Pro-ADM、sTREM-1及臨床參數(shù)對(duì)診斷及判斷AECOPD預(yù)后的意義
發(fā)布時(shí)間：2018-11-28 15:10
【摘要】：目的：（1）探討血漿腎上腺髓質(zhì)素前體（Pro-ADM）與可溶性髓系觸發(fā)受體-1（sTREM-1）在不同組及不同期慢性阻塞性肺疾�。–OPD）患者中的水平變化及其臨床意義；（2）評(píng)價(jià)生物學(xué)指標(biāo)和臨床參數(shù)對(duì)預(yù)測(cè)慢性阻塞性肺疾病急性加重期（AECOPD）預(yù)后的價(jià)值。 方法：研究對(duì)象分為3組：COPD急性加重期(AECOPD)組（n=79）、COPD穩(wěn)定期（StableCOPD，SCOPD）組（n=29）、健康對(duì)照組（n=20），分別抽取三組患者外周靜脈血，對(duì)于其中17名AECOPD組患者，另外抽取其入院后14-30天（緩解期）、入院后6個(gè)月（穩(wěn)定期）的外周靜脈血；采用酶聯(lián)免疫吸附法（ELISA）測(cè)定三組研究對(duì)象及17名AECOPD組患者三個(gè)不同時(shí)期的血漿Pro-ADM及sTREM-1濃度；用單因素及多因素Logistic回歸分析評(píng)估臨床參數(shù)、實(shí)驗(yàn)室指標(biāo)、肺功能情況對(duì)半年內(nèi)生存率的影響；用Kaplan-Meier曲線分析發(fā)生臨床預(yù)后不良的時(shí)間。結(jié)果：（1）與健康對(duì)照組相比，血漿Pro-ADM水平在AECOPD組及SCOPD組 均明顯升高，差異均具有顯著統(tǒng)計(jì)學(xué)意義（P0.001）；AECOPD組與SCOPD組血漿Pro-ADM水平差異無統(tǒng)計(jì)學(xué)意義（P=0.217）；血漿sTREM-1濃度在AECOPD組、SCOPD組及健康對(duì)照組間比較無統(tǒng)計(jì)學(xué)差異（P=0.065）。對(duì)于其中17名AECOPD組患者，，分別檢測(cè)了其急性期、緩解期及穩(wěn)定期的血漿Pro-ADM和sTREM-1濃度，血漿Pro-ADM濃度分別為（559.41±33.20）pg/ml、（456.47±32.84）pg/ml、（216.47±24.72）pg/ml，差異具有顯著的統(tǒng)計(jì)學(xué)意義（P0.001）；血漿sTREM-1濃度分別為（15.36±1.82）pg/ml、（9.87±1.19）pg/ml、（8.36±1.04）pg/ml，差異有顯著統(tǒng)計(jì)學(xué)意義（P0.001）。（2）受試者工作特征曲線（ROC曲線）結(jié)果顯示：以345pg/ml為閾值，pro-ADM診斷SCOPD的靈敏度和特異度分別為62.1%和90%（P0.001）；pro-ADM鑒別COPD（包括AECOPD及SCOPD）與健康者的最佳閾值是185pg/ml，靈敏度和特異度分別為72.2%和65%（P0.001）。（3）多因素分析顯示：影響半年內(nèi)生存率的獨(dú)立因素是急性期PaCO2（P=0.008，RR=1.197）、CRP（P=0.017，RR=1.102）和WBC（P=0.028，RR=0.387）。（4）Kaplan-Meier生存曲線顯示，Pro-ADM375pg/ml的AECOPD患者較375pg/ml者更易出現(xiàn)臨床預(yù)后不良，差異有統(tǒng)計(jì)學(xué)意義（P=0.049）。 結(jié)論：連續(xù)觀察血漿Pro-ADM、sTREM-1濃度變化在反應(yīng)AECOPD病情嚴(yán)重程度上有一定的臨床價(jià)值，血漿Pro-ADM不僅可作為鑒別COPD患者和健康人的敏感生物學(xué)指標(biāo)，其入院時(shí)的水平還可部分預(yù)測(cè)預(yù)后，入院時(shí)Pro-ADM375pg/ml使得半年內(nèi)發(fā)生預(yù)后不良的概率由11.1%升高到44.1%（P=0.03）。急性期PaCO2、CRP及WBC水平是影響生存率的獨(dú)立因素。
[Abstract]:Objective: (1) to investigate the changes and clinical significance of plasma adrenomedullin precursor (Pro-ADM) and soluble myeloid triggered receptor-1 (sTREM-1) in patients with chronic obstructive pulmonary disease (COPD). (2) to evaluate the value of biological and clinical parameters in predicting the prognosis of (AECOPD) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods: the subjects were divided into three groups: (AECOPD) group (n = 79), COPD stable phase) (n = 29) and healthy control group (n = 20) during acute exacerbation of COPD. Peripheral venous blood was drawn from three groups of patients. 17 patients in AECOPD group were enrolled in this study. In addition, peripheral venous blood was extracted from 14-30 days (remission period) and 6 months (stable phase) after admission. The plasma Pro-ADM and sTREM-1 concentrations in three groups and 17 patients with AECOPD were measured by Elisa (ELISA). Univariate and multivariate Logistic regression analysis was used to evaluate the effect of clinical parameters, laboratory parameters and pulmonary function on the survival rate within half a year, and Kaplan-Meier curve was used to analyze the time when the clinical prognosis was poor. Results: (1) compared with the healthy control group, the plasma Pro-ADM level in the AECOPD group and the SCOPD group was significantly higher than that in the control group (P0.001). There was no significant difference in plasma Pro-ADM level between AECOPD group and SCOPD group (P0. 217), but there was no significant difference in plasma sTREM-1 level between AECOPD group, SCOPD group and healthy control group (P0. 065). In 17 patients with AECOPD, the plasma Pro-ADM and sTREM-1 concentrations in acute, remission and stable phases were measured, and the plasma Pro-ADM concentrations were (559.41 鹵33.20) pg/ml, (456.47 鹵32.84) pg/ml, respectively. The difference of (216.47 鹵24.72) pg/ml, was statistically significant (P0. 001). Plasma sTREM-1 concentrations were (15.36 鹵1.82) pg/ml, (9.87 鹵1.19) pg/ml, (8.36 鹵1.04) pg/ml, respectively. The difference was statistically significant (P0. 001). (2). The results of the operating characteristic curve (ROC curve) showed that the sensitivity and specificity of pro-ADM in the diagnosis of SCOPD were 62.1% and 90%, respectively, using 345pg/ml as the threshold value (P0. 001). The best threshold for pro-ADM to distinguish COPD (including AECOPD and SCOPD) from healthy people is 185pg / ml. The sensitivity and specificity were 72. 2% and 65% (P0. 