COPD合并肺部感染患者血清MMP-9、IL-17a、NGAL变化及预测价值分析

Changes and predictive value of serum MMP-9,IL-17a and NGAL levels in patients with COPD and pulmonary infection

目的 探究慢性阻塞性肺疾病(COPD)合并肺部感染患者血清基质金属蛋白酶-9(MMP-9)、白介素-17a(IL-17a)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)变化及预测价值,为COPD合并肺部感染的临床治疗提供借鉴。方法 选取2016年9月-2020年9月于石家庄市第三医院呼吸内科就诊的140例COPD患者,根据肺部感染情况将其分为感染组(n=53)和未感染组(n=87)。比较两组MMP-9、IL-17a、NGAL水平,采用受试者工作特征(ROC)曲线评价血清MMP-9、IL-17a、NGAL水平单独及联合检测对COPD合并肺部感染的预测价值。结果 53例COPD合并肺部感染患者,共检出病原菌62株,以革兰阴性菌(40.32%)为主。感染组血清MMP-9、IL-17a、NGAL水平分别为(243.27±30.06)μg/L、(316.37±37.72)ng/L、(40.42±6.83)ng/mL,高于非感染组[(132.83±21.13)μg/L、(163.53±19.14)ng/L、(25.27±3.02)ng/mL],差异均有统计学意义(t=25.481、31.725、5.025,P均<0.05)。ROC曲线结果显示,MMP-9、IL-17a、NGAL水平联合检测诊断肺部感染的曲线下面积(AUC)为0.829,均高于MMP-9、IL-17a、NGAL单独诊断的0.714、0.679、0.730,差异均有统计学意义(Z=2.563、2.968、2.421,P均<0.05)。结论 COPD合并肺部感染患者MMP-9、IL-17a、NGAL水平升高,三者联合检测对COPD合并肺部感染有一定预测价值。

Objectives To explore the changes and predictive value of serum matrix metalloproteinase-9(MMP-9), interleukin-17a(IL-17a) and neutrophil gelatinase-associated lipocalin(NGAL) levels in patients with chronic obstructive pulmonary disease(COPD) and pulmonary infection. To provide reference for clinical treatment of COPD complicated with pulmonary infection. Methods A total of 140 COPD patients treated in the Respiratory Department of the Shijiazhuang Third Hospital were enrolled from September 2016 to September 2020. According to presence or absence of pulmonary infection, they were divided into infection group(n=53) and non-infection group(n=87). The levels of MMP-9, IL-17a and NGAL were compared between the two groups. The predictive values of serum MMP-9, IL-17a and NGAL levels single index and combined detection in COPD combined with pulmonary infection were evaluated by receiver operating characteristic(ROC) curve. Results A total of 62 strains of pathogenic bacteria were detected in 53 COPD patients with pulmonary infection,and the main pathogen was Gram-negative bacteria(40.32%). The serum levels of MMP-9, IL-17a and NGAL in the infected group were(243.27±30.06)μg/L,(316.37±37.72)ng/L and(40.42±6.83)ng/mL, respectively, which were higher than those in the non-infected group [(132.83±21.13)μg/L,(163.53±19.14)ng/L,(25.27±3.02)ng/mL];the differences were statistically significant(t=25.481,31.725,5.025;all P<0.05). The results of ROC curves analysis showed that area under curve(AUC) of MMP-9 combined with IL-17a and NGAL in the diagnosis of pulmonary infection was 0.829, greater than that of MMP-9, IL-17a, NGAL single index(0.714, 0.679, 0.730);the differences were statistically significant(Z=2.563, 2.968, 2.421;all P<0.05). Conclusion The levels of MMP-9, IL-17a and NGAL increased in patients with COPD and pulmonary infection, and their combined detection had certain predictive value for COPD combined with pulmonary infection.