Based on ROC to explore the relationship between the changes of serum α1-AT and NE levels and the severity of AECOPD and the value of predicting respiratory failure
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摘要: 目的 基于受试者工作特征(ROC)曲线探讨慢阻肺急性加重期(AECOPD)患者血清α1-抗胰蛋白酶(α1-AT)、嗜中性粒细胞弹性蛋白酶(NE)水平变化与病情程度间关系及预测呼吸衰竭的价值。方法 选取2018年2月-2020年2月期间我院AECOPD患者94例作为观察组，同期稳定期COPD患者44例作为对照组。比较两组血清α1-AT、NE水平及不同病情程度AECOPD患者血清α1-AT、NE水平，分析AECOPD患者血清α1-AT、NE水平与病情程度相关性，logistic回归分析AECOPD并发呼吸衰竭的影响因素，ROC曲线分析血清α1-AT、NE水平对AECOPD并发呼吸衰竭的预测价值。结果 观察组血清α1-AT、NE水平高于对照组(P < 0.05)；随AECOPD病情程度增加，血清α1-AT、NE水平逐渐升高(P < 0.05)；AECOPD患者血清α1-AT、NE水平与病情程度相关性呈正相关关系(P < 0.05)；AECOPD并发呼吸衰竭患者血清α1-AT、NE水平高于未并发呼吸衰竭患者(P < 0.05)；logistic回归分析显示，血清α1-AT、NE水平升高均为AECOPD并发呼吸衰竭的危险因素(P < 0.05)；ROC曲线显示，血清α1-AT、NE联合预测AECOPD并发呼吸衰竭的AUC值0.841最大，对应敏感度为72.73%，特异度为85.25%。结论 AECOPD患者血清α1-AT、NE表达明显升高，与病情程度呈正相关，且血清α1-AT、NE水平与AECOPD患者发生呼吸衰竭有关，通过测定其水平可有效预测呼吸衰竭发生风险，为临床治疗提供指导。
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关键词:
- 慢阻肺急性加重期 /
- α1-抗胰蛋白酶 /
- 嗜中性粒细胞弹性蛋白酶 /
- 病情程度 /
- 呼吸衰竭
Abstract: Objective To explore the relationship between the changes in serum α1-antitrypsin (α1-AT) and neutrophil elastase (NE) levels and the severity of the disease in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and predicting the value of respiratory failure based on the receiver operating characteristic (ROC) curve.Methods From February 2018 to February 2020, 94 patients with AECOPD in our hospital were selected as the observation group, and 44 patients with stable COPD were selected as the control group during the same period. The levels of serum α1-AT and NE in the two groups and the levels of serum α1-AT and NE in patients with different degrees of AECOPD were compared. The correlation between serum α1-AT and NE levels and the degree of AECOPD was analyzed. logistic regression was used to analyze the influencing factors of AECOPD complicated with respiratory failure. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum α1-AT and NE levels for AECOPD complicated with respiratory failure.Results The serum levels of α1-AT and NE in the observation group were higher than those in the control group (P＜0.05).Serum α1-AT and NE levels gradually increased with the increase of AECOPD severity (P < 0.05). The serum levels of α1-AT and NE were positively correlated with the severity of AECOPD (P＜0.05).The serum levels of α1-AT and NE in AECOPD patients complicated with respiratory failure were higher than those without respiratory failure (P＜0.05). logistic regression analysis showed that elevated serum levels of α1-AT and NE were risk factors for AECOPD complicated with respiratory failure (P＜0.05).The ROC curve showed that serum α1-AT and NE combined to predict AECOPD complicated with respiratory failure had the highest AUC value of 0.841, corresponding sensitivity of 72.73% and specificity of 85.25%.Conclusion The expression of serum α1-AT and NE in AECOPD patients is significantly increased, which is positively correlated with the severity of the disease, and the serum α1-AT and NE levels are related to the occurrence of respiratory failure in patients with AECOPD. The determination of serum α1-AT and NE levels can effectively predict the risk of respiratory failure and provide guidance for clinical treatment. -
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表 1 两组血清α1-AT、NE水平对比
x±S 组别 例数 α1-AT/(mg·L-1) NE/(μg·L-1) 观察组 94 10.37±2.21 249.84±39.86 对照组 44 6.14±1.58 124.38±24.37 t 11.396 19.241 P < 0.001 < 0.001 
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表 2 不同病情程度AECOPD患者血清α1-AT、NE水平
x±S 病情程度 例数 α1-AT/(mg·L-1) NE/(μg·L-1) 轻度 32 8.25±1.86 206.52±36.08 中度 36 10.29±2.17 247.37±35.72 重度 26 13.09±2.39 306.58±46.87 F 36.857 46.815 P < 0.001 < 0.001
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表 3 AECOPD并发呼吸衰竭的单因素分析
例(%)，x±S 相关因素 并发呼吸衰竭(33例) 未并发呼吸衰竭(61例) t/χ2 P 性别 男 21(63.64) 41(67.21) 0.122 0.727 女 12(36.36) 20(32.79) 年龄/岁 < 60 9(27.27) 32(52.46) 5.524 0.019 ≥60 24(72.73) 29(47.54) 病程/年 < 10 8(24.24) 34(55.74) 8.594 0.003 ≥10 25(75.76) 27(44.26) 肺功能 FEV1/L 0.91±0.27 1.17±0.35 3.709 < 0.001 FVC/L 1.71±0.38 2.13±0.42 4.781 < 0.001 α1-AT/(mg·L-1) 12.31±3.09 9.32±2.41 5.190 < 0.001 NE/(μg·L-1) 271.56±41.86 238.09±33.42 4.235 < 0.001
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表 4 AECOPD并发呼吸衰竭的多因素分析
相关因素 β S.E. Wald χ2 P OR 95%CI α1-AT 1.552 0.497 9.752 < 0.001 4.721 3.257~6.843 NE 1.493 0.512 8.497 < 0.001 4.448 2.815~7.029 赋值：α1-AT、NE水平以均值为界， < 均值赋值为1，≥均值赋值为2
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表 5 血清α1-AT、NE水平对AECOPD并发呼吸衰竭的预测价值
指标 AUC 95%CI Z P cut-off值 敏感度/% 特异度/% α1-AT 0.758 0.659~0.840 4.577 < 0.001 >10.31 μg/mL 72.73 73.77 NE 0.712 0.610~0.801 3.693 < 0.001 >257.17 ng/mL 67.58 78.69 联合 0.841 0.751~0.908 7.847 < 0.001 72.73 85.25
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