The Investigation Of The Relationship Among The Serum Levels Of Fibronectin，High Sensitivity C-reactin Protein，Fn/hs-CRP， Procalcitonin Of Patients With AECOPD

Objective: To observe serum of fibronectin (Fn),highsensitivity C-reactin protein (hs-CRP),Fn/hs-CRP ratio and procalci-tionin(PCT) levels of patients with acute exacerbations of chronicobstructive pulmonary disease(AECOPD),and the relationshipsbetween with combined COPD assessment and BODE index,and tostudy the relationships between Fn,hs-CRP,Fn/hs-CRP ratio,PCT andseverity and prognosis of AECOPD patients.Methods：1.Objects andsettings:sixty patients with AECOPD who were hospitalized in Affi-liated Hospital of Luzhou Medical College between December2011and May2012were chosen to the research(male39,femal21,average age67.47±9.29).All cases were diagnosed according to TheCOPD Guideline published by Chinese Medical Committee in2007.Patients with increased WBC,neutrophils count and neutrophil ratioand sputum culture and smear for bacteria were positive.Excludedcriteria:①other lung diseases:bronchiectasis,bronchial asthma,pulmo-nary tuberculosis,interstitial lung disease;②serious heart and liverdiseases;③malignancy;④autoimmune diseases;⑤recent serioussurgery,trauma,other parts of the infection;⑥cognitive impairmentand mental disorder;⑦patients can’t been measured by pulmonaryfunction test.Control group: fifteen healthy physical examines (male 9,female6,average age61.27±4.74) from outpatient department ofhospital, excluding respiratory and systemicinflammatory diseasesand no allergic history were observed as control group.All COPDpatients were divided into four groups with combined COPDassessment:group A：typically GOLD1or GOLD2(mild ormoderate airflow limitation) and/or0-1exacerbation per year andmMRC grade0-1or CAT score＜10.Group B:typically GOLD1or GOLD2(mild or moderate airflow limitation) and/or0-1exacerbation per year and mMRC grade≥2or CAT score≥10.Group C：typically GOLD3or GOLD4(severe or very severeairflow limitation) and/or≥2exacerbation per year and mMRCgrade0-1or CAT score＜10.Group D:typically GOLD3or GOLD4(Severe or Very Severe airflow limitation) and/or≥2exacerbationper year and mMRC grade≥2or CAT score≥10.All COPDpatients were divided into four groups with BODE index.BODEindex which contains the body-mass index (B),the degree of airflowobstruction (O),and functional dyspnea (D),and exercise capacity (E)as assessed by six-minute-walk test.Group1:BODE index score0-2,group2:BODE index score3-4,group3:BODE index score5-6,group4:BODE index score7-10.2.The serum levels of Fn,PCTand hs-CRP measure:the blood was collected from each patient andwas extracted the serum through centrifuge for15minutes with aspeed2000r/min. The blood plasma were preserved in refrigeratorwith-70℃.The serum levels of Fn and PCT were measure byenzyme-linked immunosorbent assay (ELISA) and hs-CRP weremeasure by immunological scatting turbidity method.Results:1.Thecomparison among four groups in serum levels of Fn,hs-CRP,Fn/hs-CRP and PCT with combined COPD assessment:(1)The serum levels of Fn in groups：control group＞A group＞B group＞Cgroup＞D group(P＜0.05).(2)The serum levels of hs-CRP ingroups:control group＜A group＜C group＜D group(P＜0.05),controlgroup＜B group＜C group＜D group(P＜0.05);there was nosignificant difference between group A and group B(P＞0.05).(3)TheFn/hs-CRP ratio in groups:A group＞C group＞D group(P＜0.05)，Bgroup＞C group＞D group(P＜0.05);there was no significantdifference between group A and group B(P＞0.05).(4)The serumlevels of PCT in groups:A group＜B group,C group,D group(P＜0.05),B group＞C group(P＜0.05),control group＜A group,B group,Cgroup,D group(P＜0.05);the serum levels of PCT in group D wasno significant different from group B and group C respectively (P＞0.05).2.The serum levels of Fn and Fn/hs-CRP ratio showed anegative correlation with combined COPD assessment (r=-0.905,P＜0.01;r=-0.772,P＜0.01);the serum levels of hs-CRP and PCTshowed a postive correlation with combined COPD assessment (r=0.642,P＜0.01;r=0.498,P＜0.01).The correlation order was Fn,hs-CRP,Fn/hs-CRP,PCT from the highest to lowest.3.The comparison amongfour groups in serum levels of Fn,hs-CRP,Fn/hs-CRP and PCTwith BODE index:(1)the serum levels of Fn in groups:4group＜2group,3group(P＜0.01),control group＜2group,3group,4group(P＜0.01);there was no significant difference between group2and group3(P＞0.05).(2)The serum levels of hs-CRP in groups：4group＞2group,3group(P＜0.05),control group＜2group,3group,4group(P＜0.01);there was no significant difference between group2andgroup3(P＞0.05).(3)The Fn/hs-CRP ratio in groups:4group＜2 group,3group(P＜0.05);there was no significant difference betweengroup2and group3(P＞0.05).(4)The serum levels of PCT ingroups:4group＞3group(P＜0.05),control group＜2group,3group,4group(P＜0.01);the serum levels of PCT in group2was nosignificant different from group3and group4respectively (P＞0.05).4.The serum levels of Fn and Fn/hs-CRP ratio showed anegative correlation with BODE index (r=-0.606，P＜0.01；r=-0.552，P＜0.01);the serum levels of hs-CRP and PCT showed a positivecorrelation with BODE index (r=0.471，P＜0.01；r=0.257，P＜0.05).The correlation order was Fn，hs-CRP，Fn/hs-CRP，PCT from thehighest to lowest.Conclusions:1.The combined COPD assessmentwas increased with ascension in hs-CRP levels and PCT levels anddecline in Fn levels and Fn/hs-CRP ratio.With higher combinedCOPD assessment groups,patients had more symptoms and higherrisks.2.The BODE index score was increased with ascension inhs-CRP levels and PCT levels and decline in Fn levels and Fn/hs-CRP ratio.With higher BODE index scores，patients had seriousdyspnea,reduced capacity to perform physical activities,poorquality of life and nutritional status.3.The Fn and Fn/hs-CRPin AECOPD patients related to combined COPD assessment andBODE index mainly.