HBP和PLR在AECOPD中的应用价值

蒋菁; 李梅华; 杨丽芬; 任朝凤; 赵娅琳; 刘兴许; 周冬玉; 郑章敏

doi:10.12259/j.issn.2095-610X.S20241018

HBP和PLR在AECOPD中的应用价值

doi: 10.12259/j.issn.2095-610X.S20241018

昆明市第一人民医院呼吸与危重症医学科，云南昆明　650011

基金项目: 昆明市卫生健康委员会科研基金资助项目（2022-03-02-005）

详细信息

作者简介:
蒋菁（1997～），女，云南马关人，在读硕士研究生，住院医师，主要从事呼吸科临床工作

通讯作者:
李梅华，E-mail：524396521@qq.com

中图分类号: R563.9
计量
- 文章访问数: 495
- HTML全文浏览量: 197
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-17
- 网络出版日期: 2024-10-14
- 刊出日期: 2024-10-31

Application Value of HBP and PLR in AECOPD

Dept. of Respiratory and Critical Care Medicine，The 1st People’s Hospital of Kunming，Kunming Yunnan 650011，China

摘要

摘要: 目的探讨肝素结合蛋白（HBP）和血小板与淋巴细胞的比值（PLR）与慢性阻塞性肺疾病急性加重（AECOPD）的相关性，并分别评估其在AECOPD的预测和辅助诊断中的临床应用价值。方法选取2022年11月至2023年12月昆明医科大学附属甘美医院呼吸与危重症医学科住院部及门诊就诊的慢性阻塞性肺疾病患者146例作为研究对象，以因咳嗽、咳痰、喘息等症状加重，需要住院治疗或改变治疗方案的COPD患者为慢阻肺急性加重组（AECOPD组，n = 96），以同时期门诊复诊的、无呼吸道症状加重的COPD患者为慢阻肺稳定组（SCOPD组，n = 50）。收集入院当天测定所得的淋巴细胞数和血小板数值，通过计算得出PLR值，使用免疫荧光干式定量法测出HBP的值，比较2组间HBP和PLR水平的高低以及组间有无差异，通过二元Logistic回归分析的方法分析HBP和PLR是否是AECOPD发生的独立危险因素，并依据ROC曲线分析HBP和PLR在AECOPD发生的预测和辅助诊断中是否有应用价值。结果 2组患者的性别、年龄、吸烟情况及高血压、糖尿病、冠心病等一般资料比较，差异均无统计学意义；AECOPD组患者血清中HBP和PLR的水平明显高于SCOPD组患者的水平，且HBP和PLR均为AECOPD发生的独立危险因素（P < 0.05）；HBP取截断值30.09 ng/mL时，灵敏度和特异度分别是97.9%、98%；PLR取截断值164.0835时，灵敏度和特异度分别是57.3%、90%；HBP和PLR联合检测时，AUC值较单个指标时更高（P < 0.05）。结论 HBP和PLR对AECOPD有预测和辅助诊断的作用，二者联合检测时对AECOPD的预测和辅助诊断价值更高。
- 慢性阻塞性肺疾病急性加重 /
- 肝素结合蛋白 /
- PLR
Abstract: Objective To investigate the relationship between heparin binding protein （HBP） and platelet-to-lymphocyte ratio （PLR） and acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, and evaluate their clinical value in the prediction and diagnosis of AECOPD. Methods Patients with chronic obstructive pulmonary disease （COPD） who visited the inpatient department and outpatient department of Respiratory and Critical Care Medicine of Ganmei Hospital Affiliated to Kunming Medical University from November 2022 to December 2023 were selected as the study objects. Symptoms such as cough, sputum and wheezing were aggravated. COPD patients requiring hospitalization or change of treatment regimen were classified as acute COPD plus recombination （AECOPD group）, and COPD patients with no exacerbation of respiratory symptoms were classified as COPD stabilization group （SCOPD group）. Lymphocyte count and platelet values measured on the day of admission were collected, PLR values were calculated, and HBP values were measured by immunofluorescence dry quantification. The levels of HBP and PLR between the two groups and whether there were differences between the two groups were compared. Binary logistic regression analysis was used to analyze whether HBP and PLR were independent risk factors for the occurrence of AECOPD, and whether HBP and PLR had application value in predicting the occurrence of AECOPD and assisting diagnosis according to ROC curve. Results There were no significant differences in gender, age, smoking status, hypertension, diabetes, coronary heart disease and other general data between the two groups. Serum levels of HBP and PLR in AECOPD group were significantly higher than those in SCOPD group, and both HBP and PLR were independent risk factors for AECOPD. When the truncation value of HBP was 30.09 ng/mL, the sensitivity and specificity were 97.9% and 98%, respectively. When PLR truncation value is 164.0835, the sensitivity and specificity are 57.3% and 90%, respectively. The AUC value of HBP and PLR combined detection is higher than that of single index. Conclusions HBP and PLR can predict and assist the diagnosis of AECOPD, and the combined detection of HBP and PLR has a higher value in predicting and assisting the diagnosis of AECOPD.
- Acute exacerbation of chronic obstructive pulmonary disease /
- Heparin-binding protein /
- PLR

