摘要
目的探索慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者血清甘油磷脂代谢物溶血磷脂酰胆碱(lysophosphatidylctholine,LPC)18∶3,溶血磷脂酰乙醇胺(lysophosphatidylethanolamine,LPE)16∶1水平及两者对临床预后的相关性研究。方法选取2019年1月~2022年1月唐山市人民医院诊治的112例AECOPD患者为AECOPD组,根据随访3个月预后分为生存组(n=90)和死亡组(n=22)。以同期60例COPD稳定期患者为稳定期组,60例健康人群为对照组。应用高效液相色谱-串联质谱法(HPLC-MS/MS)检测各组血清LPC18∶3和LPE16∶1水平。相关性采用Pearson相关性分析。Logistic回归分析AECOPD患者预后影响因素。受试者工作特征(ROC)曲线分析LPC18∶3,LPE16∶1的预后评估价值。K-M曲线比较不同血清LPC18∶3和LPE16∶1表达组AECOPD患者预后差异。结果AECOPD组血清LPC18:3(21.67±4.35μmol/L)、LPE16∶1(16.20±5.17μmol/L)、峰值呼气流速占预计值的百分比(PEF%pred)、第1秒用力呼气容积占预计值百分比(FEV1%pred),1秒钟用力呼气容积占用力肺活量百分比(FEV1/FVC%)低于稳定期组(43.24±6.17μmol/L,32.19±5.98μmol/L)和对照组(68.14±8.78μmol/L,44.82±7.44μmol/L),差异具有统计学意义(F/χ^(2)=461.240~1102.534,均P<0.05)。AECOPD组血清LPC18∶3,LPE16∶1水平与肺功能指标PEF%pred,F%pred,FEV1/FVC%呈显著正相关(r=0.603~0.756,均P<0.05)。死亡组AECOPD患者COPD病程、降钙素原高于生存组(t=3.961,2.509),PEF%pred,FEV1%pred,FEV1/FVC%,血清LPC18:3(17.20±4.11μmol/L)和LPE16:1(10.15±3.03μmol/L)低于生存组(22.76±4.35μmol/L,17.68±5.22μmol/L),差异具有统计学意义(t=4.141~6.490,均P<0.05)。血清LPC18:3(OR=0.691,95%CI:0.519~0.920),LPE16:1(OR=0.586,95%CI:0.382~0.901)是影响AECOPD患者预后独立保护因素;COPD病程(OR=1.510,95%CI:1.203~1.895)、降钙素原(OR=1.759,95%CI:1.159~2.671)是危险因素。血清LPC18∶3,LPE 16∶1二者联合对AECOPD患者预后评估的曲线下面积(95%CI)为0.866(0.822~0.907),优于血清LPC18∶3,LPE16∶1单独预测的0.794(0.748~0.830),0.786(0.739~0.836),差异具有统计学意义(Z=3.957,4.195,P=0.002,<0.001)。血清LPC18∶3,LPE16∶1低表达组AECOPD患者的死亡风险高于血清LPC18∶3,LPE16∶1高表达组,差异具有统计学意义(Log-Rankχ^(2)=4.475,5.763,P=0.034,0.016)。结论AECOPD患者血清甘油磷脂代谢物LPC18:3,LPE16:1水平显著降低,与肺功能状况有关,两者联合能够有效评估AECOPD患者预后。
Objective To explore the expression levels of serum glycerophospholipid metabolites lysophosphatidylcholine(LPC)18∶3 and lysophosphatidylethanolamine(LPE)16∶1 in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and their correlation with clinical prognosis.Methods A total of 112 AECOPD patients diagnosed and treated in Tangshan People’s Hospital from January 2019 to January 2022 were selected as the AECOPD group.According to the 3-month follow-up prognosis of the AECOPD group patients,they were divided into survival group(n=90)and death group(n=22).During the same period,60 stable COPD patients were selected as the stable period group,while 60 healthy individuals in the same period were selected as the control group.High performance liquid chromatography tandem mass spectrometry(HPLC-MS/MS)was used to detect serum LPC18∶3 and LPE16∶1 levels in each group.Pearson method was used to analyze their correlation.Logistic regression analysis was used to analyze factors affecting the prognosis of AECOPD patients.Receiver operating characteristic curve was drawn to evaluate the prognostic value of LPC18∶3 and LPE16∶1 in AECOPD patients.The prognosis of AECOPD patients with different serum LPC18∶3 and LPE16∶1 expression groups was compared by K-M curve.Results Serum LPC18∶3(21.67±4.35μmol/L),LPE16∶1(16.20±5.17μmol/L),PEF%pred,FEV1%pred,and FEV1/FVC%in AECOPD group were lower than those of stable phase group(43.24±6.17μmol/L,32.19±5.98μmol/L)and the control group(68.14±8.78μmol/L,44.82±7.44μmol/L),with significant differences(F=461.240~1102.534,all P<0.05).The serum LPC18∶3 and LPE16:1 levels in the AECOPD group were positively correlated with lung function indicators such as PEF%pred,FEV1%pred,and FEV1/FVC%(r=0.603~0.756,allP<0.05).The course of COPD and PCT of AECOPD patients in the death group were higher than those in the survival group(t=3.961,2.509),while the PEF%pred,FEV1%pred,FEV1/FVC%,serum LPC18∶3(17.20±4.11μmol/L),and LPE16∶1(10.15±3.03μmol/L)in the death group were lower than those in the survival group(22.76±4.35μmol/L,17.68±5.22μmol/L),with significant differences(t=4.141~6.490,all P<0.05).Serum LPC18∶3(OR=0.691,95%CI:0.519~0.920)and LPE16∶1(OR=0.586,95%CI:0.382~0.901)were independent protective factors,while the course of COPD(OR=1.510,95%CI:1.203~1.895)and procalcitonin(OR=1.759,95%CI:1.159~2.671)were risk factors affecting the prognosis of AECOPD patients.The area under the curve(95%CI)of combined serum LPC 18∶3 and LPE16∶1 for prognosis evaluation of AECOPD patients was better than that of serum LPC18∶3 and LPE16∶1 predicted separately[0.866(0.822~0.907)vs 0.794(0.748~0.830),0.786(0.739~0.836)](Z=3.957,4.195,P=0.002,<0.001).The mortality risk of AECOPD patients in the low expression group of LPC 18:3 and LPE16∶1 was higher than that in the high expression group of LPC18∶3 and LPE16∶1(log rankχ^(2)=4.475,5.763,P=0.034,0.016).Conclusion The serum levels of glycerophospholipid metabolites LPC18∶3 and LPE16∶1 in AECOPD patients were decreased,which were related to lung function status.The combination of the two may effectively evaluate the prognosis of AECOPD patients.
作者
金吉明
吴艳杰
闫世林
李占增
柳洋
JIN Jiming;WU Yanjie;YAN Shilin;LI Zhanzeng;LIU Yang(Department of Emergency,Tangshan People’s Hospital,Hebei Tangshan 063000,China)
出处
《现代检验医学杂志》
CAS
2024年第4期93-99,共7页
Journal of Modern Laboratory Medicine
基金
河北省医学科学研究课题(20191726)。
