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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2017, Vol. 10 ›› Issue (06) : 668 -672. doi: 10.3877/cma.j.issn.1674-6902.2017.06.007

所属专题： 文献；

论著

血清胱抑素C与稳定期慢性阻塞性肺疾病患者疾病严重程度相关性分析
庞志刚1, 成孟瑜1, 许建英1,†()   
  1. 1. 030032　太原，山西医学科学院　山西大医院呼吸与危重症医学科
  • 收稿日期:2017-10-16 出版日期:2017-12-20
  • 通信作者: 许建英
  • 基金资助:
    山西省青年科技研究基金资助(2014021040-4)

Correlative analysis of the level of serum cystatin-C in different severity of patients with stable chronic obstructive pulmonary disease

Zhigang Pang1, Mengyu Cheng1, Jianying Xu1,†()   

  1. 1. Department of Respiratory Medicine, Shanxi Dayi Hospital Affiltated to Shanxi Medical University, Taiyuan 030032, China
  • Received:2017-10-16 Published:2017-12-20
  • Corresponding author: Jianying Xu
  • About author:
    Corresponding author: Xu Jianying, Email:
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庞志刚, 成孟瑜, 许建英. 血清胱抑素C与稳定期慢性阻塞性肺疾病患者疾病严重程度相关性分析[J]. 中华肺部疾病杂志(电子版), 2017, 10(06): 668-672.

Zhigang Pang, Mengyu Cheng, Jianying Xu. Correlative analysis of the level of serum cystatin-C in different severity of patients with stable chronic obstructive pulmonary disease[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(06): 668-672.

目的

探讨稳定期慢性阻塞性肺疾病(COPD)患者不同气流受限及疾病严重程度时血清胱抑素C(Cys-C)水平的变化及其相关性，寻找评估稳定期COPD患者疾病严重程度的生物标志物。

方法

选取山西大医院2016年1月至12月门诊随访的94例COPD患者作为COPD组；选取同期本院体检中心的31例健康体检者作为健康对照组，分别行肺功能检查，同时检测血清胱抑素C和肌酐(Cr)水平，计算肾小球滤过率(GFR)。根据肺功能FEV1%预计值将COPD组患者分为GOLD1、2、3、4级；根据过去1年的加重次数、生活质量评分(CAT)又将COPD组患者分为A、B、C、D四个亚组。

结果

COPD组患者血清Cys-C水平高于健康对照组，差异有统计学意义(P<0.05)；COPD患者全球慢性阻塞性肺疾病防治倡议(GOLD)1、2、3、4级血清Cys-C水平差异有统计学意义(P<0.01)，GOLD 4级患者血清Cys-C水平高于GOLD1、2和3级；COPDA、B、C、D组患者血清Cys-C水平差异有统计学意义(P<0.01)，D组血清Cys-C水平高于A、B组，C组血清Cys-C水平高于A组；相关性分析显示血清Cys-C与CRP呈正相关，与GFR、FEV1%预计值呈负相关。

结论

稳定期COPD患者血清胱抑素C水平增高，并且随着气流受限及综合评估严重程度的加重而升高，提示胱抑素C可作为评估COPD严重程度的生物标志物。

关键词: 肺疾病，慢性阻塞性, 胱抑素C, 肺功能
Objective

To observe change and the correlation of serum Cystatin C ( Cys-C) levels of the stability of stable chronic obstructive pulmonary disease (COPD) patients with different limited airflow and the severity of disease.

Methods

A total of 94 COPD patients of Shanxi Dayi hospital from January 2016 to December were followed up as COPD group; 31 healthy subjects in the hospital physical examination center were selected as healthy control group. Pulmonary function tests, serum cystatin C and creatinine (Cr) levels were measured respectively, meanwhile, Calculated glomerular filtration rate. According to the estimated percentage of pulmonary function FEV1, the patients with COPD were divided into four different subgroups: GOLD1, 2, 3 and 4stage; According to the history of acute exacerbation number and COPD assessment test, the patients with COPD were divided into four different subgroups: A, B, C and D.