HTML全文

图 1 各指标在AECOPD组、SCOPD组2组间差异分析

A：HBP在2组间的差异； B：PLR在2组间的差异。^****P < 0.0001。

Figure 1. Difference analysis of each index between AECOPD group and SCOPD group

下载: 全尺寸图片幻灯片

图 2 HBP、PLR及HBP联合PLR对预测和辅助诊断AECOPD的ROC曲线

Figure 2. ROC curves of HBP，PLR and HBP combined PLR for prediction and auxiliary diagnosis of AECOPD

下载: 全尺寸图片幻灯片

表 1 AECOPD组、SCOPD组2组患者一般资料比较（$ \bar x \pm s $，n，M（P25，P75））

Table 1. Comparison of general data between AECOPD group and SCOPD group （$ \bar x \pm s $，n，M（P25，P75））

组别	AECOPD组	SCOPD组	χ²/t/Z	P
n	96	50
性别
男	79	42	0.068	0.795
女	19	8
年龄（岁）	73.48 ± 9.70	76.20 ± 11.10	−1.530	0.128
吸烟情况
现在吸烟	22	5	3.690	0.158
过去吸烟	54	32
从不吸烟	20	13
合并症[n（%）]
冠心病	28	16	0.125	0.723
高血压	49	32	2.235	0.135
糖尿病	37	17	0.291	0.590
^*P < 0.05。

下载: 导出CSV

表 2 各指标在AECOPD组和SCOPD组的2组间水平[M（P25，P75）]

Table 2. Inter-group level of each indicator in AECOPD group and SCOPD group[M（P25，P75）]

标志物	AECOPD组	SCOPD组	Z	P
HBP	66.78（44.05，112.16）	12.70（7.89，20.39）	−9.793	< 0.001^*
PLR	174.81（123.28，253.83）	112.36（82.70，143.82）	−5.310	< 0.001^*
^*P < 0.05。

下载: 导出CSV

表 3 单因素logistics回归分析

Table 3. One-way logistics regression analysis

因素	B	SE	Wald	P	OR（95%CI）
HBP	0.366	0.102	12.923	< 0.001^*	1.442（1.181，1.760）
PLR	0.017	0.004	17.859	< 0.001^*	1.017（1.009，1.026）
^*P < 0.05。

下载: 导出CSV

表 4 多因素logistics回归分析

Table 4. Multi-factor logistics regression analysis

因素	B	SE	Wald	P	OR（95%CI）
HBP	0.747	0.341	4.801	0.028^*	2.111（1.082，4.120）
PLR	0.050	0.023	4.814	0.028^*	1.052（1.005，1.100）
^*P < 0.05。

下载: 导出CSV

表 5 HBP和PLR对AECOPD的诊断价值

Table 5. Diagnostic value of HBP and PLR in AECOPD

标志物	AUC	Cut-off值	灵敏度	特异度	95%CI		P
标志物	AUC	Cut-off值	灵敏度	特异度	下限	上限	P
HBP	0.995	30.09	0.979	0.98	0.986	1.000	< 0.001^*
PLR	0.768	164.0835	0.573	0.90	0.693	0.844	< 0.001^*
HBP+PLR	0.998	0.51	0.99	0.98	0.994	1.000	< 0.001^*
^*P < 0.05。

