老年慢性阻塞性肺疾病急性加重期患者血清hs-CRP、CTRP-9、YKL-40水平变化及临床意义

目的探讨老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者血清超敏C反应蛋白(hs-CRP)、补体C1q/肿瘤坏死因子相关蛋白-9(CTRP-9)和甲壳质酶蛋白-40(YKL-40)水平变化及临床意义。方法选取157例老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD),其中AECOPD 63例作为AECOPD组,稳定期COPD 94例作为稳定期COPD组;另选取同期健康体检者50例作为对照组。比较3组血清hs-CRP、CTRP-9、YKL-40水平和肺功能指标,采用Pearson相关性分析探讨血清hs-CRP、CTRP-9和YKL-40水平与COPD患者肺功能指标相关性,应用受试者工作特征(ROC)曲线分析血清hs-CRP、CTRP-9和YKL-40对AECOPD患者诊断价值。结果3组血清hs-CRP、CTRP-9、YKL-40水平和肺功能指标总体比较差异有统计学意义(P<0.01)。与对照组比较,AECOPD组和稳定期COPD组血清hs-CRP、CTRP-9和YKL-40水平均升高,第1秒用力呼气容积占预计值百分比(FEV1%)和第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)均降低,差异有统计学意义(P<0.01);与稳定期COPD组比较,AECOPD组血清hs-CRP、CTRP-9和YKL-40水平升高,FEV1%和FEV1/FVC降低,差异有统计学意义(P<0.01)。Pearson相关性分析结果显示,COPD患者血清hs-CRP、CTRP-9和YKL-40水平与FEV1%及FEV1/FVC呈负相关(P<0.01)。ROC曲线分析结果显示,血清hs-CRP、CTRP-9和YKL-40诊断AECOPD的最佳截断值分别为10.54 mg/L、148.58 ng/ml和46.23 ng/ml,此时诊断AECOPD具有较高的敏感度与特异度,且血清CTRP-9和YKL-40诊断AECOPD的曲线下面积高于血清hs-CRP。结论老年COPD患者血清hs-CRP、CTRP-9和YKL-40水平升高,且与肺功能指标密切相关;血清hs-CRP、CTRP-9和YKL-40可作为诊断AECOPD的标志物,且血清CTRP-9和YKL-40诊断AECOPD的价值高于血清hs-CRP。

Changes and Clinical Significance of Serum hs-CRP,CTRP-9 and YKL-40 in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Objective To explore the level changes and clinical significance of serum high-sensitivity C-reactive protein(hs-CRP),complement C1q/tumor necrosis factor related protein-9(CTRP-9)and chitinase protein-40(YKL-40)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 157 elderly patients with chronic obstructive pulmonary disease(COPD)were selected as subjects,including 63 AECOPD patients(AECOPD group)and 94 stable COPD patients(stable COPD group).Another 50 healthy people who underwent physical examination during the same period were selected as control(control group).Serum level of hs-CRP,CTRP-9 and YKL-40 and pulmonary function indexes were compared among three groups.The Pearson correlation analysis was introduced to explore the correlation between these serum inflammatory markers and pulmonary function indexes of COPD patients.The diagnostic value of hs-CRP,CTRP-9 and YKL-40 in AECOPD patients was evaluated using the receiver operating characteristic(ROC)curve.Results There were significant differences in serum hs-CRP,CTRP-9,YKL-40 level and lung function indexes among three groups(P<0.01).Compared with the control group,serum hs-CRP,CTRP-9 and YKL-40 level in AECOPD group and stable COPD group was increased,while percentage of forced expiratory volume in first second(FEV1%)and forced expiratory volume in one second/forced vital capacity(FEV1/FVC)were decreased(P<0.01).Compared with stable COPD group,serum hs-CRP,CTRP-9 and YKL-40 level in AECOPD group was significantly higher,while FEV1%and FEV1/FVC were significantly lower(P<0.01).Pearson correlation analysis showed that serum hs-CRP,CTRP-9 and YKL-40 level of COPD patients were negatively correlated with FEV1%and FEV1/FVC levels(P<0.01).ROC curve analysis showed that the optimal cut-off value of serum hs-CRP,CTRP-9 and YKL-40 in the diagnosis of AECOPD was 10.54 mg/L,148.58 ng/ml and 46.23 ng/ml,respectively.On this condition,the diagnosis of AECOPD showed high sensitivity and specificity,while the area under ROC curve of serum CTRP-9 and YKL-40 was greater than that of serum hs-CRP in AECOPD diagnosis.Conclusion The serum levels of hs-CRP,CTRP-9 and YKL-40 are increased and closely-related to pulmonary function in elderly patients with COPD.Serum hs-CRP,CTRP-9 and YKL-40 could be used as markers in the diagnosis of AECOPD,while the diagnostic value of serum CTRP-9 and YKL-40 is higher than that of hs-CRP.