Clinical Significance Of Fibrinogen And Pre-albumin Ratioin In Chronic Obstructive Pulmonary Disease

Background and ObjectiveChronic obstructive pulmonary disease（COPD）is a chronic respiratory disease characterized by progressive breathing difficulties and decreased lung function,which has becomed an important global health problem due to its high prevalence,poor survival and prognosmation,and heavy socio-economic burden.Acute exacerbation of COPD（AECOPD）is an important cause affecting the quality of life of COPD patients,causing damage to lung function and causing financial burden,so early diagnosis and early treatment of COPD patients is an important part of COPD management.Lung function testing is the gold standard for clinical diagnosis of slow-blocking lungs and assessment of the degree of air flow restriction,but the measurement value of lung function is easily affected by a variety of factors,and when patients have acute breathing difficulties,active hemoptysis,unstable vital signs,etc,can not complete the lung function test,affecting the assessment of the disease.Therefore,it is necessary to identify the conventional test indicators that can be used to assist in the diagnosis of COPD,to identify the different course stages of COPD and to assess airflow constraints to meet the clinical management needs of COPD patients in different situations.Fibrinogen-to-Prealbumin ratio（FPR）is a new inflammatory index that combines fibrinogen and pre-albumin to reflect the body’s blood clotting and nutritional status,and several studies have confirmed that FPR is associated with the activity and severity of diseases such as acute pancreatitis,stomach cancer,liver cancer,and so on.Based on whether or not there is a chronic pulmonary disease,which disease stage will be included in the study group,collect the patient’s inflammatory index,lung function,explore the relationship between FPR and COPD diagnosis,slow-blocking lung disease phased and limited airflow.Objects and MethodsRetrospective Collection Patients with Acute Aggravated Chronic Obstructive Pulmonary Disease（AECOPD Group）and Patients with Stable Period chronic Obstructive Pulmonary Disease（SCOPD Group）hospitalized at the Second Affiliated Hospital of Zhengzhou University from June 2017 to October 2020 General information on health check-ups（health groups）in the same period:age,sex,medical history,height,weight and smoking history,etc.Inflammation indicators:interlethional-6,procalcitonin（PCT）,C-reactive protein,fibrinogen,prealbumin,lung function indicators:1st second force exhalation（FEV1）,force lung capacity（FVC）,FEV1 as a percentage of the expected value（FEV1%pred）,The fibrinogen-to-prealbumin ratio（FPR）is calculated based on the data collected.The levels of general data,inflammatory index and lung function index of patients in health group,SCOPD group and AECOPD group were discussed,and patients in AECOPD group were grouped according to FEV1%pred,and mild airflow restricted group（FEV1%pred≥80%and 50%≤FEV₁%pred<80%,109 cases）,moderate airflow restricted group（30%≤FEV₁%pred<50%,51 cases）,severe airflow restricted group（FEV1%pred<30%,20 cases）,comparing general data,inflammatory indicators and lung function of three groups of patients,mapping ROC curve,analyzing the efficacy of IL-6,PCT,CRP and FPR diagnosis of slow-blocking lungs,further mapping ROC curve,analyzing the effectiveness of IL-6,PCT,CRP and FPR diagnosis of different courses of COPD.Results（1）The differences in sex composition,age,BMI and smoking historyin patients in the health group,SCOPD group and AECOPD group were not statistically significant（P>0.05）,and the levels of IL-6,PCT,CRP,FIB,PA,and FPR in patients in the AECOPD group were higher than those of SCOPD In the group of patients,the difference was statistically significant（P<0.05）,and the difference in the SCOPD group was statistically significant（P<0.05）and the difference in PA was not statistically significant in patients with IL-6,PCT,CRP,FIB,and FPR levels（P>0.05）;AECOPD group-SCOPD group,AECOPD group-health group,SCOPD group-health group two-two comparison,IL-6,PCT,CRP,FIB,FPR differences are statistically significant（P<0.05）,PA differences between SCOPD group-health groups are not statistically significant（P>0.05）.The differences were statistically significant（P<0.05）in patients in the AECOPD group in patients with FEV1,FEV1%pred,and FVC levels were lower than in the SCOPD group,FVC level is lower than health group patients,the difference is statistically significant（P<0.05）,AECOPD group-SCOPD group,AECOPD group-health group,SCOPD group-health group two-two comparison,The differences between FEV1,FEV1%pred,and FVC are statistically significant（P<0.05）.（2）The differences in sex composition,age,BMI and smoking history of patients in the mild airflow restricted group,the moderate airflow restricted group,and the severe airflow restricted group were not statistically significant（P>0.05）.Comparing inflammatory indicators,the results showed that the differences between IL-6,PCT,CRP,FIB and FPR were statistically significant（P<0.05）and PA（P=0.584>0.05）were not statistically significant.Mild-moderate,moderate-heavy,mild-moderate groups were compared between two or two,and the results showed that the differences between IL-6,PCT,CRP,FIB and FPR were statistically significant（P<0.05）,when compared between the two groups,mild-moderate PA（P=0.384）,moderate-heavy PA（P=0.901）,and mild-heavy PA（P=0.458）,the differences were not statistically significant（P>0.05）.（3）ROC curve for diagnosis of COPD:IL-6（AUC and are 95%CI 0.81,（0.764,0.855））,PCT（AUC and 95%CI are 0.787,（0.729,0.845））,CRP（AUC and 95%CI are 0.831,（0.758,0.867））,FPR（AUC and 95%CI are 0.857,（0.816,0.897））respectively for slow-blocking lungs have good diagnostic performance.The diagnostic best truncation values,sensitivity and specificity of the indicators were IL-6 8.414（78.0%,76.8%）,PCT 0.126（87.5%,55.1%）,CRP 7.878（72.7%,81.2%）,FPR15.089（67.4%,95.7%）,and the Jordon index was 0.548,0.426,0.539 and 0.631.ROC curve for determining the stages of different stages of COPD:IL-6（AUC and 95%CI are 0.66,（0.596,0.724））,PCT（AUC and 95%CI are 0.735,（0.677,0.793））,respectively CRP（AUC and 95%CI are 0.704,（0.639,0.769））,FPR（AUC and 95%CI are 0.795,（0.742,0.848））respectively for the chronic pulmonary disease phased have better diagnostic performance.The diagnostic best truncation values,sensitivity and specificity of the indicators were IL-6 16.084（78%,89.3%）,PCT 0.737（45.6%,91.4%）,CRP 9.512（62.8%,76.2%）,FPR18.681（65.6%,83.3%）,and the Jordon index was 0.360,0.456,0.390 and 0.489.Conclusions（1）The FPR level of patients with acute exacerbation period was higher than that of patients with chronic pulmonary resistance during stabilization period,and the level of FPR in patients with stability period was higher than that of healthy population;（2）The FPR level of patients with severe airflow restriction is higher than that of patients with low airflow restriction,which can be used to determine the degree of air flow restriction in patients who are unable to perform lung function;（3）FPR can be used as a reference index for the diagnosis of slow-blocking lung when the patient is unable to complete the lung function test;（4）FPR can be used to determine the stabilization and acute exacerbation periods of patients with chronic pulmonary resistance.