慢性阻塞性肺疾病急性加重期患者CGRP、Msr1与肺功能、血气指标的相关性

Correlation between CGRP,Msr1 and pulmonary function,blood gas indexes in patients with acute exacerbation of chronic obstructive pulmonary disease

目的 探究血清降钙素基因相关肽(CGRP)、巨噬细胞清除受体1(Msr1)表达水平与慢性阻塞性肺疾病急性加重期(AECOPD)患者肺功能、血气指标的相关性。方法 选取2019年6月至2021年6月在本院就诊的慢性阻塞性肺疾病(COPD)患者114例作为研究对象,其中AECOPD患者47例,作为AECOPD组,病情稳定患者67例作为COPD稳定组。收集整理患者性别、体重指数(BMI)、年龄、吸烟史、白细胞计数(WBC)、肺功能指标[第1秒用力呼气容积与用力肺活量的比值(FEV_(1)/FVC)、第1秒用力呼气容积占预计值的百分比(FEV_(1)%pred)]及血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]等基本资料,选取同期于本院进行体检的健康志愿者114例作为对照组。酶联免疫吸附试验(ELISA)检测血清CGRP、Msr1水平;分析AECOPD患者血清中CGRP、Msr1表达水平与肺功能及血气指标间的相关性;绘制受试者工作特征(ROC)曲线分析CGRP、Msr1表达水平对AECOPD的诊断价值;采用多因素Logistic回归分析AECOPD发生的影响因素。结果 AECOPD组吸烟史比例、WBC、PaCO_(2)水平均高于COPD稳定组及对照组,PaO_(2)、FEV_(1)/FVC及FEV_(1)%pred水平均低于COPD稳定组及对照组,差异有统计学意义(P<0.05);对照组、COPD稳定组、AECOPD组血清CGRP、Msr1表达水平依次升高,差异有统计学意义(P<0.05);AECOPD患者血清CGRP、Msr1表达水平均与吸烟史、WBC及PaCO_(2)呈正相关(P<0.05),与PaO_(2)、FEV_(1)/FVC、FEV_(1)%pred呈负相关(P<0.05);CGRP、Msr1二者联合诊断AECOPD的曲线下面积(AUC)为0.927(95%CI:0.863~0.967),明显高于二者单独诊断(Z_(联合诊断vs. CGRP)=2.417、P=0.016;Z_(联合诊断vs. Msr1)=2.384、P=0.017);吸烟史、CGRP、Msr1是COPD患者发生AECOPD的危险因素(P<0.05),FEV_(1)/FVC及FEV_(1)%pred是保护因素(P<0.05)。结论 CGRP、Msr1水平在AECOPD患者血清中呈高表达,二者均与患者肺功能及血气指标密切相关,对临床诊断AECOPD具有一定的价值。

Objective To investigate the correlation between the expression levels of serum calcitonin gene related peptide(CGRP),macrophage clearance receptor 1(Msr1)and pulmonary function and blood gas indexes in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 114 patients with chronic obstructive pulmonary disease(COPD)who visited the hospital from June 2019 to June 2021 were selected as study subjects,including 47 patients with AECOPD as AECOPD group and 67 patients with stable condition as COPD stable group.The gender,body mass index(BMI),age,smoking history,white blood cell count(WBC),pulmonary function index[ratio of forced expiratory volume in the first second to forced vital capacity(FEV_(1)/FVC),and percentage of forced expiratory volume in the first second to predicted value(FEV_(1)%pred)],blood gas indexes[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))]and other basic data of patients were collected,114 healthy volunteers who were examined in the hospital at the same time were selected as the control group.The levels of serum CGRP and Msr1 were detected by enzyme-linked immuno sorbent assay(ELISA).The correlation between the expression levels of CGRP and Msr1 in serum of patients with AECOPD and lung function and blood gas indexes was analyzed.The diagnostic value of CGRP and Msr1 expression levels in AECOPD was analyzed by receiver operating characteristic(ROC)curve.Multivariate Logistic regression was used to analyze the influencing factors of AECOPD.Results The proportion of smoking history,WBC and PaCO_(2) levels in AECOPD group were higher than those in stable COPD group and control group,PaO_(2),FEV_(1)/FVC and FEV_(1)%pred levels were lower in stable COPD group and control group,and the differences were statistically significant(P<0.05).The levels of serum CGRP and Msr1 in the control group,stable COPD group and AECOPD group increased in turn,the differences were statistically significant(P<0.05).Serum CGRP and Msr1 expression levels in AECOPD patients were positively correlated with smoking history,WBC and PaCO_(2)(P<0.05),and negatively correlated with PaO_(2),FEV_(1)/FVC,FEV_(1)%pred(P<0.05).The area under the curve(AUC)of the combination of CGRP and Msr1 in the diagnosis of AECOPD was 0.927(95%CI:0.863-0.967),which was greatly higher than that of single detection of CGRP and Msr1(Z_(combination vs.CGRP)=2.417,P=0.016;Z_(combination vs.Msr1)=2.384,P=0.017).Smoking history,CGRP and Msr1 were risk factors for AECOPD in COPD patients(P<0.05),FEV_(1)/FVC and FEV_(1)%pred were protective factors(P<0.05).Conclusion CGRP and Msr1 are highly expressed in the serum of patients with AECOPD.Both of them are closely related to the lung function and blood gas indexes of patients,and have certain value in clinical diagnosis of AECOPD.