摘要
目的探讨血清肝素结合蛋白(HBP)、第1秒用力呼气容积与用力肺活量的比值(FEV_(1)/FVC)、最大呼气峰值流速(PEF)在慢性阻塞性肺疾病(COPD)患者病情严重程度及预后评估中的应用价值,为后期指导临床治疗提供依据。方法选择2019年2月至2021年6月就诊于张家港市第一人民医院的60例COPD患者作为研究组(稳定期25例,急性加重期35例;存活47例,死亡13例),另选择同期行健康体检的60例健康者,作为对照组,开展前瞻性研究。比较对照组和研究组研究对象血清HBP、FEV_(1)/FVC、PEF水平,研究组稳定期和急性加重期患者血清HBP、FEV_(1)/FVC、PEF水平,研究组不同预后(生存和死亡)患者血清HBP、FEV_(1)/FVC、PEF水平;分析COPD患者血清HBP水平与肺功能指标的相关性;绘制受试者工作特征曲线(ROC),分析HBP、FEV_(1)/FVC、PEF对COPD患者预后的诊断价值。结果研究组患者血清HBP水平高于对照组,且急性加重期患者较稳定期患者升高,死亡患者较生存患者升高;研究组患者FEV_(1)/FVC、PEF水平均低于对照组,且急性加重期患者较稳定期患者降低,死亡患者较生存患者降低(均P<0.05);COPD患者血清HBP与FEV_(1)/FVC、PEF均呈负相关(r=-0.652、-0.617,均P<0.05);ROC曲线结果显示,HBP、FEV_(1)/FVC、PEF预测患者预后的曲线下面积(AUC)分别为0.855、0.909、0.891,其中FEV_(1)/FVC对COPD患者预后的诊断价值最高(均P<0.05)。结论血清HBP、FEV_(1)/FVC、PEF可在一定程度上反映COPD患者病情与预后,且血清HBP与FEV_(1)/FVC、PEF呈显著负相关,其中FEV_(1)/FVC对COPD患者预后的诊断价值最高,对于指导临床治疗、改善患者预后具有一定的参考价值。
Objective To analyze the application value of serum heparin binding protein(HBP),the ratio of forced expiratory volume in one second and forced vital capacity(FEV_(1)/FVC),peak expiratory flow(PEF)in the evaluation of severity and prognosis of patients with chronic obstructive pulmonary disease(COPD),so as to provide reference for clinical treatment later stage.Methods A total of 60 cases patients with COPD who visited in the Zhangjiagang First People's Hospital from February 2019 to June 2021 were selected as the study group(with 25 cases in the stable period,the other 35 cases in the acute exacerbation period;with 47 cases in survival,the other 13 cases in death),another 60 cases healthy subjects who underwent physical examination at the same time were selected as the control group,a prospective research was carried.The levels of serum HBP,FEV_(1)/FVC and PEF of research subjects between the control group and the study group,the levels of serum HBP,FEV_(1)/FVC and PEF of patients in stable period and acute exacerbation period in the study group,the levels of serum HBP,FEV_(1)/FVC and PEF of patients with different prognosis(survival and death)in the study group were compared;the correlation between serum HBP level and pulmonary function indexs of COPD patients were analyzed;the diagnostic value of HBP,FEV_(1)/FVC and PEF for the prognosis of COPD patients were analyzed through drawing the receiver operator characterist(ROC)curve.Results The serum HBP level of patients in the study group was higher than that in the control group,and patients in acute exacerbation period were higher than that patients in the stable period,patients in death were higher than patients in survival;the levels of FEV_(1)/FVC and PEF of patients in the study group were lower than those in the control group,and patients in the acute exacerbation period were lower than patients in the stable period,patients in death were lower than patients in survival(all P<0.05);the level of serum HBP was negatively correlated with the levels of FEV_(1)/FVC and PEF in COPD patients(r=-0.652,-0.617,all P<0.05);the ROC curve results showed that,the area under the curve(AUC)of HBP,FEV_(1)/FVC and PEF in predicting the prognosis of patients were 0.855,0.909 and 0.891,respectively,among them,the FEV_(1)/FVC had the highest diagnostic value for the prognosis of COPD patients(all P<0.05).Conclusion Serum HBP,FEV_(1)/FVC and PEF can reflect the condition and prognosis of COPD patients to a certain extent,and serum HBP is negatively correlated with FEV_(1)/FVC and PEF respectively,among them FEV_(1)/FVC has the highest diagnostic value for the prognosis of COPD patients,it has certain reference value for guiding clinical treatment and improving the prognosis of patients.
作者
钱倩雯
卢芳
QIAN Qianwen;LU Fang(Department of Respiratory and Critical Care Medicine,Zhangjiagang First People's Hospital,Suzhou,Jiangsu 215600,China)
关键词
慢性阻塞性肺疾病
肝素结合蛋白
第1秒用力呼气容积与用力肺活量的比值
最大呼气峰值流速
Chronic obstructive pulmonary disease
Heparin binding protein
Ratio of forced expiratory volume in one second and forced vital capacity
Peak expiratory flow
