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中华肺部疾病杂志(电子版) ›› 2017, Vol. 10 ›› Issue (02) : 187 -191. doi: 10.3877/cma.j.issn.1674-6902.2017.02.015

所属专题： 专题评论； 文献；

论著

血清可溶性人基质裂解素2和降钙素原水平的变化在AECOPD患者中的病情评估
朱默然1, 许德凤2,†(), 赵云峰3, 刘锦铭4, 赵蕾2   
  1. 2. 200135　上海，上海市浦东新区公利医院呼吸内科
    3. 200125　上海，上海市浦东新区浦南医院呼吸内科
    4. 200433　上海，上海市肺科医院肺循环科
  • 收稿日期:2016-11-10 出版日期:2017-04-20
  • 通信作者: 许德凤
  • 基金资助:
    上海市浦东新区卫生系统重点专科建设项目资助(PWZZ2013－07)

Index changes of serumal soluble human stromelysin-2 and procalcitonin assess the patients of AECOPD

Moran Zhu1, Defeng Xu2,†(), Yunfeng Zhao3, Jinming Liu4, Lei Zhao2   

  1. 1. Ningxia Medical University, Yinchuan 750003, China
    2. Respiratory Medicine, Gongli Hospital, the Second Military Medical University, Shanghai 200135
    3. Respiratory Medicine, Shanghai Punan Hospital, Shanghai 200125, China
    4. Department of pulmonary circulation, Pulmonary Hospital, Shanghai 200433, China
  • Received:2016-11-10 Published:2017-04-20
  • Corresponding author: Defeng Xu
  • About author:
    Corresponding author: Xu Defeng, Email:
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引用本文：

朱默然, 许德凤, 赵云峰, 刘锦铭, 赵蕾. 血清可溶性人基质裂解素2和降钙素原水平的变化在AECOPD患者中的病情评估[J]. 中华肺部疾病杂志(电子版), 2017, 10(02): 187-191.

Moran Zhu, Defeng Xu, Yunfeng Zhao, Jinming Liu, Lei Zhao. Index changes of serumal soluble human stromelysin-2 and procalcitonin assess the patients of AECOPD[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(02): 187-191.

目的

探讨血清可溶性人基质裂解素2(sST2)与慢性阻塞性肺疾病急性加重期(AECOPD)患者病情严重程度的关系及临床意义。

方法

检测120例(Ⅰ级30例、Ⅱ级30例、Ⅲ级30例和Ⅳ级30例)AECOPD患者治疗前后的血清sST2、降钙素原(PCT)、C反应蛋白(CRP)水平，并分析血清sST2、PCT、CRP水平与CAT评分、6 min步行距离(6 minutes walk distance, 6MWD)之间的相关性。另选择30例体检正常人员作为对照组。

结果

①AECOPD组治疗前血清sST2、PCT、CRP水平显著高于治疗后和对照组(P值均<0.05)，且在一定程度上随着病情严重程度的增加而增加；②COPD严重程度分级与血清sST2、CRP、PCT水平存在相关性(r＝0.588，r＝0.447，r＝0.305，P值均小于0.01)，Ⅰ级、Ⅱ级COPD患者血清sST2水平明显低于Ⅲ级、Ⅳ级患者(t＝9.600，P<0.01)；③血清sST2水平与患者CAT量表呈正相关(r＝0.363，P<0.01)，随着血清sST2水平的升高，CAT量表数值也升高；与6MWD呈负相关(r＝－0.434，P<0.01)，随着血清sST2水平的升高，6MWD距离下降。

结论

Ⅲ级、Ⅳ级AECOPD患者血清sST2水平高于Ⅰ级、Ⅱ级AECOPD患者，随病情好转，血清sST2水平降低显著。血清sST2水平可以在一定程度上反映AECOPD患者病情严重程度，对AECOPD患者病情评估具有临床价值。

关键词: 急性加重，肺疾病，慢性阻塞性, 可溶性人基质裂解素2, 降钙素原, C反应蛋白, CAT评分量表, 6 min步行试验
Objective

To analyse the severity of disease and the evaluation of serum quality of life value of serumal soluble human stromelysin-2 and procalcitonin in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods

The serumal soluble human stromelysin-2, procalcitonin, C reactive protein were detected in 120 hospitalized AECOPD patients before and after the treatment, and to study the correlation above indexes with severity of COPD, COPD assessment test(CAT) and 6 minutes walk distance (6MWD).

Results

Compared with after the treatment patients and healthy control group, serumal levels of the soluble human stromelysin-2, procalcitonin, C-reactive protein were significantly elevated in the patient with AECOPD before the treatment(P<0.05). To some extent, the levels of these indicators were increasing with the increase in the severity of the disease. The severity classification of COPD were positively correlated with serum sST2, CRP and PCT levels (r=0.588, r=0.132, r=0.305, P<0.01), serum sST2 level of the combined Class Ⅰ and Ⅱ COPD patients was significantly lower than the combined Class Ⅲ and Ⅳ COPD patients (t=9.600, P<0.01). The serumal sST2 was positively correlated with CAT (r=0.363, P<0.01), and was negatively correlated with 6MWD (r=-0.434, P<0.01).

Conclusions

The serumal sST2 levels in Ⅲ, Ⅳ level AECOPD patients were higher than Ⅰ, Ⅱ stage AECOPD patients, and with the condition improved, serumal sST2 decreased significantly. Serumal sST2 can reflect the severity of AECOPD patients in some extent, and has certain clinical value to evaluate the condition of AECOPD patients.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Soluble human stromelysin-2, Procalcitonin, C-reactive protein, COPD assessment test, 6 minutes walk test
表1 不同级别AECOPD患者治疗前后血清sST2、PCT、CRP含量差异性
分　级 治疗前/后 CRP(mg/L) PCT(ng/ml) sST2(ng/L)
Ⅰ级(n＝30) 治疗前 22.33±16.05 0.24±0.13 107.96±46.71
? 治疗后 4.87±3.06 0.06±0.05 72.24±12.25
? t值 2.426 3.014 4.878
? 前后比较P值 0.022 0.005 0.000
Ⅱ级(n＝30) 治疗前 30.02±20.17 0.32±0.19 178.57±66.62
? 治疗后 6.04±4.43 0.03±0.02 90.66±29.44
? t值 3.281 4.112 10.216
? 前后比较P值 0.003 0.000 0.000
Ⅲ级(n＝30) 治疗前 25.14±17.17 1.32±0.29 238.93±101.44
? 治疗后 7.16±3.58 0.33±0.12 89.03±18.13
? t值 3.663 2.520 8.835
? 前后比较P值 0.001 0.017 0.000
Ⅳ级(n＝30) 治疗前 63.43±28.82 3.60±1.20 394.67±88.60
? 治疗后 8.84±4.51 0.04±0.01 114.41±29.95
? t值 5.426 5.024 17.438
? 前后比较P值 0.000 0.000 0.000
对照组(n＝30) ? 0.99±0.90 0.06±0.05 66.91±8.20
? t值 7.167 3.072 13.476
? 与AECOPD患者治疗后P值 0.000 0.003 0.000
图1 AECOPD患者治疗后血清sST2水平与CAT量表之间的散点图
图2 120例AECOPD患者治疗后血清sST2水平与6MWD的散点图
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