摘要
目的探析血清可溶性髓系细胞触发受体-1(sTREM-1)、N端脑钠肽前体(NT-BNP)与白三烯B4(LTB4)水平在慢性阻塞性肺疾病急性加重期(AECOPD)并发心力衰竭中的诊断价值。方法采用回顾性研究,选择2021年1月至2022年2月秦皇岛市第三医院收治的43例慢性阻塞性肺疾病(COPD)稳定期患者作为COPD组,并选取2020年1月至2021年2月本院收治的63例AECOPD合并心力衰竭患者作为AECOPD合并心力衰竭组。根据美国纽约心脏病协会(NYAH)心功能分级标准将其分成Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者,各21、22、11、9例。采用全自动免疫荧光分析仪检测sTREM-1、LTB4水平,采用干式生化分析仪测定NT-BNP水平。比较两组的sTREM-1、NT-BNP、LTB4的表达差异,根据双变量Pearson相关性分析sTREM-1、NT-BNP、LTB4与心功能分级的相关性。采用受试者工作特征(ROC)曲线分析sTREM-1、NT-BNP、LTB4及联合检测对AECOPD合并心力衰竭的诊断价值。结果AECOPD合并心力衰竭组的sTREM-1、NT-BNP及LTB4表达分别为(43.47±8.67)pg/L、(4951.72±604.58)ng/L、(18.51±23.69)μg/L,均显著高于COPD组[(10.64±2.35)pg/L、(1526.34±234.86)ng/L、(8.62±1.38)μg/L],差异均有统计学意义(P<0.05)。AECOPD合并心力衰竭患者sTREM-1、NT-BNP、LTB4与心功能分级呈正相关(r=0.587,0.551,0.497,P<0.05)。sTREM-1、NT-BNP与LTB4联合检测诊断AECOPD合并心力衰竭的AUC为0.931,高于单独的sTREM-1、NT-BNP、LTB4检测(AUC=0.706、0.778、0.823)。sTREM-1、NT-BNP与LTB4联合诊断AECOPD合并心力衰竭的敏感度、准确度为96.72%、93.65%,均高于单纯sTREM-1、NT-BNP、LTB4检测(敏感度:89.47%、87.93%、86.44%;准确度:80.95%、80.28%、80.95%)。结论sTREM-1、NT-BNP、LTB4水平在AECOPD患者呈高表达,同时随着心力衰竭患者严重程度的增加,其血清sTREM-1、NT-BNP与LTB4水平均明显升高,可成为临床预测AECOPD合并心力衰竭患者的病情严重程度的评价指标。3者联合检测在AECOPD患者中的敏感度、准确度及诊断效能较单独检测更为显著,值得临床推广及应用。
Objective To analyze the diagnostic value of serum soluble myeloid cell trigger receptor-1(sTREM-1),N-terminal pro-B type natriuretic peptide(NT-BNP),and leukotriene B4(LTB4)levels in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with heart failure.Methods In a retrospective study,43 chronic obstructive pulmonary disease(COPD)patients admitted to Qinhuangdao Third Hospital from January 2021 to February 2022 were selected as the control group,and 63 patients with AECOPD and heart failure admitted to the same hospital from January 2020 to February 2021 were selected as the AECOPD combined with heart failure group.According to the New York Heart Association(NYAH)cardiac function grading standards,patients of AECOPD combined with heart failure group were divided into gradesⅠ,Ⅱ,Ⅲ,andⅣ,with 21,22,11,and 9 cases each.The levels of sTREM-1 and LTB4 were detected using a fully automated immunofluorescence analyzer,and NT-BNP was measured using a dry biochemical analyzer.The expression of sTREM-1,NT-BNP,LTB4 were compared between the two groups.The correlation between sTREM-1,NT-BNP,and LTB4 was statistically analyzed by bivariate Pearson correlation analysis.The diagnostic value of sTREM-1,NT-BNP,LTB4 and combined detection in AECOPD with heart failure was analyzed using the receiver operating characteristic(ROC)curve.Results The expressions of sTREM-1,NT-BNP and LTB4 in AECOPD combined with heart failure group were(43.47±8.67)pg/L,(4951.72±604.58)ng/L(18.51±23.69)μg/L,which were significantly higher than those in COPD group[(10.64±2.35)pg/L,(1526.34±234.86)ng/L,(8.62±1.38)μg/L],the differences were statistically significant(P<0.05).There was a positive correlation between sTREM-1,NT-BNP,LTB4 and cardiac function grading in AECOPD patients with heart failure(r=0.587,0.551,0.497,P<0.05).The combined detection of sTREM-1,NT-BNP,and LTB4 for the diagnosis of AECOPD with heart failure had an AUC of 0.931,which was higher than the individual detection of sTREM-1,NT-BNP,and LTB4(AUC=0.706,0.778,0.823).The sensitivity and accuracy of combined detection of sTREM-1,NT-BNP,and LTB4 for the diagnosis of AECOPD with heart failure were 96.72%,93.65%,which were higher than those of simple sTREM-1,NT-BNP,and LTB4 detection(sensitivity:89.47%,87.93%,86.44%;accuracy:80.95%,80.28%,80.95%).Conclusion The levels of sTREM-1,NT-BNP,and LTB4 are highly expressed in AECOPD patients.At the same time,as the severity of heart failure increases,the serum levels of sTREM-1,NT-BNP,and LTB4 are significantly increased,which can be used as evaluation indicators for clinical prediction of the severity of AECOPD patients with heart failure.The sensitivity,accuracy,and diagnostic efficacy of the three combined tests in AECOPD patients are more significant than those of individual tests,and are worthy of clinical promotion and application.
作者
王彩霞
田玉晶
未会朵
陈胜敏
WANG Cai-xia;TIAN Yu-jing;WEI Hui-duo(Department of Cardiology and Brain,Qinhuangdao Hebei 066000,China;Department of Sensology,Qinhuangdao Third Hospital,Qinhuangdao Hebei 066000,China;Department of Hand Surgery,Third Hospital of Hebei Medical University,Shijiazhuang Hebei 050051,China)
出处
《临床和实验医学杂志》
2023年第24期2585-2589,共5页
Journal of Clinical and Experimental Medicine
基金
河北省2019年度医学科学研究课题(编号:20191160)。
