慢性阻塞性肺疾病急性加重期...-羟基脱氧鸟苷测定价值探讨_郑海茹.pdf

基金项目海南省重点研发计划项目(编号:ZDYF2019132)慢慢性性阻阻塞塞性性肺肺疾疾病病急急性性加加重重期期谷谷胱胱甘甘肽肽过过氧氧化化酶酶、丙丙二二醛醛、8 8-羟羟基基脱脱氧氧鸟鸟苷苷测测定定价价值值探探讨讨郑海茹,吴熊军,许文彬(海南医学院第二附属医院,海南 海口 570311)摘要 目的 分析外周血谷胱甘肽过氧化酶(GSH-PX)、丙二醛(MDA)、8-羟基脱氧鸟苷(8-OHdG)与慢性阻塞性肺疾病急性加重期(AECOPD)病情严重程度的相关性。方法 我院收治的 128 例 AECOPD 患者为观察组,100 例健康体检者为对照组,根据简化急性生理学评分(SAPS)评分系统将观察组患者分为轻度组(20 29 分,n=42)、中度组(30 39 分,n=46)及重度组(40 分,n=40),根据预后分为存活组(n=98)和死亡组(n=30),检测外周血 GSH-PX、MDA、8-OHdG 水平,分析外周血 GSH-PX、MDA、8-OHdG 水平与 AECOPD 严重程度相关性,分析 GSH-PX、MDA、8-OHdG 水平对 AECOPD 及预后的预测价值。结果 观察组 GSH-PX 水平低于对照组,MDA、8-OHdG 水平高于对照组(P0.05);重度组 GSH-PX 水平低于中、轻度组,MDA、8-OHdG 水平高于中、轻度组,中度组 GSH-PX 水平低于轻度组,MDA、8-OHdG 水平高于轻度组(P0.05)。AECOPD 严重程度与 GSH-PX 水平呈负相关,与 MDA、8-OHdG 水平呈正相关(P0.05)。GSH-PX、MDA、8-OHdG 联合预测AECOPD 的灵敏度为 95.32%、AUC 为 0.943,均高于单独诊断(P0.05)。存活组 GSH-PX 水平高于死亡组,MDA、8-OHdG水平低于死亡组(P0.05);GSH-PX、MDA、8-OHdG 联合预测 AECOPD 预后的敏感度为88.50%,AUC 为0.863,高于单独检测(P0.05)。结论 AECOPD 患者外周血 GSH-PX 降低和 MDA、8-OHdG 水平升高与病情严重程度有关,且三者联合预测AECOPD 及预后价值较高,可为临床诊治提供参考,可进一步推广。关键词 慢性阻塞性肺疾病急性加重期;谷胱甘肽过氧化酶;丙二醛;8-羟基脱氧鸟苷;病情严重程度中图分类号 R563 文献标志码 A 文章编号 1672-6170(2023)03-0058-05Discussion on the detection value of glutathione peroxidase,malondialdehyde and 8-hydroxydeoxyguanosine in acute exacerbation of chronic obstructive pulmonary disease ZHENG Hai鄄ru,WU Xiong鄄jun,XU Wen鄄bin(The Second Affiliated Hospital of Hainan Medical College,Haikou 570311,China)Abstract Objective To analyze the correlation between the levels of peripheral blood glutathione peroxidase(GSH-PX),malondialdehyde(MDA)and 8-hydroxy-2 deoxyguanosine(8-OHdG)and the severity of acute exacerbation of chronic obstructive pul-monary disease(AECOPD).Methods A total of 128 patients with AECOPD admitted to our hospital were selected as an observationgroup.Another 100 healthy individuals were selected as a control group.According to simple acute physiology score(SAPS II),thepatients in the observation group were divided into a mild group(20-29 scores,n=42),a moderate group(30-39 score,n=46)and asevere group(40,n=40).According to the prognosis,the patients were divided into a survival group(n=98)and a death group(n=30).Levels of peripheral blood GSH-PX,MDA and 8-OHdG were measured,and their correlation with the severity of AECOPDwas analyzed.The predictive value of the three indexes for AECOPD and the prognosis was also analyzed.Results Peripheral bloodGSH-PX level in the observation group was lower than that in the control group,and the levels of MDA and 8-OHdG were higher thanthose in the control group(P0.05).The level