下载: 导出CSV

参考文献(18)

[1]	Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease(2024 report)[EB/OL][2023- 12-26].
[2]	Wu F,Deng Z S,Tian H S,et al. Progress in pre-chronic obstructive pulmonary disease[J]. Chinese Journal of Tuberculosis and Respiratory Diseases,2023,46(10):1028-1034.
[3]	梁振宇,王凤燕,陈子正,等. 2023年GOLD慢性阻塞性肺疾病诊断、管理及预防全球策略更新要点解读[J]. 中国全科医学,2023,26(11):1287-1298.
[4]	陈典,隆寰宇,李姝润,等. 2024年GOLD慢性阻塞性肺疾病诊断、治疗、管理及预防全球策略更新要点解读[J/OL]. 中国全科医学: 1-12[2024-02-25].
[5]	Xu X, Zhou L, Tong Z. The relationship of fractional exhaled nitric oxide in patients with AECOPD[J]. International Journal of Chronic Obstructive Pulmonary Disease, 2023, 18: 3037-3046. Xu X,Zhou L,Tong Z. The relationship of fractional exhaled nitric oxide in patients with AECOPD[J]. International Journal of Chronic Obstructive Pulmonary Disease,2023,18:3037-3046.
[6]	张重威,罗茜,曹彦,等. 有潜力的脓毒症生物标志物: 肝素结合蛋白[J]. 中国急救医学,2021,41(10):916-921. doi: 10.3969/j.issn.1002-1949.2021.10.017
[7]	Chen G,Wu C,Luo Z,et al. Platelet-lymphocyte ratios: A potential marker for pulmonary tuberculosis diagnosis in COPD patients[J]. International Journal of Chronic Obstructive Pulmonary Disease,2016, 11:2737-2740.
[8]	慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组. 慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2017年更新版)[J]. 国际呼吸杂志,2017,37(14):1041-1057. doi: 10.3760/cma.j.issn.1673-436X.2017.14.001
[9]	Guo P,Li R,Piao T H,et al. Pathological mechanism and targeted drugs of COPD[J]. International Journal of Chronic Obstructive Pulmonary Disease,2022,17:1565-1575.
[10]	Zinellu A,Zinellu E,Mangoni A A,et al. Clinical significance of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute exacerbations of COPD: Present and future[J]. European Respiratory Review,2022,31(166):220095.
[11]	Sjöbeck M,Sternby H,Herwald H,et al. Heparin-binding protein is significantly increased in acute pancreatitis[J]. BMC Gastroenterology,2021,21:1-7. doi: 10.1186/s12876-020-01553-z
[12]	Soehnlein O,Kai-Larsen Y,Frithiof R,et al. Neutrophil primary granule proteins HBP and HNP1–3 boost bacterial phagocytosis by human and murine macrophages[J]. The Journal of Clinical Investigation,2008,118(10):3491-3502. doi: 10.1172/JCI35740
[13]	冯立伟,王婕莹,王洪亮,等. 肝素结合蛋白在重症患者中的临床应用[J]. 中国急救医学,2023,43(7):579-584. doi: 10.3969/j.issn.1002-1949.2023.07.013
[14]	Gautam N,Olofsson A M,Herwald H,et al. Heparin-binding protein (HBP/CAP37): A missing link in neutrophil-evoked alteration of vascular permeability[J]. Nature Medicine,2001,7(10):1123-1127. doi: 10.1038/nm1001-1123
[15]	Gonzalez M L,Ruan X,Kumar P,et al. Functional modulation of smooth muscle cells by the inflammatory mediator CAP37[J]. Microvascular research,2004,67(2):168-181. doi: 10.1016/j.mvr.2003.12.007
[16]	Olofsson A M,Vestberg M,Herwald H,et al. Heparin-binding protein targeted to mitochondrial compartments protects endothelial cells from apoptosis[J]. The Journal of Clinical Investigation,1999,104(7):885-894. doi: 10.1172/JCI6671
[17]	Dong Y,Zhou X,Zhang Y,et al. Application value of blood Heparin-binding protein in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease[J]. Contrast Media & Molecular Imaging,2021,2021(16):1-6.
[18]	徐靖宇,胡斯明,徐莉,等. 血小板/淋巴细胞比值在慢性阻塞性肺病急性加重早期诊断中的应用价值[J]. 中国实验诊断学,2022,26(7):968-971. doi: 10.3969/j.issn.1007-4287.2022.07.006

