2024 年第 7 期 第 0 卷

血清标志物对老年慢性阻塞性肺疾病合并肺部感染临床诊断及预后评估的价值分析

Clinical diagnosis and prognostic value of serum markers in elderly patients with chronic obstructive pulmonary disease complicated with pulmonary infection

作者：王宛莹1史展2贺思琪3王子旋1王宝增1

英文作者：Wang Wanying1 Shi Zhan2 He Siqi3 Wang Zixuan1 Wang Baozeng1

单位：1首都医科大学附属北京天坛医院感染科，北京100070；2北京医院重症医学科，北京100050；3首都医科大学附属北京天坛医院呼吸科，北京100070

英文单位：1Department of Infectious Diseases Beijing Tiantan Hospital Capital Medical University Beijing 100070 China; 2Department of Critical Care Medicine Beijing Hospital Beijing 100050 China; 3Department of Respiratory Medicine Beijing Tiantan Hospital Capital Medical University Beijing 100070 China

关键词：慢性阻塞性肺疾病；肺部感染；生长停滞特异性蛋白6；纤溶酶原激活物抑制剂1；血清胆碱酯酶

英文关键词：Chronicobstructivepulmonarydisease;Pulmonaryinfection;Growtharrestspecificprotein6;Plasminogenactivatorinhibitor-1;Serumcholinesterase

• 摘要：

• 目的 探讨血清生长停滞特异性蛋白6（Gas6）、纤溶酶原激活物抑制剂1（PAI-1）和血清胆碱酯酶（S-ChE）对老年慢性阻塞性肺疾病（COPD）合并肺部感染临床诊断及预后评估的价值。方法 选择首都医科大学附属北京天坛医院2021年1月至2023年1月收治的106例COPD合并肺部感染患者作为感染组，另纳入同期111例COPD未合并肺部感染患者作为非感染组。根据预后情况将感染组患者分为生存组（83例）与死亡组（23例）。比较非感染组和感染组患者血清Gas6、PAI-1、S-ChE水平。比较生存组和死亡组患者一般资料。采用受试者工作特征曲线分析血清Gas6、PAI-1和S-ChE对老年COPD患者发生肺部感染以及肺部感染患者发生死亡的预测价值；采用多因素Logistic回归方法分析影响老年COPD合并肺部感染患者预后的因素。结果 感染组血清Gas6、PAI-1水平高于非感染组，S-ChE水平低于非感染组，差异均有统计学意义（均P＜0.001）。受试者工作特征曲线分析结果显示，血清Gas6、PAI-1、S-ChE及三者联合诊断COPD患者发生肺部感染的曲线下面积分别为0.787、0.797、0.782、0.889，三者联合诊断的曲线下面积高于各自单独诊断（Z=4.527、5.435、4.167，均P＜0.001）。死亡组COPD全球倡议Ⅲ级、合并糖尿病比例以及血清Gas6、PAI-1水平高于生存组，第1秒用力呼气容积占预计值百分比、第1秒用力呼气容积与用力肺活量比值以及S-ChE水平低于生存组（均P＜0.05）。多因素Logistic回归分析结果显示，Gas6、PAI-1是老年COPD并发肺部感染患者发生死亡的危险因素，S-ChE是保护因素（均P＜0.05）。受试者工作特征曲线分析结果显示血清Gas6、PAI-1、S-ChE三者联合诊断COPD合并肺部感染患者死亡的曲线下面积高于各自单独检测（均P＜0.05）。结论 老年COPD合并肺部感染患者血清Gas6、PAI-1水平升高，S-ChE水平降低，三者对疾病的临床诊断和预后评估具有一定的价值。

• Objective To investigate the clinical diagnosis and prognostic value of serum growth arrest specific protein 6 (Gas6), plasminogen activator inhibitor-1 (PAI-1) and serum cholinesterase (S-ChE) in elderly patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary infection. Methods A total of 106 COPD patients with pulmonary infection admitted to Beijing Tiantan Hospital, Capital Medical University from January 2021 to January 2023 were selected as the infection group, and 111 COPD patients without pulmonary infection during the same period were included as the non-infection group. According to the prognosis, the patients in the infection group were divided into survival group (83 cases) and death group (23 cases). The serum Gas6, PAI-1 and S-ChE levels were compared between the non-infection group and the infection group. The general data of the survival group and the death group were compared. Receiver operating characteristic curve was used to analyze the predictive value of serum Gas6, PAI-1 and S-ChE for pulmonary infection and death in elderly COPD patients. Multivariate Logistic regression was used to analyze the factors affecting the prognosis of elderly COPD patients with pulmonary infection. Results  The levels of serum Gas6 and PAI-1 in the infection group were higher than those in the non-infection group, and the level of S-ChE was lower than that in the non-infection group (all P<0.001). The results of receiver operating characteristic curve showed that the area under the curve of serum Gas6, PAI-1, S-ChE and their combination in the diagnosis of pulmonary infection was 0.787, 0.797, 0.782, 0.889, respectively. The area under the curve of the combined diagnosis of the three was higher than that of their individual diagnosis （Z=4.527, 5.435, 4.167; all P＜0.001）. The proportions of patients with GOLD grade Ⅲ and diabetes mellitus, and the levels of serum Gas6 and PAI-1 in the death group were higher than those in the survival group; the levels of ratio of forced expiratory volume in the first second to percentage of expected value, forced expiratory volume in the first second/forced vital capacity ratio and S-ChE were lower than those in the survival group (all P<0.05). Multivariate Logistic regression analysis showed that Gas6 and PAI-1 were risk factors for death in elderly patients with COPD complicated with pulmonary infection, and S-ChE was a protective factor (all P<0.05). The receiver operating characteristic curve showed that the area under the curve of the combined diagnosis of serum Gas6, PAI-1 and S-ChE was higher than that of their individual detection (all P<0.05). Conclusion  The levels of serum Gas6 and PAI-1 are increased and S-ChE is decreased in elderly COPD patients with pulmonary infection, which has certain value in the clinical diagnosis and prognosis evaluation of the disease.