Pro-ADM、sTREM-1及临床参数对诊断及判断AECOPD预后的意义
发布时间：2018-11-28 15:10
【摘要】：目的：（1）探讨血浆肾上腺髓质素前体（Pro-ADM）与可溶性髓系触发受体-1（sTREM-1）在不同组及不同期慢性阻塞性肺疾病（COPD）患者中的水平变化及其临床意义；（2）评价生物学指标和临床参数对预测慢性阻塞性肺疾病急性加重期（AECOPD）预后的价值。 方法：研究对象分为3组：COPD急性加重期(AECOPD)组（n=79）、COPD稳定期（StableCOPD，SCOPD）组（n=29）、健康对照组（n=20），分别抽取三组患者外周静脉血，对于其中17名AECOPD组患者，另外抽取其入院后14-30天（缓解期）、入院后6个月（稳定期）的外周静脉血；采用酶联免疫吸附法（ELISA）测定三组研究对象及17名AECOPD组患者三个不同时期的血浆Pro-ADM及sTREM-1浓度；用单因素及多因素Logistic回归分析评估临床参数、实验室指标、肺功能情况对半年内生存率的影响；用Kaplan-Meier曲线分析发生临床预后不良的时间。结果：（1）与健康对照组相比，血浆Pro-ADM水平在AECOPD组及SCOPD组 均明显升高，差异均具有显著统计学意义（P0.001）；AECOPD组与SCOPD组血浆Pro-ADM水平差异无统计学意义（P=0.217）；血浆sTREM-1浓度在AECOPD组、SCOPD组及健康对照组间比较无统计学差异（P=0.065）。对于其中17名AECOPD组患者，，分别检测了其急性期、缓解期及稳定期的血浆Pro-ADM和sTREM-1浓度，血浆Pro-ADM浓度分别为（559.41±33.20）pg/ml、（456.47±32.84）pg/ml、（216.47±24.72）pg/ml，差异具有显著的统计学意义（P0.001）；血浆sTREM-1浓度分别为（15.36±1.82）pg/ml、（9.87±1.19）pg/ml、（8.36±1.04）pg/ml，差异有显著统计学意义（P0.001）。（2）受试者工作特征曲线（ROC曲线）结果显示：以345pg/ml为阈值，pro-ADM诊断SCOPD的灵敏度和特异度分别为62.1%和90%（P0.001）；pro-ADM鉴别COPD（包括AECOPD及SCOPD）与健康者的最佳阈值是185pg/ml，灵敏度和特异度分别为72.2%和65%（P0.001）。（3）多因素分析显示：影响半年内生存率的独立因素是急性期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生存曲线显示，Pro-ADM375pg/ml的AECOPD患者较375pg/ml者更易出现临床预后不良，差异有统计学意义（P=0.049）。 结论：连续观察血浆Pro-ADM、sTREM-1浓度变化在反应AECOPD病情严重程度上有一定的临床价值，血浆Pro-ADM不仅可作为鉴别COPD患者和健康人的敏感生物学指标，其入院时的水平还可部分预测预后，入院时Pro-ADM375pg/ml使得半年内发生预后不良的概率由11.1%升高到44.1%（P=0.03）。急性期PaCO2、CRP及WBC水平是影响生存率的独立因素。
[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 卤33.20) pg/ml, (456.47 卤32.84) pg/ml, respectively. The difference of (216.47 卤24.72) pg/ml, was statistically significant (P0. 001). Plasma sTREM-1 concentrations were (15.36 卤1.82) pg/ml, (9.87 卤1.19) pg/ml, (8.36 卤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.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：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 卤33.20) pg/ml, (456.47 卤32.84) pg/ml, respectively. The difference of (216.47 卤24.72) pg/ml, was statistically significant (P0. 001). Plasma sTREM-1 concentrations were (15.36 卤1.82) pg/ml, (9.87 卤1.19) pg/ml, (8.36 卤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.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.9
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