慢性阻塞性肺疾病急性加重期患者血清GRO-α、MRpro-ADM水平变化及临床意义

摘要

Objective To observe the changes in levels of the serum growth-regulated oncogene-α(GRO-α) and mid-regional fragment of pro-adrenomedullin (MRpro-ADM) in patients with acute exacerbation of chronic obstructive pul-monary disease(AECOPD) and its clinical significance.Methods A total of 79 patients with AECOPD(AECOPD group) were collected. At the same time,60 patients with stable COPD (stable COPD group) and 60 healthy volunteers (control group) were randomly selected. The serum GRO-α levels of the three groups were detected by the enzyme-linked immunosorbent assay,and MRpro-ADM levels of three groups were detected by the time-resolved immunofluorescence as-say. And the forced expiratory volume in one second (FEV1 ),forced vital capacity (FVC),FEV1/FVC were measured. The correlation between serum GRO-α,MRpro-ADM,and lung function such as FEV1 ,FVC,and FEV1/FVC were ana-lyzed by Pearson product moment correlation analysis. The diagnostic value of GRO-α,MRpro-ADM for AECOPD were an-alyzed by the receiver operating characteristic(ROC) curve.Results The serum levels of GRO-α and MRpro-ADM in the AECOPD group and stable COPD group were higher than those of the control group,and the AECOPD group was higher than the stable COPD group (both P<0. 05). Compared with the control group,the levels of FEV1,FVC,and FEV1/FVC in the AECOPD group and stable COPD group were lower,and the AECOPD group was lower than the stable COPD group (all P<0. 05 ). The serum level of GRO-α was negatively correlated with FEV1 ,FVC,and FEV1/FVC (r =-0. 471,-0. 509,and -0. 511 respectively;all P<0. 05). The serum level of MRpro-ADM was negatively correlated with FEV1 ,FVC,and FEV1/FVC (r= -0. 539,-0. 517,and -0. 498;all P<0. 05). The area under the ROC curve (AUC)of serum GRO-α for predicting AECOPD was 0. 854,the best cut-off value was 109. 34 ng/L,and the sensitivity and the specificity were separately 0. 82 and 0. 91 with accuracy of 0. 83. The AUC of serum MRpro-ADM for predicting AECOPD was 0. 808,the best cut-off value was 1. 28 nmol/L,and the sensitivity and the specificity were 0. 75 and 0. 82, respectively,with the accuracy of 0.77.Conclusion The serum levels of GRO-α and MRpro-ADM in patients with AECO-PD significantly increase,which can be used as important markers for clinical diagnosis of AECOPD.%目的 观察慢性阻塞性肺疾病急性加重期(AECOPD)患者血清生长调节致癌基因-α(GRO-α)、肾上腺髓质素前体中段肽(MRpro-ADM)的水平变化,并探讨其临床意义.方法 选取79例AECOPD患者为AECOPD组,并于同期随机选取60例稳定期COPD患者为稳定期COPD组、60例健康体检者为对照组.采用酶联免疫吸附法测定各组血清GRO-α水平,时间分辨免疫荧光法测定各组血清MRpro-ADM水平,同时测定各组第一秒用力呼气容积(FEV1)、用力肺活量(FVC),计算FEV1/FVC.血清GRO-α、MRpro-ADM与肺功能指标FEV1、FVC、FEV1/FVC的相关性采用Pearson相关分析;绘制受试者工作特征曲线(ROC曲线)分析血清GRO-α、MRpro-ADM预测AECOPD的诊断价值.结果 与对照组相比,AECOPD组、稳定期COPD组血清GRO-α、MRpro-ADM水平高,且AECOPD组较稳定期COPD组高(P均<0.05).与对照组相比,AECOPD组、稳定期COPD组FEV1、FVC、FEV1/FVC低,且AECOPD组较稳定期COPD组低(P均<0.05).血清GRO-α水平与FEV1、FVC、FEV1/FVC均呈负相关关系(r分别为-0.471、-0.509、-0.511,P均<0.05);血清MRpro-ADM与FEV1、FVC、FEV1/FVC均呈负相关关系(r分别为-0.539、-0.517、-0.498,P均<0.05).血清GRO-α预测AECOPD的ROC曲线下面积为0.854,最佳截断值为109.34 ng/L,此时灵敏度、特异度分别为0.82、0.91,准确性为0.83;血清MRpro-ADM预测AECOPD的ROC曲线下面积为0.808,最佳截断值为1.28 nmol/L,此时灵敏度、特异度分别为0.75、0.82,准确性为0.77.结论 AECOPD患者血清GRO-α、MRpro-ADM水平升高,早期检测可作为辅助诊断AECOPD的重要生物学标志物.