慢性阻塞性肺疾病急性加重患者血浆CC16的动态变化及临床意义
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摘要
目的观察慢性阻塞性肺疾病(简称慢阻肺)急性加重患者血浆Clara细胞分泌蛋白(CC16)的动态变化,探讨其在疾病发生发展过程中的作用与临床意义。方法慢阻肺急性加重患者71例作为观察组,于入院后第1天和第7天完成CAT评分及采取静脉血2 ml,并记录患者第1秒用力呼气容积占预计值百分比(FEV_1%pred)、用力肺活量占预计值百分比(FVC%pred)、FEV_1和FVC的比值(FEV_1/FVC)、动脉血二氧化碳分压(PaCO_2)、白细胞计数(WBC)、中性粒细胞百分比(NEUT%)、C反应蛋白(CRP)、降钙素原(PCT)、住院时间。健康成年人20例作为对照组,采取静脉血2 ml。检测比较两组血浆CC16水平及其动态变化,并分析其与CAT评分、住院时间的相关性。结果慢阻肺急性加重患者血浆CC16水平较对照组显著降低,肺功能明显低于健康对照组,WBC、NEUT%较健康对照组均明显升高,差异均具有统计学意义(P<0.05)。与入院第1天相比,慢阻肺急性加重患者入院第7天的血浆CC16水平、CAT评分、PaCO_2、WBC、NEUT%、CRP、PCT均明显降低,差异均有统计学意义(P<0.05)。慢阻肺急性加重患者血浆CC16水平与其CAT评分呈负相关(r=–0.704,P<0.001),与住院时间呈负相关(r=–0.351,P=0.003)。结论 CC16参与慢阻肺急性加重的发生发展过程,并与疾病的严重程度及预后密切相关,其动态变化可用于预测慢阻肺急性加重患者的病情变化及评估其临床治疗效果,结合临床常用指标综合分析可缩短住院时间。
Objective To observe the dynamic changes of plasma Clara cell secretory protein(CC16) in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD), and to explore its role in the occurrence and development of the disease and clinical significance. Methods A total of 71 AECOPD patients were included in this study as observation group. All subjects completed the CAT questionnaire and were sampled 2 ml of venous blood on day1 and day 7 after their admission. And the percentage of forced expiratory volume in the first second(FEV_1% pred),percentage of forced vital capacity in the estimated value(FVC%pred), FEV_1/FVC ratio, arterial partial pressure of carbon dioxide(PaCO_2), white blood cell count(WBC), the proportion of neutrophils(NEUT%), C-reactive protein(CRP),procalcitonin(PCT) and the length of stay of subjects were recorded. Another 20 healthy adults were enrolled as the control group. Each subject of the control group was sampled 2 ml of venous blood. The plasma CC16 levels of the two groups were tested and compared, and analyzed its correlation with CAT score and length of stay. Results The plasma CC16 level of AECOPD patients was significantly lower than that of the control group, lung function was significantly lower than that of the healthy control group, WBC and NEUT% were significantly higher than that of the healthy control group, and the difference was statistically significant(P<0.05). Compared with day 1 after admission, the plasma CC16 level, CAT score, PaCO_2, WBC, NEUT%, CRP, PCT of AECOPD patients on day 7 were significantly decreased, with statistically significant differences(P<0.05). The plasma CC16 level of AECOPD patients was negatively correlated with their CAT score(r=–0.704, P<0.001), and also was negatively correlated with the length of stay(r=–0.351, P=0.003).Conclusions CC16 is involved in the development and progression of AECOPD and closely related to the severity and prognosis of the disease. Its dynamic changes can predict the condition changes and evaluate the clinical treatment effect of patients with AECOPD. Combined with common clinical indicators, CC16 can shorten the length of stay of patients.
Objective To observe the dynamic changes of plasma Clara cell secretory protein(CC16) in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD), and to explore its role in the occurrence and development of the disease and clinical significance. Methods A total of 71 AECOPD patients were included in this study as observation group. All subjects completed the CAT questionnaire and were sampled 2 ml of venous blood on day1 and day 7 after their admission. And the percentage of forced expiratory volume in the first second(FEV_1% pred),percentage of forced vital capacity in the estimated value(FVC%pred), FEV_1/FVC ratio, arterial partial pressure of carbon dioxide(PaCO_2), white blood cell count(WBC), the proportion of neutrophils(NEUT%), C-reactive protein(CRP),procalcitonin(PCT) and the length of stay of subjects were recorded. Another 20 healthy adults were enrolled as the control group. Each subject of the control group was sampled 2 ml of venous blood. The plasma CC16 levels of the two groups were tested and compared, and analyzed its correlation with CAT score and length of stay. Results The plasma CC16 level of AECOPD patients was significantly lower than that of the control group, lung function was significantly lower than that of the healthy control group, WBC and NEUT% were significantly higher than that of the healthy control group, and the difference was statistically significant(P<0.05). Compared with day 1 after admission, the plasma CC16 level, CAT score, PaCO_2, WBC, NEUT%, CRP, PCT of AECOPD patients on day 7 were significantly decreased, with statistically significant differences(P<0.05). The plasma CC16 level of AECOPD patients was negatively correlated with their CAT score(r=–0.704, P<0.001), and also was negatively correlated with the length of stay(r=–0.351, P=0.003).Conclusions CC16 is involved in the development and progression of AECOPD and closely related to the severity and prognosis of the disease. Its dynamic changes can predict the condition changes and evaluate the clinical treatment effect of patients with AECOPD. Combined with common clinical indicators, CC16 can shorten the length of stay of patients.