001). (3) multivariate analysis showed that the independent factor influencing the survival rate within 6 months was PaCO2 (P0. 008 RRN 1. 197), CRP (P0. 017). RR=1.102) and WBC (0.387). (4) Kaplan-Meier survival curve showed that AECOPD patients with Pro-ADM375pg/ml were more likely to have poor clinical prognosis than those with 375pg/ml (P0. 049). Conclusion: continuous observation of plasma Pro-ADM,sTREM-1 concentration has certain clinical value in the severity of reactive AECOPD. Plasma Pro-ADM can not only be used as a sensitive biological index for differentiating COPD patients from healthy people. On admission, Pro-ADM375pg/ml increased the probability of adverse prognosis from 11.1% to 44.1% (P0.03). The levels of PaCO2,CRP and WBC in acute stage are independent factors affecting survival rate.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.9
[Abstract]:Objective: (1) to investigate the changes and clinical significance of plasma adrenomedullin precursor (Pro-ADM) and soluble myeloid triggered receptor-1 (sTREM-1) in patients with chronic obstructive pulmonary disease (COPD). (2) to evaluate the value of biological and clinical parameters in predicting the prognosis of (AECOPD) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods: the subjects were divided into three groups: (AECOPD) group (n = 79), COPD stable phase) (n = 29) and healthy control group (n = 20) during acute exacerbation of COPD. Peripheral venous blood was drawn from three groups of patients. 17 patients in AECOPD group were enrolled in this study. In addition, peripheral venous blood was extracted from 14-30 days (remission period) and 6 months (stable phase) after admission. The plasma Pro-ADM and sTREM-1 concentrations in three groups and 17 patients with AECOPD were measured by Elisa (ELISA). Univariate and multivariate Logistic regression analysis was used to evaluate the effect of clinical parameters, laboratory parameters and pulmonary function on the survival rate within half a year, and Kaplan-Meier curve was used to analyze the time when the clinical prognosis was poor. Results: (1) compared with the healthy control group, the plasma Pro-ADM level in the AECOPD group and the SCOPD group was significantly higher than that in the control group (P0.001). There was no significant difference in plasma Pro-ADM level between AECOPD group and SCOPD group (P0. 217), but there was no significant difference in plasma sTREM-1 level between AECOPD group, SCOPD group and healthy control group (P0. 065). In 17 patients with AECOPD, the plasma Pro-ADM and sTREM-1 concentrations in acute, remission and stable phases were measured, and the plasma Pro-ADM concentrations were (559.41 鹵33.20) pg/ml, (456.47 鹵32.84) pg/ml, respectively. The difference of (216.47 鹵24.72) pg/ml, was statistically significant (P0. 001). Plasma sTREM-1 concentrations were (15.36 鹵1.82) pg/ml, (9.87 鹵1.19) pg/ml, (8.36 鹵1.04) pg/ml, respectively. The difference was statistically significant (P0. 001). (2). The results of the operating characteristic curve (ROC curve) showed that the sensitivity and specificity of pro-ADM in the diagnosis of SCOPD were 62.1% and 90%, respectively, using 345pg/ml as the threshold value (P0. 001). The best threshold for pro-ADM to distinguish COPD (including AECOPD and SCOPD) from healthy people is 185pg / ml. The sensitivity and specificity were 72. 2% and 65% (P0. 001). (3) multivariate analysis showed that the independent factor influencing the survival rate within 6 months was PaCO2 (P0. 008 RRN 1. 197), CRP (P0. 017). RR=1.102) and WBC (0.387). (4) Kaplan-Meier survival curve showed that AECOPD patients with Pro-ADM375pg/ml were more likely to have poor clinical prognosis than those with 375pg/ml (P0. 049). Conclusion: continuous observation of plasma Pro-ADM,sTREM-1 concentration has certain clinical value in the severity of reactive AECOPD. Plasma Pro-ADM can not only be used as a sensitive biological index for differentiating COPD patients from healthy people. On admission, Pro-ADM375pg/ml increased the probability of adverse prognosis from 11.1% to 44.1% (P0.03). The levels of PaCO2,CRP and WBC in acute stage are independent factors affecting survival rate.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R563.9
【共引文獻(xiàn)】
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