相关文章(20)

[1]	马葳, 李梅华, 蒋菁, 刘兴许, 杨丽芬, 李丽. 肝素结合蛋白及血清淀粉样蛋白A在AECOPD合并肺部感染中的研究进展, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230228
[2]	杨超, 杜俊毅, 蒲丹, 许小靓, 陈敏, 刘翱. 肠道活菌制剂对慢性阻塞性肺疾病急性加重患者的疗效, 昆明医科大学学报.
[3]	杨霞, 冯梅, 吴颖, 朱晶. 稳定期慢性阻塞性肺疾病中医肺康复治疗的疗效, 昆明医科大学学报.
[4]	孙士波, 罗壮, 杜晓华, 杨娇, 业秀林, 张冬先, 杨为民. 血浆环指蛋白5检测在慢性阻塞性肺疾病中的意义, 昆明医科大学学报.
[5]	刘虎军, 高莉萍. 不同剂量盐酸氨溴索注射液治疗老年慢性阻塞性肺疾病急性加重期患者对炎性细胞因子的影响, 昆明医科大学学报.
[6]	戴百章, 任朝凤, 郑勤玲, 杨艳霞, 李梅华. 慢性阻塞性肺病急性加重患者淋巴细胞组成变化, 昆明医科大学学报.
[7]	李亚萍, 李永霞, 牛小群, 海冰, 曹宇, 柴燕玲. 吸烟与炎性因子在慢性阻塞性肺疾病急性加重期合并肺动脉高压中的相关性, 昆明医科大学学报.
[8]	海冰. DOSE指数评分系统在慢性阻塞性肺疾病中的应用价值, 昆明医科大学学报.
[9]	毕虹. 昆明地区慢性阻塞性肺疾病患者肺功能影响因素分析, 昆明医科大学学报.
[10]	胡伟华. 氨溴索对老年慢性阻塞性肺病急性加重期的疗效对比, 昆明医科大学学报.
[11]	陈敏. 大剂量盐酸氨溴索在慢性阻塞性肺疾病急性加重患者治疗中的临床价值, 昆明医科大学学报.
[12]	戴百章. 慢性阻塞性肺病急性加重期低氧血症与CAT评分, 昆明医科大学学报.
[13]	刘荣. 慢性阻塞性肺疾病急性加重患者机械通气后期应用俯卧位通气呼吸和循环的临床评价, 昆明医科大学学报.
[14]	杨焕芝. 不同营养支持方式对慢性阻塞性肺疾病急性加重期患者感染的影响, 昆明医科大学学报.
[15]	董昭兴. HRCT划分慢性阻塞性肺疾病不同表型的临床特征观察, 昆明医科大学学报.
[16]	任朝凤. 彩色多谱勒超声与数字平板影像对慢性阻塞性肺病急性加重患者右心室功能临床评估, 昆明医科大学学报.
[17]	王长捷. 双水平正压通气在拒绝插管的老年慢性阻塞性肺病急性加重呼吸衰竭病人的应用, 昆明医科大学学报.
[18]	. 慢性阻塞性肺疾病合并肺栓塞的临床分析, 昆明医科大学学报.
[19]	. 布地奈德雾化吸入治疗慢性阻塞性肺疾病加重期疗效分析, 昆明医科大学学报.
[20]	柴燕玲. 血清降钙素原水平在慢性阻塞性肺疾病急性加重期优化抗菌治疗中的临床意义, 昆明医科大学学报.