血清α1-抗胰蛋白酶水平在慢性阻塞性肺疾病稳定期患者高压氧治疗前后的变化及其临床预测价值

Changes of serumα1-antitrypsin levels before and after hyperbaric oxygen treatment in patients with stable COPD and its clinical predictive value

目的探讨血清α1-抗胰蛋白酶(α1-AT)在慢性阻塞性肺疾病(COPD)稳定期患者接受高压氧(HBO)治疗前后的变化及其临床预测价值。方法选取2021年8月至2022年7月莆田学院附属医院老年医学科收治的COPD稳定期患者59例作为研究对象。所有患者入院后均进行常规对症治疗,然后联合HBO辅助治疗。分别于治疗前后采用速率散射比浊法测定患者血清α1-AT水平,采用免疫比浊法测定患者血清C-反应蛋白(CRP)水平,采用肺功能仪检测患者肺功能的变化。采用Spearman相关性分析患者血清α1-AT水平与血清CRP水平、肺功能指标的关系。根据患者预后将患者分为预后良好组(n=34)和预后不良组(n=25),采用受试者工作特征(ROC)曲线分析HBO治疗后患者血清α1-AT水平对预后的预测价值。结果HBO治疗后患者血清α1-AT水平[(1.41±0.15)g/L]明显低于治疗前[(1.77±0.19)g/L],差异有统计学意义(t=11.423,P<0.01);血清CRP水平[(3.52±0.75)mg/L]明显低于治疗前[(7.75±0.24)mg/L],差异有统计学意义(t=41.261,P<0.01)。血清α1-AT水平与血清CRP水平呈明显的正相关(r=0.874,P=0.034),与患者残气量/肺总量(RV/TLC)比值呈明显的负相关(r=-0.478,P=0.005)。预后良好组血清α1-AT和CRP水平均明显低于预后不良组(P<0.05或P<0.01)。血清α1-AT诊断特异度和灵敏度明显高于CRP(79.3%vs.72.2%、82.4%vs.75.9%,均P<0.05)。结论COPD稳定期患者接受HBO治疗后血清α1-AT水平明显降低,且预后良好组患者血清α1-AT呈低表达,对患者预后具有良好的预测价值。

Objective To explore the changes of serumα1-antitrypsin(α1-AT)levels before and after hyperbaric oxygen treatment in patients with stable COPD and its clinical predictive value.Methods A total of 59 patients with stable COPD admitted to the Department of Gerontology of the Affiliated Hospital of Putian University from August 2021 to July 2022 were selected as the research subjects.All patients received conventional symptomatic treatment after admission,and then the treatment combined with HBO therapy.Before and after treatment,serumα1-AT levels were measured by rate-scattering turbidity.Serum C-reactive protein(CRP)levels were measured by immunoturbidimetry,and the lung function changes were detected by pulmonary function meter.Spearman correlation analysis was used to analyze the relationship between serumα1-AT level,serum CRP level,and pulmonary function index.According to the prognosis,the patients were divided into good prognosis(n=34)group and poor prognosis group(n=25).Receiver operating charactecistic(ROC)curve was used to analyze the predictive value of serumα1-AT level after HBO therapy.Results The serumα1-AT level of 59 patients after treatment[(1.41±0.15)g/L]was significantly lower than that before treatment[(1.77±0.19)g/L],and the difference was statistically significant(t=11.423,P<0.01).The serum CRP level after treatment[(3.52±0.75)mg/L)]was significantly lower than that before treatment[(7.75±0.24)mg/L)],and the difference was statistically significant(t=41.261,P<0.01).The Spearman correlation analysis showed that the serumα1-AT level was positively correlated with serum CRP level in 59 patients(r=0.874,P=0.034)and negatively correlated with pulmonary function index RV/TLC(r=-0.478,P=0.005).After treatment,serumα1-AT and CRP levels in the good prognosis group were significantly lower than those in the poor prognosis group(P<0.05 or P<0.01).The diagnostic specificity and sensitivity of serumα1-AT were significantly higher than those of CRP(79.3%vs.72.2%,and 82.4%vs.75.9%,all P<0.05).Conclusion The serumα1-AT level in the patients with stable COPD was significantly decreased after HBO therapy,and the serumα1-AT level was low in the patients in the good prognosis group,which had good predictive value for prognosis.