%0 Journal Article %T 血清可溶性血管内皮生长因子受体-1在AECOPD患者合并肺炎风险评估和预后判断中的价值
Diagnostic and prognostic value of solublefms-like tyrosine kinase 1 in patients with AECOPD accompanied with pneumonia %A 邵细琴 %A 陈扬波 %A 孙 妍 %A 李 娜 %A 陈丹晨 %J 西安交通大学学报(医学版) %D 2019 %R 10.7652/jdyxb201904018 %X 摘要:目的 分析可溶性血管内皮生长因子受体-1(sFlt-1)在慢性阻塞性肺疾病急性加重期(AECOPD)是否合并社区获得性肺炎(CAP)患者中的差异,并评估其判断预后的潜力。方法 对2016年1月至2017年10月就诊于浙江省立同德医院及温州市中心医院连续性符合条件的CAP患者(n=48)、CAP+AECOPD患者(n=20)或AECOPD(n=34)患者进行了前瞻性队列研究。通过常规自动化测试C-反应蛋白(CRP)、hs肌钙蛋白T、NTproBNP、降钙素原和血液计数,并采用电化学发光免疫法分析sFlt-1水平。结果 不同诊断组患者的炎症指标、sFlt-1、血红蛋白、纤维蛋白原有明显差异(P<0.05)。CAP+AECOPD组的CRP、sFlt-1、降钙素原、hs肌钙蛋白T、NT-proBNP、纤维蛋白原较AECOPD组显著升高(P<0.05),而血红蛋白较AECOPD组显著下降(P<0.05)。CRP(r=0.504,P=0.005)、sFlt-1(r=0.384,P=0.009)和降钙素原(r=0.307,P=0.042)与住院时间呈显著正相关。与入院时相比,sFlt-1水平在出院后再入院的患者中表现更高[(27.91±5.82)ng/L vs. (16.26±4.33)ng/L,P=0.022],并且在30d内死亡患者中sFlt-1水平[(30.46±5.74)ng/L]更高。sFlt-1水平高于19.451ng/L区分AECOPD和CAP+AECOPD的阳性预测值为66%,阴性预测值为80%,灵敏度为66%,特异性为80%,ROC曲线下面积为0.78。结论 血清sFlt-1水平能快速区分AECOPD患者是否合并CAP,而且可以初步预测住院时间和短期临床预后。
ABSTRACT: Objective To analyze the variation of soluble fms-like tyrosine kinase receptor-1 (sFlt-1) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with community-acquired pneumonia (CAP) and to evaluate its potential for judging prognosis. Methods A prospective cohort study was conducted on patients with CAP (n=48), CAP+AECOPD (n=20) or AECOPD (n=34) in our hospital from January 2016 to October 2017. The levels of CRP, HS troponin T, NTproBNP, procalcitonin and blood counts were measured by routine automated test, and the sFlt-1 level was analyzed by electrochemiluminescence immunoassay. Results The inflammatory markers, sFlt-1, hemoglobin, and fibrinogen were significantly different in different diagnosis groups (P<0.05). Compared with those in AECOPD group, CRP, sFlt-1, procalcitonin, hs-troponin T, NT-proBNP, and fibrinogen in CAP+AECOPD group increased significantly (P<0.05), while hemoglobin in CAP+AECOPD group decreased significantly (P<0.05). The results of Spearman correlation analysis showed that CRP (r=0.504, P=0.005), sFlt-1 (r=0.384, P=0.009) and calcitonin (r=0.307, P=0.042) had a significant positive correlation with the time of hospitalization. Compared with admission, the concentration of sFlt-1 was higher in the hospitalized patients after discharge [(27.91±5.82)ng/L vs. (16.26±4.33)ng/L, P=0.022], and the concentration of sFlt-1 (30.46±5.74)ng/L was higher in the patients who died within 30 days. The positive predictive value of sFlt-1 concentration higher than 19.451 for AECOPD and CAP+AECOPD was 66%, the negative predictive value was 80%, the sensitivity was 66%, the specificity was 80%, and the area under the ROC curve was 0.78. Conclusion Determination of serum sFlt-1 level can not only quickly distinguish whether AECOPD is associated with CAP, but also %K 慢性阻塞性肺疾病(COPD) %K 急性加重期 %K 社区获得性肺炎(CAP) %K 可溶性血管内皮生长因子受体-1(sFlt-1) %K 炎症指标
chronic obstructive pulmonary disease (COPD) %K acute exacerbation %K community-acquired pneumonia %K soluble fms-like tyrosine kinase receptor-1 (sFlt-1) %K inflammatory marker %U http://yxxb.xjtu.edu.cn//oa/darticle.aspx?type=view&id=201904018