of GSH-PX in the severe group was lower than that of the moderate and the mildgroups,and the levels of MDA and 8-OHdG in the severe group were higher than those of the moderate and the mild groups(P0.05).The level of GSH-PX in the moderate group was lower than that of the mild group,and the levels of MDA and 8-OHdG in themoderate group were higher than those in the mild group(P0.05).The severity of AECOPD was negatively correlated with GSH-PX,and positively correlated with MDA and 8-OHdG(P0.05).The sensitivity and area under ROC curve(AUC)of the combination ofGSH-PX,MDA and 8-OHdG to predict AECOPD were 95.32%and 0.943,respectively,which were higher than those of each index(P0.05).GSH-PX level in the survival group was higher than that in the death group,and the levels of MDA and 8-OHdG werelower than those in the death group(P0.05).The sensitivity and AUC of the combination of the three indexes to predict theprognosis of AECOPD were 88.50%and 0.863,respectively,which were higher than those of each index(P0.05)。见表 1。本研究经医院伦理委员会批准。表 1 观察组和对照组一般资料比较组别性别n(%)男女年龄(岁)COPD 病程(年)观察组(n=128)74(57.81)54(42.19)66.235.775.071.33 轻度组25(59.52)17(40.48)65.215.634.761.25 中度组27(58.70)19(41.30)65.035.574.261.18 重度组22(55.00)18(45.00)65.485.764.451.22对照组(n=100)58(58.00)42(42.00)66.805.925.231.40统计量2=0.001t=0.732t=0.881P0.9770.4650.3791.2 方法1.2.1 病情严重程度评估 采用简化急性生理学评分(SAPS)9评估,共 17 项,每项最低 0 分,最高 26 分,总分越高病情越重。1.2.2 外周血 GSH-PX、MDA、8-OHdG 水平测定 于入院当天抽取外周静脉血 5 ml,3000 r/min 下离心5 min,进行离心沉淀细胞,-70 保存,比色法测定 GSH-PX,硫代巴比妥酸法测定 MDA,双抗夹心酶联免疫法检测 8-OHdG 水平。1.2.3 预后 采用电话、门诊行 28 d 随访,记录生存情况。1.3 统计学方法 采用 SPSS 20.0 软件处理数据。计量资料以均数标准差表示,组间比较采用单因素方差分析及 t 检验;采用 ROC 曲线评价指标对AECOPD 及预后的诊断价值;相关性分析采用Spearman 分析。P0.05 为差异有统计学意义。2 结果2.1 观察组和对照组 GSH-PX、MDA、8-OHdG 水平比较 观察组 GSH-PX 低于对照组,MDA、8-OHdG 高于对照组(P0.05)。见表 2。表 2 观察组和对照组 GSH-PX、MDA、8-OHdG 水平比较组别GSH-PX(kU/L)MDA(mol/L)8-OHdG(ng/ml)观察组(n=128)136.3010.708.702.3110.691.73对照组(n=100)197.2616.303.850.442.150.16t33.97620.78049.177P0.0010.0010.0012.2 不同病情严重程度 AECOPD 患者 GSH-PX、MDA、8-OHdG 水平比较 重度组 GSH-PX 低于中、轻度组,MDA、8-OHdG 高于中、轻度组;中度组GSH-PX 低于轻度组,MDA、8-OHdG 高于轻度组(P0.05)。见表 3。2.3 外 周 血 GSH-PX、MDA、8-OHdG 水 平 与AECOPD 病情程度的相关性分析 AECOPD 病情严重程度与 GSH-PX 呈负相关,(r=-0.814,P 0.05),与 MDA、8-OHdG 呈正相关(r=0.877,r=0.769,P0.05)。2.4 外周血 GSH-PX、MDA、8-OHdG 水平诊断AECOPD 效能分析 ROC 曲线显示,GSH-PX、MDA、8-OHdG 联合预测 AECOPD 的灵敏度和 AUC高于单独诊断(P0.05)。见表 4 和图 1。95 实用医院临床杂志 2023 年 5 月第 20 卷第 3 期 表 3 不同病情严重程度 AECOPD 患者 GSH-PX、MDA、8-OHdG 水平比较组别GSH-PX(kU/L)MDA(mol/L)8-OHdG(ng/ml)轻度组(n=42)151.2913.47*#5.671.22*#6.300.75*#中度组(n=46)