呼出气一氧化氮分数及血清磷脂酶A2水平与COPD患者并发阻塞性睡眠呼吸暂停低通气综合征的相关性分析

Correlation analysis of fractional exhaled nitric oxide and serum phospholipase A2 level with obstructive sleep apnea hypopnea syndrome in COPD patients

目的:分析呼出气一氧化氮分数(FeNO)及血清磷脂酶A2(PLA2)水平与慢性阻塞性肺疾病(COPD)患者并发阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的相关性。方法:选取2021年6月至2024年6月于兰州市肺科医院收治的164例COPD患者为研究对象,对其资料进行回顾性分析,其中稳定期COPD患者纳入稳定期组(n=95),COPD并发OSAHS患者纳入睡眠障碍组(n=69)。比较两组FeNO,嗜酸性粒细胞(EOS)百分比,血清C反应蛋白(CRP)、降钙素原(PCT)、PLA2水平。采用Logistic回归模型分析FeNO、EOS百分比及血清CRP、PCT、PLA2水平与COPD并发OSAHS的相关性,采用受试者工作特征(ROC)曲线评估FeNO,EOS百分比,血清CRP、PCT、PLA2水平单独预测及FeNO、血清PLA2水平联合预测COPD患者并发OSAHS的价值。结果:睡眠障碍组FeNO、EOS百分比及血清CRP、PCT、PLA2水平均显著高于稳定期组(P<0.05)。Logistic回归模型分析显示,FeNO、EOS百分比及血清CRP、PCT、PLA2水平均是影响COPD患者并发OSAHS的危险因素(P<0.05)。ROC曲线中,FeNO、EOS百分比及血清CRP、PCT、PLA2水平单独预测COPD患者并发OSAHS的AUC分别为0.767、0.631、0.645、0.647、0.707,敏感性分别为81.16%、76.81%、82.61%、47.83%、60.87%,特异性分别为66.32%、48.42%、42.11%、81.05%、75.79%,截断值分别为24.37%、5.31%、8.51 mg/L、0.80 ng/mL、174.25 ng/mL;其中FeNO、血清PLA2单独预测COPD患者并发OSAHS的AUC显著大于血清CRP、PCT、PLA2水平的AUC(P<0.05)。FeNO、血清PLA2水平联合预测COPD患者并发OSAHS的AUC为0.816,敏感性为81.16%,特异性为70.53%。结论:FeNO、血清PLA2水平与COPD患者并发OSAHS密切相关,相较于常规炎症指标更具诊断与预测价值。

Objective:To analyze the correlation between fractional exhaled nitric oxide(FeNO)and serum phospholipase A2(PLA2)level with obstructive sleep apnea hypopnea syndrome(OSAHS)in chronic obstructive pulmonary disease(COPD)patients.Methods:A total of 164 COPD patients admitted to Pulmonary Hospital of Lanzhou from June 2021 to June 2024 were selected as the research subjects,and the data were retrospectively analyzed.Among them,stable COPD patients were included in the stable group(n=95),and COPD patients with OSAHS were included in the sleep disorder group(n=69).FeNO,eosinophil(EOS)percentage,serum C-reactive protein(CRP),procalcitonin(PCT),and PLA2 levels were compared between the two groups.Logistic regression model was used to analyze the correlation between FeNO,EOS percentage,serum CRP,PCT,PLA2 levels and COPD complicated with OSAHS.Receiver operating characteristic(ROC)curve was used to evaluate FeNO,EOS percentage.The value of serum CRP,PCT and PLA2 levels alone and FeNO and serum PLA2 levels combined in predicting OSAHS in COPD patients.Results:FeNO,EOS percentage and serum CRP,PCT and PLA2 levels in sleep disorder group were significantly higher than those in stable period group(P<0.05).Logistic regression model analysis showed that FeNO,EOS percentage and serum CRP,PCT and PLA2 levels were risk factors affecting OSAHS in COPD patients(P<0.05).In ROC curve,the AUC of FeNO,EOS percentage and serum CRP,PCT and PLA2 levels independently predicting OSAHS in COPD patients were 0.767,0.631,0.645,0.647 and 0.707,respectively.The sensitivity was 81.16%,76.81%,82.61%,47.83%,60.87%,and the specificity was 66.32%,48.42%,42.11%,81.05%,75.79%,respectively.The cut-off values were 24.37%,5.31%,8.51 mg/L,0.80 ng/mL and 174.25 ng/mL,respectively.The AUC of FeNO and serum PLA2 in predicting OSAHS in COPD patients was significantly higher than that of serum CRP,PCT and PLA2 levels(P<0.05).The AUC of FeNO and serum PLA2 combined predicted OSAHS in COPD patients was 0.816,the sensitivity was 81.16%,and the specificity was 70.53%.Conclusions:FeNO and serum PLA2 levels are closely related to OSAHS complications in COPD patients,and are more valuable in diagnosis and prediction than conventional inflammatory indicators.