血清α1-AT、CD64感染指数、NE水平与慢性阻塞性肺疾病急性加重期患者病情程度及发生呼吸衰竭的关系

Relationship of serum α1-AT, CD64 index, and NE levels with disease severity and respiratory failure in AECOPD patients

摘要:

目的 探讨血清α1-抗胰蛋白酶（α1-AT）、嗜中性粒细胞弹性蛋白酶（NE）、血细胞抗原64（CD64）感染指数与慢性阻塞性肺疾病（COPD）急性加重期病情程度及发生呼吸衰竭的关系。方法 选取2021年1月—2022年7月新疆石河子大学医学院第一附属医院呼吸内科确诊的COPD急性加重期患者134例作为急性加重期组，另选取同期该院就诊的稳定期COPD患者130例作为稳定期组。对比两组患者的血清α1-AT、NE、CD64感染指数、血气肺功能指标；并按照简化急性生理学评分Ⅱ（SAPSⅡ）将COPD分为轻、中、重度进行分析，根据患者是否发生呼吸衰竭将急性加重期患者进行分组，并绘制受试者工作特征（ROC）曲线分析COPD急性加重期患者发生呼吸衰竭与α1-AT、NE、CD64感染指数的关系。结果 急性加重期组患者的血清α1-AT、NE、CD64感染指数、动脉血二氧化碳分压（PaCO₂）均高于稳定期组，第1秒呼气容积/用力肺活量（FEV₁/FVC）、FEV₁占预计值的百分比（FEV₁%pred）、动脉血氧分压（PaO₂）均低于稳定期组（P <0.05）。轻、中、重度患者血清α1-AT、NE、CD64感染指数、PaCO₂随病情的严重程度逐渐升高，FEV₁/FVC、FEV₁%pred、PaO₂随病情的严重程度逐渐降低（P <0.05）。呼吸衰竭组血清α1-AT、NE、CD64感染指数、PaCO₂均高于非呼吸衰竭组，FEV₁/FVC、FEV₁%pred、PaO₂均低于非呼吸衰竭组（P <0.05）。ROC曲线分析结果显示，α1-AT + NE + CD64感染指数联合诊断的敏感性最高，为97.40%（95% CI：0.843，0.990），SAPSⅡ的特异性最高，为83.05%（95% CI：0.731，0.917）、NE的曲线下面积最高，为0.951（95% CI：0.878，0.981）。结论 COPD急性加重期患者的血清α1-AT、NE、CD64感染指数较COPD患者升高，且与病情程度相关，其中血清α1-AT、NE对诊断COPD急性加重期患者发生呼吸衰竭具有较高的价值。

Abstract:

Objective To explore the relationship of serum α1-antitrypsin (α1-AT), neutrophil elastase (NE), and cluster of differentiation 64 (CD64) index with the disease severity and respiratory failure of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods One hundred and thirty-four patients diagnosed with AECOPD in the Department of Respiratory Medicine of the First Affiliated Hospital of Shihezi University School of Medicine from January 2021 to July 2022 were selected as the acute exacerbation group. Another 134 cases of patients with stable COPD in the hospital during the same period were included as the stable group. The serum levels of α1-AT, NE, and CD64 index, and blood gas and pulmonary function indices were compared between the two groups. The AECOPD patients were stratified according to the Simplified Acute Physiology Score II (SAPS II) into mild, moderate, and severe subgroups. The AECOPD patients were also analyzed based on whether they developed respiratory failure. The relationship between the occurrence of respiratory failure and the levels of α1-AT, NE, and CD64 index in AECOPD patients was deciphered using the receiver operating characteristic (ROC) curve analysis.Results The serum levels of α1-AT, NE, and CD64 index as well as PaCO₂ in the acute exacerbation group were significantly higher than those in the stable group, while the forced expiratory volume in one second/forced vital capacity (FEV₁/FVC), FEV₁% pred, and PaO₂ in the acute exacerbation group were significantly lower than those in the stable group (P < 0.05). Comparison among the mild, moderate, and severe patients demonstrated that serum levels of α1-AT, NE, and CD64 index as well as PaCO₂ gradually increased with the disease severity (P < 0.05), and that FEV₁/FVC, FEV₁% pred, and PaO₂ gradually decreased with the disease severity (P < 0.05). The serum levels of α1-AT, NE, and CD64 index as well as PaCO₂ in patients with respiratory failure were significantly higher than those in patients without respiratory failure (P < 0.05), and FEV₁/FVC, FEV₁% pred, and PaO₂ in patients with respiratory failure were significantly lower than those in patients without respiratory failure (P < 0.05). The ROC curve analysis revealed that the sensitivity of the combined detection of α1-AT, NE, and CD64 index in diagnosing respiratory failure in AECOPD patients was the highest, being 97.40% (95% CI: 0.843, 0.990), the specificity of SAPS II in diagnosing respiratory failure in AECOPD patients was the highest, being 83.05% (95% CI: 0.731, 0.917), and that the AUC of NE in diagnosing respiratory failure in AECOPD patients was the highest, being 0.951 (95% CI: 0.878, 0.981).Conclusion The serum levels of α1-AT, NE, and CD64 index are significantly higher in AECOPD patients than those in COPD patients, and are correlated with the disease severity. Among them, serum α1-AT and NE hold significant auxiliary diagnostic values in assessing the occurrence of respiratory failure in patients with AECOPD.