血清人软骨糖蛋白-39对慢性阻塞性肺疾病急性加重的诊断价值

Diagnostic value of serum YKL-40 in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨血清人软骨糖蛋白-39(YKL-40)对于慢性阻塞性肺疾病(COPD)急性加重(AECOPD)的诊断价值。方法纳入2018年9月至2019年6月在河北北方学院附属第一医院住院AECOPD病人85例及同期70例COPD稳定期病人作为对照组,受试者均检测血清YKL-40、降钙素原(PCT)及C反应蛋白(CRP)水平,收集各受试者在院检测的肺功能、血气分析结果。观察各指标在不同的AECOPD临床分级的变化以及YKL-40与相关临床参数的关系。结果两组YKL-40(58.03±12.78)μg/L比(38.69±8.72)μg/L、PCT(7.54±2.71)μg/L比(3.72±1.79)μg/L、CRP(99.29±34.98)mg/L比(52.91±27.77)mg/L比较均差异有统计学意义。随着病人病情加重,AECOPDⅠ、Ⅱ、Ⅲ级血清YKL-40水平逐渐升高(49.23±11.26)μg/L、(56.70±10.38)μg/L、(67.93±10.32)μg/L,各组间比较均差异有统计学意义(均P<0.05)。YKL-40与PCT、CRP、动脉血二氧化碳分压(PaCO_(2))呈正相关,但与预测的第一秒用力呼气容积(FEV_(1))、第一秒用力呼气容积占预计值的百分比(FEV_(1)%)、第一秒用力呼气量占用力肺活量百分率(FEV_(1)/FVC)和动脉血氧分压(PaO2)呈负相关(P<0.05)。结论AECOPD病人血清YKL-40水平随病情加重而升高,升高程度与病情严重程度相关。

Objective To investigate the diagnostic value of serum human cartilage glycoprotein-39(YKL-40)in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease(COPD)(AECOPD).Methods A total of 85 patients with AECOPD and 70 patients with stable COPD in the First Affiliated Hospital of Hebei North University from September 2018 to June 2019 were en-rolled as the control group,and the serum levels of YKL-40,procalcitonin(PCT)and C-reactive protein(CRP)were measured,and the results of lung function and blood gas analysis were collected.The changes of each index in different clinical grades of AECOPD and the relationship between YKL-40 and related clinical parameters were observed.Results There were significant differences in YKL-40(58.03±12.78)µg/L vs.(38.69±8.72)µg/L,PCT(7.54±2.71)µg/L vs.(3.72±1.79)µg/L,and CRP(99.29±34.98)mg/L vs.(52.91±27.77)mg/L.With the aggravation of the disease,the serum YKL-40 level gradually increased(49.23±11.26)µg/L,(56.70±10.38)µg/L,(67.93±10.32)µg/L,and the differences between the groups were statistically significant(all P<0.05).YKL-40 was positively corre-lated with PCT,CRP,and arterial carbon dioxide partial pressure(PaCO_(2)),but negatively correlated with predicted forced expiratory volume in one second(FEV_(1)),forced expiratory volume in one second as a percentage of predicted value(FEV_(1)%),ratio of forced expira-tory volume in one second to occupied vital capacity(FEV_(1)/FVC),and arterial partial pressure of oxygen(PaO_(2))(P<0.05).Conclusion The serum level of YKL-40 in patients with AECOPD increases with the severity of the disease,and the degree of elevation is related to the severity of the disease.