Results

The serum Cys-C level in patients with stable COPD was higher than those in healthy controls (P<0.05). There were significant differences in the serum Cys-C among stable COPD patients of GOLD1, 2, 3 and 4stage(P<0.01), the serum Cys-C levels in GOLD4 stage were higher than GOLD1, 2, 3 stage.There were significant differences in the serum Cys-C among stable COPD patients of A, B, C and D subgroup(P<0.01), the serum Cys-C levels in D subgroup were higher than A, B subgroup, the serum Cys-C levels in C subgroup were higher than A subgroup. The serum Cys-C levels were positive correlated with CRP (P<0.01) and significantly negative correlated with FEV1(P<0.01) and GFR(P<0.01).

Conclusions

COPD patients serum Cys-C level is higher, and increased with COPD disease severity. The serum Cys-C level may become biomarkers of the assessment of severity in patients with COPD.

Key words: Chronic obstructive pulmonary disease, Cystatin-C, Lung function
表1 两组血清学指标比较[M(QR)]
组　别 例数 年龄(岁) FEV1/FVC(%) Cr(μmol/L) GFR(ml·min－1·(1.73 m2)－1) Cys-C(mg/L) CRP(mg/L)
健康对照组 31 63.4±7.9 83.91(78.03～88.37) 59.30(52.80～68.00) 92.05(78.29～123.05) 0.60(0.50～0.74) 0.82(0.58～0.93)
COPD组 94 65.9±9.6 54.03(44.26～64.36) 64.80(56.15～70.10) 86.13(68.63～105.22) 0.67(0.57～0.80) 1.00(0.50～2.23)
t/μ值 ? 1.332 －7.795 －1.727 －1.864 －2.431 －1.384
P值 ? 0.185 <0.001 0.084 0.062 0.015 0.166
表2 GOLD分级四组血清学指标比较[M(QR)]
GOLD分级 例数 FEV1(L%) Cys-C(mg/L) Cr(μmol/L) GFR(ml·min－1·(1.73 m2)－1) CRP(mg/L)
1 26 88.05(82.90～98.35) 0.68(0.56～0.76) 63.45(56.40～69.73) 84.05(68.10～105.70) 0.78(0.40～1.70)
2 28 65.55(56.30～70.25)a 0.64(0.54～0.74) 61.10(55.03～68.43) 96.99(87.32～119.16)a 0.88(0.34～1.30)
3 33 40.70(34.25～44.10)ab 0.68(0.60～0.87) 63.60(54.15～70.10) 80.52(62.75～96.80)b 1.40(0.64～2.80)
4 7 27.60(19.40～28.50)ab 1.10(0.72～1.30)abc 71.20(68.20～76.50) 59.42(57.53～80.77)ab 2.30(0.40～4.50)
H值 ? 81.095 11.919 7.371 15.324 7.674
P值 ? <0.001 0.008 0.061 0.002 0.053
表3 A、B、C、D四组血清学指标比较[M(QR)]
组　别 例数 Cr(μmol/L) Cys-C(mg/L) GFR(ml·min－1·(1.73 m2)－1) CRP(mg/L)
A 33 62.60(55.15～70.10) 0.63(0.55～0.69) 95.42(78.52～110.95) 0.80(0.45～1.40)
B 26 63.95(58.13～69.05) 0.67(0.57～0.77) 88.11(71.57～105.30) 0.74(0.28～1.21)
C 12 61.65(55.05～69.13) 0.83(0.61～0.90)a 83.42(62.02～114.32) 1.75(0.67～2.30)
D 23 67.80(58.00～72.50) 0.85(0.61～1.10)ab 70.15(55.49～82.44)ab 2.40(1.00～4.30)ab
H值 ? 2.030 17.866 13.236 16.823
P值 ? 0.566 <0.001 0.004 0.001
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