Screening for and combining serum intestinal barrier-related biomarkers to predict the disease severity of AECOPD
Screening for and combining serum intestinal barrier-related biomarkers to predict the disease severity of AECOPD
复制标题
筛选并结合血清肠屏障相关生物标志物来预测 AECOPD 的疾病严重程度。
DOI：
10.21037/apm-20-1060
复制
发表时间：
2021-02-01
影响因子：
--
通讯作者：
Xiao，Weidong
中科院分区：
文献类型：
--
作者：
Yin，Jiuheng;Wang，Shuai;Xiao，Weidong
背景
AECOPD患者肠道缺血、缺氧、氧化应激，导致肠道屏障功能衰竭。因此，需要筛选有效的肠屏障相关生物标志物来监测疾病的严重程度。
方法
我们在40例AECOPD患者和10例稳定期COPD患者中进行了一项前瞻性观察研究。记录血清I-FABP、瓜氨酸、D-乳酸、DAO和α-GST水平以及APACHE II评分。采用个人相关分析、Logistic回归模型和受试者工作特征曲线（ROC曲线）分析。
结果
AECOPD患者的I-FABP、D-乳酸和DAO水平显著高于稳定期COPD患者。COPD稳定期患者血清瓜氨酸水平较AECOPD组明显降低，而α-GST无明显变化。此外，我们观察到重度COPD患者的I-FABP、D-乳酸盐和DAO水平高于非重度COPD患者，瓜氨酸水平低于非重度COPD患者[APACHE II（非重度COPD）<20; APACHE II（重度COPD）≥20]。相关分析显示I-FABP和D-乳酸与APACHE II评分呈显著正相关，瓜氨酸与APACHE II评分呈显著负相关。治疗后，I-FABP和D-乳酸水平降低，瓜氨酸水平升高。此外，我们通过逐步Logistic回归分析筛选出瓜氨酸和DAO，它们独立影响重度COPD的诊断。此外，我们发现血清瓜氨酸和DAO的组合可以比任何单一生物标志物更有效地诊断重度COPD，这可能是一种可用于临床的支持性和方便的方法。
结论
血清I-FABP、瓜氨酸和D-乳酸可作为判断病情严重程度的指标。瓜氨酸和DAO可以诊断重度COPD，联合用药更有效。
BACKGROUND
In the patients with AECOPD, the gut displays ischemia, anoxia and oxidative stress, which lead to the intestinal barrier failure. Therefore, it is desirable to screen for effective intestinal barrier-related biomarkers to monitor the disease severity.
METHODS
We conducted a prospective observational study in 40 patients with AECOPD and 10 patients with stable COPD. The serum levels of I-FABP, citrulline, D-Lactate, DAO, and α-GST, as well as the APACHE II scores were recorded. Person correlation analysis, logistic regression models and receiver operating characteristic (ROC) curve analyses were used in our study.
RESULTS
Patients with AECOPD had significantly higher levels of I-FABP, D-Lactate, and DAO than did those with stable COPD. However, the serum citrulline level was significantly decreased in the patients with stable COPD than in those with AECOPD and the serum α-GST was not significantly changed. Additionally, we observed that there was a higher levels of I-FABP, D-Lactate, and DAO and a lower level of citrulline in patients with severe COPD than in patients with nonsevere COPD [APACHE II (nonsevere COPD) <20; APACHE II (severe COPD) ≥20]. Correlation analysis showed that I-FABP and D-Lactate had a significantly positive correlations with the APACHE II score, and citrulline had a significantly negative correlations with the APACHE II score. Following, treatment, the levels of I-FABP and D-lactate were decreased and the level of citrulline was increased. Moreover, we screened out the citrulline and DAO, which independently affected the diagnosis of severe COPD by stepwise logistics regression analysis. Additionally, we found that the combination of serum citrulline and DAO can more effectively diagnose the severe COPD than any single biomarker can, which may be a supportive and convenient method that can be used clinically.
CONCLUSIONS
Serum I-FABP, citrulline and D-Lactate could be used to assess the disease severity. Citrulline and DAO can diagnose the severe COPD and the combination is more effective.