摘要
目的分析血清淀粉样蛋白A(SAA)与老年慢性阻塞性肺疾病(COPD)患者肺弥散功能及运动受限的相关性。方法招募2020年1月至2021年7月重庆大学附属涪陵医院收治的188例老年稳定期COPD患者,均接受肺功能测试(PFT)和心肺运动试验(CPET)评估。将肺一氧化碳弥散因子(T_(L)CO)<肺正常下限(LLN)的患者纳入弥散功能异常组(102例),T_(L)CO≥LLN的患者纳入弥散功能正常组(86例)。采用酶联免疫吸附试验(ELISA)测定患者SAA水平。采用Pearson相关分析探讨SAA水平与峰值摄氧量(VO_(2peak))的相关性。采用多因素logistic回归分析老年COPD患者肺弥散功能的影响因素。采用多元线性回归模型分析老年COPD患者的SAA水平与第1秒用力呼气容量的Z评分(FEV_(1Z-score))、FEV_(1)与预测值的百分比(ppFEV_(1))的关联性。采用受试者工作特征(ROC)曲线分析SAA水平对老年COPD患者肺弥散功能异常的预测效能。结果多因素logistic回归分析结果显示,较低的ppFEV_(1)、用力肺活量的Z评分(FVC_(Z-score))、(FEV_(1)/FVC)_(Z-score)是促进老年COPD患者肺弥散功能异常的独立危险因素(P<0.05),较高的ppFVC、FEV_(1)/FVC、肺泡通气量的Z评分(VA_(Z-score))是抑制老年COPD患者肺弥散功能异常的独立保护因素(P<0.05)。弥散功能异常组SAA水平显著高于弥散功能正常组[(135.09±58.05)ng/mL vs(78.10±32.81)ng/mL,t=8.079,P<0.001]。ROC曲线分析结果显示,SAA水平具有预测老年COPD患者肺弥散功能异常的应用价值[AUC(95%CI)=0.797(0.735~0.860),P<0.001],最佳截断值为85.07 ng/mL,其对应的灵敏度和特异度分别为77.50%和69.80%。多元线性回归分析结果显示,FEV_(1Z-score)与ppFEV_(1)每降低一个单位,弥散功能异常组患者的SAA水平分别升高0.009(95%CI:-0.013~-0.005)ng/mL、0.149(95%CI:-0.210~-0.088)ng/mL。Pearson相关分析结果显示,老年COPD患者的SAA水平与VO_(2peak)呈负相关(r=-0.512,P<0.001)。结论在老年COPD患者中,SAA水平与FEV_(1Z-score)有关,检测SAA水平有助于鉴别老年COPD肺弥散功能异常患者。此外,SAA水平与VO_(2peak)呈负相关,说明导致FEV_(1)降低的机制可能有助于解释老年COPD肺弥散功能异常患者运动受限的原因。
Objective To analyze the correlation of serum amyloid A(SAA)with pulmonary diffusion function and exercise limitation in elderly patients with chronic obstructive pulmonary disease(COPD).Methods A total of 188 elderly patients with stable COPD who were admitted to Chongqing University Fuling Hospital from January 2020 to July 2021 were recruited.All the patients underwent pulmonary function test(PFT)and cardiopulmonary exercise testing(CPET)evaluations.The patients with transfer factor for carbon monoxide(T_(L)CO)of lung<lower limit of normal lung(LLN)were included in the abnormal diffusion function group(102 cases),and the patients with T_(L)CO≥LLN were included in the normal diffusion function group(86 cases).SAA levels were determined using enzyme-linked immunosorbent assay(ELISA).Pearson correlation analysis was used to investigate the correlation between SAA level and peak oxygen uptake(VO_(2peak)).Multivariate logistic regression was used to analyze the influencing factors of pulmonary diffusion function in the elderly patients with COPD.Multivariate linear regression model was used to analyze the correlation of SAA level with Z-score of forced expiratory volume in the first second(FEV_(1Z-score))and FEV_(1)as a percentage of predicted value(ppFEV_(1))in the elderly COPD patients.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of SAA level on pulmonary diffusion dysfunction in the elderly patients with COPD.ResultsThe results of multivariate logistic regression analysis showed that lower ppFEV_(1),Z-score of forced vital capacity(FVC_(Z-score)),(FEV_(1)/FVC)_(Z-score) were independent risk factors for promoting pulmonary diffusion dysfunction in the elderly COPD patients(P<0.05),and higher FVC as a percentage of predicted value(ppFVC),FEV_(1)/FVC,and Z-score of alveolar ventilation(VA_(Z-score))were independent protecting factors for inhibiting pulmonary diffusion dysfunction in the elderly COPD patients(P<0.05).The SAA level in the abnormal diffusion function group was higher than that in the normal diffusion function group[(135.09±58.05)ng/mL vs(78.10±32.81)ng/mL,t=8.079,P<0.001].The results of ROC curve analysis showed that SAA level had application value in predicting pulmonary diffusion dysfunction in the elderly COPD patients[AUC(95%CI)=0.797(0.735-0.860),P<0.001],and the optimal cut-off value was 85.07 ng/mL.The corresponding sensitivity and specificity were 77.50%and 69.80%,respectively.The results of multivariate linear regression analysis showed that for each unit decrease in FEV_(1Z-score)and ppFEV_(1),the SAA level of the patients in the abnormal diffusion function group was increased by 0.009(95%CI:-0.013--0.005)ng/mL and 0.149(95%CI:-0.210--0.088)ng/mL.The results of Pearson correlation analysis showed that SAA level was negatively correlated with VO_(2peak) in the elderly patients with COPD(r=-0.512,P<0.001).Conclusion In elderly COPD patients,SAA level is associated with FEV_(1Z-score),and detecting the SAA level can help to identify the elderly COPD patients with pulmonary diffusion dysfunction.In addition,there is a negative correlation between SAA level and VO_(2peak),suggesting that the mechanism leading to FEV_(1) reduction may help to explain the exercise limitation in the elderly COPD patients with pulmonary diffusion dysfunction.
作者
欧阳
钟粲野
张树堂
王卫
OU Yang;ZHONG Canye;ZHANG Shutang;WANG Wei(Department of Geriatrics,Chongqing University Fuling Hospital,Chongqing 408000,China)
出处
《中国临床新医学》
2024年第1期79-86,共8页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
基金
重庆市科卫联合医学科研项目(编号:20200371)。
关键词
血清淀粉样蛋白A
慢性阻塞性肺疾病
肺气肿表型
运动耐力
Serum amyloid A
Chronic obstructive pulmonary disease(COPD)
Emphysema phenotype
Exercise tolerance
