levels in the acute exacerbation of asthma-COPD overlap syndrome group were increased(P<0.05),and FEV_(1)%pred and FEV_(1)/FVC levels were all decreased(P<0.05);the levels of serum ECP,IL-13 and EOS in patients with acute exacerbation of asthma and COPD were positively correlated(P<0.05),and the three were negatively correlated with FEV_(1)%pred and FEV_(1)/FVC(P<0.05).The AUC of the two combined tests in acute exacerbation of asthma-COPD group overlap syndrome was 0.937,and the sensitivity and specificity were 89.3%and 85.6%.Conclusions The abnormal high expression of serum ECP,IL-13 is closely related to the occurrence and development of acute exacerbation of Asthma-copd overlap syndrome,which can reflect the degree of lung function damage of patients with asthma-COPD overlap syndrome.Combined detection of both has a high diagnostic value for patients with acute exacerbation of asthma-COPD overlap syndrome.