血清肝素结合蛋白和正五聚蛋白-3水平与慢性阻塞性肺疾病合并肺炎的相关性

目的探讨血清肝素结合蛋白（HBP）和正五聚蛋白3（PTX3）水平与慢性阻塞性肺疾病（COPD）合并肺炎的相关性。 方法选取2016年3月至2018年3月于襄阳市中心医院呼吸内科确诊为COPD患者60例（COPD组）、COPD合并肺炎患者45例（COPD合并肺炎组）以及同期健康体检者35例（对照组）作为研究对象。采用酶联免疫吸附法检测各组研究对象血清HBP和PTX3水平，并采用Spearman相关法分析其与COPD合并肺炎的相关性。 结果三组研究对象吸烟史、并发症、CRP、PCT和FEV1/FVC（%）等差异具有统计学意义（P均< 0.05）。与对照组相比，COPD组和COPD合并肺炎组患者第1秒用力呼气容积与用力肺活量比值[FEV1/FVC（%）]和FVC均显著降低；而白细胞介素（IL-8）、肿瘤坏死因子-α（TNF-α）、C-反应蛋白（CRP）和降钙素（PCT）水平均显著升高，差异具有统计学意义（P均< 0.05）；COPD合并肺炎组CRP[（68.9 ± 3.5）mg/L vs. （45.1 ± 1.67）mg/L]、PCT水平[（28.98 ± 5.9）μg/L vs. （18.34 ± 6.7）μg/L]高于COPD组，差异具有统计学意义（t = 2.517、P = 0.047，t = 4.102、P = 0.035）。三组研究对象血清HBP和PTX3水平差异具有统计学意义（F = 7.36、P = 0.003，F = 7.36、P = 0.003）；COPD组患者HBP[（372.0 ± 22.0）pg/ml]和PTX3[（5.9 ± 0.3）ng/L]均低于COPD合并肺炎组[（558.3 ± 19.4）pg/ml和（7.9 ± 0.5）ng/L]，差异有统计学意义（t = 5.289、P = 0.21，t = 3.104、P = 0.039）。血清HBP和PTX3水平均与FEV1预测值、FEV1/FVC（%）呈负相关（P均< 0.05）；血清HBP和PTX3水平与IL-8、TNF-α、CRP和PCT呈正相关（P均< 0.05）。以COPD合并肺炎组作为阳性组、对照组为阴性组构建ROC曲线，结果显示HBP、PTX3的敏感性、特异性以及阳性预测值均高于CRP、PCT、IL-8和TNF-α（P均< 0.05）。 结论血清HBP和PTX3水平可作为判断COPD患者合并肺部炎的客观指标，在评估COPD患者病情及严重程度中具有重要价值。

Correlation between serum levels of heparin binding protein,pentraxin-3 and chronic obstructive pulmonary disease complicated with pulmonary infection

ObjectiveTo investigate the correlation between the levels of serum heparin binding protein (HBP), pentraxin-3 (PTX3) and chronic obstructive pulmonary disease (COPD) with pneumonia. MethodFrom March 2016 to March 2018, a total of 60 COPD patients (COPD group), 45 COPD patients with pneumonia (COPD with pneumonia group) and 35 healthy people (control group) were selected in Respiratory Department of Xiangyang Central Hospital. The levels of serum HBP and PTX3 were measured by enzyme-linked immunosorbent assay, and the correlation between levels of HBP, PTX3 and COPD was analyzed by Spearman correlation analysis. ResultsThe differences in smoking history, complications, C-reactive protein (CRP), procalcitonin (PCT) and forced vital capacity rate of one second [FEV1/FVC(%)] among the three groups were significantly different (all P < 0.05). The FEV1/FVC(%) and FVC of COPD group and COPD with pneumonia group decreased significantly compared with control group; but the levels of interleukin (IL-8), tumor necrosis factor-α (TNF-α), CRP and PCT increased, with significant differences (all P < 0.05). Compared with COPD group, the levels of CRP [(68.9 ± 3.5) mg/L vs. (45.1 ± 1.67) mg/L] and PCT [(28.98 ± 5.9) μg/L vs. (18.34 ± 6.7) μg/L] decreased significantly (t = 4.102, P = 0.035). The levels of serum HBP and PTX3 in three groups were significanly different (F = 7.36, P = 0.003; F = 7.36, P = 0.003). Compared with COPD with pneumonia group [HBP: (558.3 ± 19.4) pg/ml, PTX3: (7.9 ± 0.5) ng/L], the levels of HBP [(372.0 ± 22.0) pg/ml] and PTX3 [(5.9 ± 0.3) ng/L] decreased significantly (t = 5.289, P = 0.21; t = 3.104, P = 0.039). Serum HBP and PTX3 were negatively correlated with FEV1 predictive value and FEV1/FVC(%), with significant differences (all P < 0.05); but were positively correlated with IL-8, TNF-α, CRP and PCT (all P < 0.05). The ROC curves were constructed taken COPD with pneumonia group as positive group and control group as negative group. The results showed that the sensitivity, specificity and positive predictive value of HBP and PTX3 were significantly higher than those of CRP, PCT, IL-8 and TNF-α (all P < 0.05). ConclusionsThe serum levels of HBP and PTX3 could be used to diagnose the COPD patients with pulmonary inflammation, with had important value in evaluating the condition and severity of COPD.