血浆五聚体蛋白酶3水平升高与肺纤维化合并肺气肿患者定量CT、肺功能和临床事件的关系

Relationship between elevated plasma pentraxin 3 level and quantitative CT,pulmonary function and clinical events in patients with combined pulmonary fibrosis with emphysema

目的探讨血浆五聚体蛋白酶3(PTX3)水平升高与肺纤维化合并肺气肿(CPFE)患者客观量化的计算机断层扫描(CT)测量值、肺功能检查(PFT)结果和临床事件之间的关系。方法招募2018年1月—2023年1月来我院就诊的46例CPFE患者。通过ELISA法检测入院时血浆PTX3水平,通过计算低衰减区百分比(%LAA)获得肺气肿病变的范围;纤维化病变的范围计算为高衰减区百分比(%HAA)。将%LAA和%HAA值合并以产生异常区域的百分比(%AA),随访再入院、急性发作、死亡等临床事件。结果经Spearman秩相关性分析,CPFE患者血浆PTX3水平与FEV1%pred(r_(s)=-0.320,P=0.030)、FEV1/FVC(r_(s)=-0.540,P<0.001)、TLC%pred(r_(s)=-0.420,P=0.004)、DLCO%pred(r_(s)=-0.341,P=0.020)均呈负相关;与%LAA(r_(s)=0.551,P<0.001)、%HAA(r_(s)=0.338,P=0.022)、%AA(r_(s)=0.548,P<0.001)均呈正相关。与未发生临床事件的患者相比,再入院患者(n=8)血浆PTX3水平相对更高[875.60(676.0,1154.40)pg/m L vs.243.40(185.20,321.20)pg/m L,P<0.05]。血浆PTX3可极好地预测CPFE患者的再入院风险,受试者工作特性曲线下面积为0.990,灵敏度和特异度分别为100.0%和94.7%。但是在多因素分析中,只有%AA被发现与住院事件的相关性最强(P=0.029)。结论CPFE患者血浆PTX3水平升高与客观定量CT参数、PFT结果以及患者再入院有关。

Objective To analyze the relationship between the elevated level of plasma pentamer protease 3(PTX3)and objective quantified computed tomography(CT)measurements,pulmonary function examination(PFT)results and clinical events in patients with pulmonary fibrosis and emphysema(CPFE).Methods A total of 46 CPFE patients who came to our hospital from January 2018 to January 2023 were recruited.The plasma PTX3 level was detected by ELISA,and the range of emphysema lesions was obtained by calculating the percentage of low attenuation area(%LAA).The range of fibrotic lesions was calculated as a percentage of high attenuation area(%HAA).The%LAA and%HAA values were combined to produce the percentage of abnormal areas(%AA),and clinical events such as readmissions,acute episodes,and death were followed.Results By Spearman rank correlation analysis,plasma PTX3 level in CPFE patients was correlated with FEV1%pred(r_(s)=-0.320,P=0.030),FEV1/FVC(r_(s)=-0.540,P<0.001),TLC%pred(r_(s)=-0.420,P=0.030),FEV1/FVC(r_(s)=-0.540,P<0.001).P=0.004),DLCO%pred(r_(s)=-0.341,P=0.020)were negatively correlated;It was positively correlated with%LAA(r_(s)=0.551,P<0.001),%HAA(r_(s)=0.338,P=0.022)and%AA(r_(s)=0.548,P<0.001).Compared with patients without clinical events,plasma PTX3 levels were higher in readmitted patients(n=8)[875.60(676.0,1154.40)pg/mL vs.243.40(185.20,321.20)pg/mL,P<0.05].Plasma PTX3 was an excellent predictor of readmission risk in CPFE patients,with an area under the subject operating characteristic curve of 0.990 and sensitivity and specificity of 100.0%and 94.7%,respectively.However,in the multivariate analysis,only%AA was found to have the strongest association with hospitalization events(P=0.029).Conclusion The increase of plasma PTX3 level in CPFE patients is related to objective quantitative CT parameters,PFT results and patient readmission.