摘要
目的 探讨血管生成素-1、-2（Ang-1、Ang-2）与特发性肺纤维化（IPF）患者临床指标的关系,评估Ang-1、Ang-2对IPF患者预后的预测价值.方法 采用回顾性分析方法,选择2014年3月至2015年1月大庆油田总医院收治的经胸部高分辨CT（HRCT）和肺组织活检确诊为IPF的91例患者.收集所有患者的一般资料、血清学指标和肺功能指标;所有患者均有2年随访期,按随访结果分为预后良好组和预后不良组,比较两组各项指标的差异.采用Pearson相关法分析Ang-1、Ang-2与肺功能指标的相关性;采用Cox比例风险模型评价各项临床指标对IPF患者预后的影响;绘制受试者工作特征曲线（ROC）,分析Ang-2对IPF患者预后的预测价值.结果 在2年随访期间,91例IPF患者中删失6例,预后良好30例,预后不良55例,预后不良率为64.71%.预后不良组Ang-2水平显著高于预后良好组（μg/L：2.88±1.63比1.89±1.22,t=2.909,P=0.005）,而Ang-1水平仅较预后良好组略有升高（μg/L：28.70±14.26比25.62±11.95,t=1.005,P=0.318）.Pearson相关分析结果显示：IPF患者Ang-2与1 s用力呼气容积（FVC1）和一氧化碳弥散量占预计值百分比（DLCO%）均呈显著负相关（r值分别为-0.227、-0.206,P值分别为0.031、0.047）,而Ang-1与FVC1、DLCO%均无相关关系（r值分别为-0.153、-0.121,P值分别为0.147、0.253）.Cox比例风险模型分析结果显示：患者吸烟时间和Ang-2水平对IPF患者预后有显著影响（均P〈0.05）,且Ang-2的影响程度明显大于吸烟时间〔相对危险度（RR）：1.236比1.006,P=0.037〕;而年龄、性别、是否吸烟及FVC1、DLCO%、Ang-1水平对IPF患者预后无明显影响（均P〉0.05）.预后分析显示：Ang-2预测IPF患者预后不良的ROC曲线下面积（AUC）为0.692;当最佳诊断值为0.35μg/L时,敏感度为61.8%,特异度为73.3%,阳性预测值为69.8%,阴性预测值为65.7%,提示Ang-2对IPF患者预后不良的预测能力较好.结论 Ang-2能较好地评价IPF患者预后,可作为早期监测IPF患者预后风险的指标之一.
Objective To explore the relationship between angiogenin-1/2 （Ang-1/2） and clinical parameters of idiopathic pulmonary fibrosis （IPF）, and to assess the value of Ang-1/2 in predicting the prognosis of patients with IPF.Methods A retrospective analysis was conducted. Ninety-one patients diagnosed as IPF by high resolution CT （HRCT） and lung biopsy admitted to Daqing Oil Field General Hospitalfrom March 2014 to January 2015 were enrolled. The general data, serum parameters and pulmonary function parameters of all patients were collected. After treatment, all of the 91 patients were followed-up to 2 years. The patients were divided into favorable prognosis group and unfavorable prognosis group according to follow-up results. The differences in all parameters between the two groups werecompared. The relationship between Ang-1, Ang-2 and lung function parameters was analyzed by Pearson correlation analysis. Cox proportional hazard regression model was used to evaluate the effect of clinical parameters on the prognosis of patients with IPF. The effect of Ang-2 in predicting prognosis of patients with IPF was analyzed by receiver operating characteristic （ROC） curve.Results During the 2-year follow-up period, 30 of 91 patients showed a favorable prognosis, and 55 showed an unfavorable prognosis with a poor prognosis rate of 64.71%, and 6 patients withdrew from the study due to loss of follow-up and death. Compared with the favorable prognosis group, Ang-2 level in the unfavorable prognosis group was significantly increased （μg/L： 2.88±1.63 vs. 1.89±1.22,t = 2.909,P= 0.005）, but Ang-1 only showed a slight increase （μg/L： 28.70±14.26 vs. 25.62±11.95,t = 1.005,P = 0.318）. The results of Pearson correlation analysis showed that Ang-2 level was negatively correlated with forced expiratory volume in 1 second （FVC1） and the percentage of carbon monoxide diffusing capacity accounting for the expected value （DLCO%;r value was -0.227 and -0.206, andP value was 0.147 and 0.253, respectively）, but no significant correlation between the level of Ang-1 and FVC1 as well as DLCO% was found （r value was -0.153 and -0.121, andP value was 0.147 and 0.253, respectively）. Cox proportional hazard regression model analysis showed that the prognosis of patients with IPF was significantly affected by smoking time and Ang-2 （bothP〈 0.05）, and the influence of Ang-2 was greater [relative risk （RR）： 1.236 vs. 1.006, P= 0.037]. Age, gender, smoking and the levels of FVC1, DLCO% and Ang-1 had no significant effect on the prognosis of IPF patients （allP〉 0.05）. Prognostic analysis showed that the area under ROC curve （AUC） of Ang-2 for predicting prognosis of patients with IPF was 0.692, and the best diagnostic point was 0.35μg/L, the sensitivity was 61.8%, the specificity was 73.3%, the positive predictive value was 69.8%, and the negative predictive value was 65.7% which indicated that Ang-2 could predict the prognosis of patients with IPF.Conclusion Ang-2 could assess the prognosis of patients with IPF, which is expected to be used as an indicator of predicting the prognosis of patients with IPF.
作者
白艳玲
朱海燕
孙启玉
顾国忠
张灵宇
李颖
杨宝峰
Bai Yanling Zhu Haiyan Sun Qiyu Gu Guozhong Zhang Lingyu Li Ying Yang Baofeng(Department of Respiratory Medicine, Training Hospital Daqing Oil Field General Hospital Affiliated to Qiqihar Medical School, Daqing 163001, Heilongfiang, China Department of Clinical Pharmacy, Training Hospital Daqing Oil Field General Hospital Affiliated to Qiqihar Medical School, Daqing 163001, Heilongjiang, Chin School of Pharmacy, Fudan University, Shanghai 201203, China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第9期789-793,共5页
Chinese Critical Care Medicine
基金
黑龙江省自然科学基金（H2013114）
