Changes In Serum Bilirubin,Uric Acid And Acute Exacerbations Of Chronic Obstructive Pulmonary Disease And Their Clinical Significance

Objective:To analyse the clinical significance and predictive value of serum bilirubin and uric acid in patients with AECOPD by comparing the relationship between acute exacerbation and stable stages of chronic obstructive pulmonary disease and the difference in expression levels between different lung function classes.Methods:Between January2021 and May 2022,119 patients diagnosed with AECOPD（AECOPD group）,60 patients diagnosed with stable COPD（SCOPD group）and 60 healthy controls（healthy control group）who were hospitalized in the Department of Respiratory and Critical Care Medicine of the Fifth Affiliated Hospital of Xinjiang Medical University were selected for retrospective analysis.Results:1.Analysis of the general data showed no statistically significant differences between the three groups in terms of gender,age and whether or not they smoked（P>0.05）.2.The differences in WBC,N%and NE counts between the three groups were statistically significant（P<0.001）.There was no significant difference in Pa CO₂between the AECOPD and SCOPD groups（P>0.05）.And the differences in FEV1%,FEV1/FVC,Pa O₂,CAT score and CRP were statistically significant（P<0.05）,where the expression levels of FEV1%,FEVI/FVC and Pa O₂were significantly lower in the AECOPD group than in the SCOPD group;while the expression levels of CAT and CRP were significantly higher in the AECOPD group than in the SCOPD group.3.There was no significant difference in DBIL between the three groups（P>0.05）.The differences in TBIL,IBIL and UA were statistically significant（P<0.05）;among them,the expression levels of TBIL and IBIL were lower in the AECOPD group<SCOPD group<control group,and a two-by-two comparison between the three groups showed that TBIL and IBIL were significantly higher in the control group than in the SCOPD and AECOPD groups,and significantly higher in the SCOPD group than in the AECOPD group The differences were statistically significant（P<0.001）;the expression level of UA was significantly lower in the AECOPD group>SCOPD group>control group,and the difference was statistically significant（P<0.05）between the three groups.4.The AECOPD group was divided into moderate and severe groups according to GOLD classification,and there was no significant difference in DBIL between the two groups（P>0.05）;while the differences in TBIL,IBIL and UA were statistically significant（P<0.001）,in which the expression levels of TBIL and IBIL in the severe group were significantly lower than those in the moderate group;while the expression levels of UA in the severe group were was significantly higher than that of the moderate group.5.Applying spearman correlation analysis between bilirubin,uric acid and AECOPD indicators:IBIL was negatively correlated with NE%（r=-0.877,P<0.001）and positively correlated with FEV1%,Pa O₂and CAT scores（r values 0.259,0.878,0.904 respectively,P<0.05）The differences were statistically significant UA levels were negatively correlated with FEV1/FVC（r=-0.729,P<0.001）and positively correlated with Pa CO₂and CRP（r values of 0.729 and 0.731,P<0.001,respectively）,with statistically significant differences.6.A binary logistic regression analysis of factors influencing acute exacerbations of chronic obstructive pulmonary disease,with AECOPD as the dependent variable and each clinical profile as the independent variable,ended up with only TBIL,UA and CRP entering the regression model,which was statistically significant（P<0.05）.Among them,UA and CRP were independent risk factors for acute exacerbation of chronic obstructive pulmonary disease,and TBIL was an independent protective factor.7.The predictive value of TBIL,UA and CRP alone and in combination for AECOPD was assessed by plotting ROC curves:when TBIL alone was used for AECOPD prediction,the results showed an area under the curve（AUC）of 0.837（95%CI:0.779-0.895,P<0.001）,and the highest diagnostic value was achieved when TBIL took a cut-off value of 10.55 mmol/L,its diagnostic value was highest,with a diagnostic sensitivity of 80%and specificity of 74.8%.When UA alone was used to predict AECOPD,the area under the curve（AUC）was 0.835（95%CI:0.772-0.899,P<0.001）,and the diagnostic value was highest when the UA cut-off value was 315.5umol/L,at which point the diagnostic sensitivity was 76.5%and the specificity was 83.3%.When CRP alone was used to predict AECOPD,the area under the curve（AUC）was 0.921（95%CI:0.883-0.958,P<0.001）,and the diagnostic value was highest when the cut-off value for CRP was 9.7 mg/L,with a sensitivity of 80.7%and a specificity of 93.3%.When TBIL,UA and CRP were combined to predict acute exacerbations of chronic obstructive pulmonary disease,the area under the curve（AUC）was 0.969（95%CI:0.949-0.989,P<0.001）,with a sensitivity of 82.4%and specificity of96.7%.Conclusion:1.serum bilirubin within the normal physiological range is reduced in patients with slow-onset lung and lower in patients with AECOPD;uric acid above normal levels is elevated in patients with slow-onset lung and higher in patients with AECOPD.2.there is a correlation between serum bilirubin and uric acid and inflammatory indexes,lung function and blood gases in patients with AECOPD,respectively.3.UA is an acute exacerbation of slow-onset lung 4.bilirubin and uric acid are more accurate in clinically predicting the risk of acute exacerbation of chronic obstructive pulmonary disease,which can assist physicians in early detection and intervention in high-risk groups in clinical care,and can achieve individualized treatment at an early stage,which has certain clinical value.