慢性阻塞性肺疾病患者肺功能MMEF/FVC与FeNO、血清标志物的相关性及意义

朱能洋; 韩志海; 陈旭昕; 张燕; 赖莉芬; 丁静; 刘方; 孟激光

doi:10.3969/j.issn.2095-5227.2022.04.001

慢性阻塞性肺疾病患者肺功能MMEF/FVC与FeNO、血清标志物的相关性及意义

Correlation between MMEF/FVC, FeNO and serum biomarkers and their clinical significance in patients with COPD

摘要

摘要:
背景既往研究发现最大中期呼气流量(maximal mid-expiratory flow，MMEF)与用力肺活量(forced vital capacity，FVC)的比值可反映慢性阻塞性肺疾病(chronic obstructive pulmonary disease，COPD)患者小气道功能，而在COPD患者中MMEF/FVC、呼出气一氧化氮(fractional exhaled nitric oxide，FeNO)和血清标志物的相关性及意义尚不清楚。
目的探索COPD患者MMEF/FVC、FeNO和血清标志物之间的相关性及意义。
方法纳入2020年1月- 2021年1月解放军总医院第六医学中心149例患者，其中COPD组58例，COPD风险组44例，健康对照组47例。比较三组受试者MMEF/FVC、FeNO、白细胞介素-6(interleukin-6，IL-6)、C反应蛋白(C-reactive protein，CRP)、肺泡表面蛋白D(surface protein D，SP-D)的表达水平及之间的相关性，并分析MMEF/FVC、FeNO联合不同血清标志物在COPD诊断中的预测价值。
结果 MMEF/FVC值在COPD组、COPD风险组、健康对照组依次升高，差异有统计学意义(P均＜0.05)；而FeNO水平依次降低，差异有统计学意义(P均＜0.05)；COPD组血清IL-6、SP-D水平高于COPD风险组和健康对照组(P均＜0.05)；三组患者中FeNO、血清标志物(IL-6、CRP、SP-D)与MMEF/FVC均低度负相关(FeNO：r=-0.289，P＜0.001；IL-6：r=-0.296，P＜0.001；CRP：r=-0.255，P=0.002；SP-D：r=-0.177，P=0.031)。血清标志物(IL-6、CRP)与FeNO呈中度正相关(分别为IL-6：r=0.323，P＜0.001；CRP：r=0.434，P＜0.001)。MMEF/FVC联合FeNO与血清标志物诊断COPD风险的受试者工作曲线下面积为0.696，95% CI为0.588～0.804。
结论 MMEF/FVC、FeNO和血清标志物之间存在一定的相关性，可作为反映COPD患者疾病严重程度的指标，联合筛查的方式可提高COPD高风险人群的识别能力。

Abstract:
Background Previous studies have found that the ratio of maximal mid-expiratory flow (MMEF) to forced vital capacity (FVC) can reflect the function of small airway in patients with chronic obstructive pulmonary disease (COPD). But the correlation between MMEF/FVC, fractional exhaled nitric oxide (FeNO), and serum biomarkers, and their clinical significance in patients with COPD are still unclear.
Objective To investigate the correlation between MMEF/FVC, FeNO, and serum biomarkers, and their significance in patients with COPD.
Methods From January 2020 to January 2021, 149 subjects in the Sixth Medical Center of Chinese PLA General Hospital were enrolled. There were 58 cases in the COPD group, 44 cases in the COPD risk group, and 47 cases in the healthy control group. The values of MMEF/FVC, FeNO, interleukin-6 (IL-6), C-reactive protein (CRP), and surface protein D (SP-D) among the three groups were compared, and then the correlation between them and the predictive value of MMEF/FVC were analyzed.
Results The value of MMEF/FVC was the highest in the healthy control group, followed by the COPD risk group, and the lowest in the COPD group (P ＜ 0.05), while the FeNO level was the highest in the COPD group, followed by the COPD risk group, and the lowest in the healthy control group (P ＜ 0.05). The levels of serum IL-6 and SP-D in the COPD group were higher than those in the COPD risk group and healthy control group (all P ＜ 0.05). FeNO (r=-0.289, P＜0.001), serum biomarkers (IL-6 r=-0.296, P＜0.001, CRP r=-0.255, P=0.002, SP-D r=-0.177, P=0.031) were all lowly negatively correlated with MMEF/FVC in the three groups of subjects. Serum biomarkers (IL-6 r=0.323, P＜0.001, CRP r= 0.434, P＜0.001 ) were moderately positively correlated with FeNO. The area under the receiver operating characteristic curve of diagnosing COPD risk group by combing MMEF/FVC with FeNO and serum biomarkers was 0.696, and the 95% confidence interval was 0.588-0.804.
Conclusion There are correlations between MMEF/FVC, FeNO and serum biomarkers, which can be used as indicators to reflect the severity of COPD. The combined screening can improve the ability to identify high-risk groups of COPD.

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