引文
1 Global Initiative for Chronic Obstructive Lung Disease(GOLD):Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease.(2017 REPORT).http://goldcopd.org.
2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).国际呼吸杂志,2017, 37(14):1041-1057.
3 Celli BR, Owen CA. The club cell and its protein, CC16:time to shine. Lancet Respir Med, 2013,1(10):757-759.
4 McAuley DF, Matthay MA. Clara cell protein CC16:a new lung epithelial biomarker for acute lung injury. Chest, 2009, 135(6):1408-1410.
5 Broeckaert F, Bernard A. Clara cell secretory protein(CC16):characteristics and perspectives as lung peripheral biomarker. Clin Exp Allergy, 2000, 30(4):469-475.
6 Laucho-Contreras ME, Polverino F, Gupta K, et al. Protective role for club cell secretory protein-16(CC16)in the development of COPD. Eur Respir, 2015, 45(6):1544-1556.
7 Long XB, Hu S, Wang N, et al. Clara cell 10-kDa protein gene transfection inhibits NF-kappaB activity in airway epithelial cells.PloS One, 2012, 7:e35960.
8 Lomas DA, Silverman EK, Edwards LD, et al. Evaluation of serum CC16 as a biomarker for COPD in the ECLIPSE cohort. Thorax,2008,63(12):1058-1063.
9 Zhu L, Di PY, Wu R,et al. Repression of CC16 by cigarette smoke(CS)exposure. PloS One, 2015, 10(1):e0116159.
10 Petersen H, Leng S, Belinsky SA, et al. Low plasma CC16 levels in smokers are associated with a higher risk for chronic bronchitis.Eur Respir J, 2015,46(5):1501-1503.
11 Laucho-Contreras ME, Polverino F, Tesfaigzi Y, et al. Club cell protein 16(CC16)augmentation:a potential disease-modifying approach for chronic obstructive pulmonary disease(COPD).Expert Opin Ther Targets, 2016, 20(7):869-883.
12 Park HY, Churg A, Wright J, et al. Club cell protein 16 and disease progression in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2013,188(12):1413-1419.
13袁泉,李斌,陈果.无创正压通气对AECOPD并发呼吸衰竭患者血清KL-6、CC16及和肽素水平的影响.标记免疫分析与临床,2017,24(9):1028-1032.
14王文学,吴飞燕,黄文溪.痰热清治疗慢性阻塞性肺疾病患者肺部感染疗效及对肺表面活性蛋白与克拉氏细胞蛋白的影响.中华医院感染学杂志,2015, 25(6):1309-1311.
15程艳慧,张勇,何东初.COPD患者血清IL-4、IL-8、TNF-α、CC16水平变化与气道炎症损伤的探讨.临床肺科杂志,2010, 15(5):661-663.
2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).国际呼吸杂志,2017, 37(14):1041-1057.
3 Celli BR, Owen CA. The club cell and its protein, CC16:time to shine. Lancet Respir Med, 2013,1(10):757-759.
4 McAuley DF, Matthay MA. Clara cell protein CC16:a new lung epithelial biomarker for acute lung injury. Chest, 2009, 135(6):1408-1410.
5 Broeckaert F, Bernard A. Clara cell secretory protein(CC16):characteristics and perspectives as lung peripheral biomarker. Clin Exp Allergy, 2000, 30(4):469-475.
6 Laucho-Contreras ME, Polverino F, Gupta K, et al. Protective role for club cell secretory protein-16(CC16)in the development of COPD. Eur Respir, 2015, 45(6):1544-1556.
7 Long XB, Hu S, Wang N, et al. Clara cell 10-kDa protein gene transfection inhibits NF-kappaB activity in airway epithelial cells.PloS One, 2012, 7:e35960.
8 Lomas DA, Silverman EK, Edwards LD, et al. Evaluation of serum CC16 as a biomarker for COPD in the ECLIPSE cohort. Thorax,2008,63(12):1058-1063.
9 Zhu L, Di PY, Wu R,et al. Repression of CC16 by cigarette smoke(CS)exposure. PloS One, 2015, 10(1):e0116159.
10 Petersen H, Leng S, Belinsky SA, et al. Low plasma CC16 levels in smokers are associated with a higher risk for chronic bronchitis.Eur Respir J, 2015,46(5):1501-1503.
11 Laucho-Contreras ME, Polverino F, Tesfaigzi Y, et al. Club cell protein 16(CC16)augmentation:a potential disease-modifying approach for chronic obstructive pulmonary disease(COPD).Expert Opin Ther Targets, 2016, 20(7):869-883.
12 Park HY, Churg A, Wright J, et al. Club cell protein 16 and disease progression in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2013,188(12):1413-1419.
13袁泉,李斌,陈果.无创正压通气对AECOPD并发呼吸衰竭患者血清KL-6、CC16及和肽素水平的影响.标记免疫分析与临床,2017,24(9):1028-1032.
14王文学,吴飞燕,黄文溪.痰热清治疗慢性阻塞性肺疾病患者肺部感染疗效及对肺表面活性蛋白与克拉氏细胞蛋白的影响.中华医院感染学杂志,2015, 25(6):1309-1311.
15程艳慧,张勇,何东初.COPD患者血清IL-4、IL-8、TNF-α、CC16水平变化与气道炎症损伤的探讨.临床肺科杂志,2010, 15(5):661-663.