Clinical Value Analysis Of HCY,MPO,LP-PLA2 And Related Inflammatory Indexes In Serum On Patients With Chronic Obstructive Pulmonary Disease

The objective:The aim is to observe the levels of homocysteine(HCY),myeloperoxidase(MPO)and lipoprotein-associated phospholipase A2(Lp-PLA2)and related inflammatory indexes in serum on patients with chronic obstructive pulmonary disease(COPD)and to explore and discuss the clinical value of HCY,MPO,Lp-PLA2 on evaluating the severity degrees,acute exacerbation and prognosis of COPD patients.The method:The acute exacerbation of COPD patients treated in the Department of Respiratory Medicine of Sighing County People's Hospital from January 2017 to September 2018 were adopted.Forty-nine suitable patients with simple exacerbation of COPD were selected as group A1,forty-eight patients with exacerbation of COPD connected with cardiovascular and cerebrovascular diseases were selected as group B1.And fifty-four healthy control group were selected as group C.Medical history were respectively gathered.Pulmonary function was measured at admission and HCYwas measured in venous serum.MPO,Lp-PLA2,white blood cell(WBC),percentage of neutrophils(NEU%),c-reactive protein(CRP),ESR and other inflammatory indicators were measured.At the same time,patients with stable COPD after treatment and discharged from the hospital were followed up and were respectively divided into stable COPD group A2 and group B2.(1)One-way ANOVA was carried out on the HCY,MPO,Lp-PLA2,WBC,NEU%,CRP and ESR in serum in the group A1,B1 and C.The two groups were compared and tested by independent sample T;(2)HCY,MPO,Lp-PLA2,WBC,NEU%,CRP and ESR in serum were tested by paired samples T for stable group A2 after treatment in the A1 group and stable group B2 after treatment in the B1 group.And the changes of different indexes before and after treatment in the two groups were compared.(3)Correlation analysis was carried out on the levels of HCY,MPO,Lp-PLA2 in serum of patients in A1,A2,B1 and B2 groups and inflammatory indexes,such as the first second forced expiratory volume 1 second(FEVI),WBC,NEU%,CRP,ESR,etc.(4)The diagnostic value of HCY,MPO,Lp-PLA2 in serum in the A1 and B1 group patients was analyzed by using ROC curve.And the optimal diagnostic boundary value and the specificity and sensitivity at this boundary value were measured.(5)Logistic regression was applied for analyzing the death factors of the acute exacerbation of COPD patients.The result:1.WBC,NEU,CRP,ESR,HCY,MPO,Lp-PLA2 results in the group A1 and group B1 were higher than those in group c and FEV1 results in group A1 and group B1 were lower than those in the group C.The difference was statistically significant among the three groups(P was less than zero point zero five).The difference was not statistically significant between group B1 and group A1 on NEU%,but the other differences were statistically significant(P was less than zero point zero five).The difference was not statistically significant on results of Lp-PLA2 in the group A1 and group C(P was more than zero point zero five),but the results of WBC,NEU%,CRP,ESR,HCY,MPO were higher than those in the group C.And the results of FEV1 were lower than those in group C.And the differences between the two groups were statistically significant(P was less than zero point zero five).2.The results of HCY,MPO,WBC,NEU%,CRP and ESR in the group A1 were higher than those in the group A2 and FEV1 was lower than that in the group A2.The difference between the two groups was statistically significant(P was less than zero point zero five),but there was no statistically significant difference between the two groups of Lp-PLA2(P was more than zero point zero five).However,the results of HCY,MPO,Lp-PLA2,WBC,NEU%,CRP and ESR in the group B1 were higher than those in the group B2,FEV1 was lower than that in the group B2 and the difference between the two groups was statistically significant(Pwas less than zero point zero five).3.HCY of patients of group A1 had significant positive correlation with WBC,NEU%,CRP and ESR and significant negative correlation with FEV1.MPO had significant positive correlation with WBC,NEU%and CRP and had significant negative correlation with FEV1.However,Lp-PLA2 results had no correlation with other indexes.The HCY and MPO results of patients in the group A2 had positive correlation with WBC,NEU%and CRP results in the same time and had negative correlation with FEV1.However,Lp-PLA2 level had no correlation with other indexes.HCY,MPO,Lp-PLA2 results of patients in the group B1 had significant positive correlation with WBC,NEU%,CRP and significantly negatively correlated with FEV1.HCY and MPO results of patients in group B2 were significantly positively correlated with WBC,NEU%and CRP and had significant negative correlation with FEV1.Lp-PLA2 was significantly negatively correlated with FEV1,but had no correlation with other indicators.4.The results of ROC curve analysis showed that the boundary value of diagnosis of HCY for exacerbation of COPD was thirteen point one umol/L.The AUC at this time was zero point seven two seven.The sensitivity was seventy-three point four seven percent.The specificity was sixty-five point three one percent and the Jordan index was zero point three eight seven eight.The boundary value of diagnosis of MPO for exacerbation of COPD was forty-two point three ng/m L.The AUC at this time was zero point seven one five.The sensitivity was fifty-nine point one eight.The specificity was seventy-nine point five nine percent.And the Jordan index was zero point three eight seven eight.The boundary value of diagnosis of Lp-PLA2 for exacerbation of COPD was six hundred fifty-eight point seven IU/L.The AUC was zero point five three one.The sensitivity was fourteen point two nine percent.The specificity was ninety-seven point nine six percent.And Jordan index was zero point one two two four.At the same time,the results showed that HCY had a boundary value of diagnosis of sixteen-six point six umol/L for COPD patients with cardiovascular and cerebrovascular diseases.And the AUC at this time was zero point eight three nine.The sensitivity was sixty-eight point seven five.The specificity was eighty-seven point five.And the Jordan index was zero point five six two five.MPO had a boundary value of diagnosis of fifty-two point one ng/m L for exacerbation of COPD patients complicated with cardiovascular and cerebrovascular diseases.At this time,the AUC was zero point eight one four.The sensitivity was seventy-seven point zero eight percent.The specificity was eighty-seven point five percent.And Jordan index was zero point six four five eight.The diagnostic cutoff value of PLA2 for COPD group with cardiovascular and cerebrovascular diseases was five hundred forty IU/L.The AUC at this time was zero point seven zero nine.The sensitivity was sixty-two point five.The specificity was eighty-one point two five percent.And Jordan index was zero point four three seven five.5.HCY,MPO and Lp-PLA2 in serum can be used as independent risk factors for hospitalization death of patients with acute exacerbation of COPD.And patients with acute exacerbation of COPD connected with cardiovascular and cerebrovascular diseases were significantly higher than patients with acute exacerbation of COPD alone in terms of hospitalization days,hospitalization expenses,late mortality rate,high HCY,high MPO and high Lp-PLA2 population proportion.The conclusion:1.The levels HCY,MPO,Lp-PLA2 in serum of COPD patients can be used as indicators to judge the severity degrees of the disease and evaluate the prognosis.Combined with WBC,CRP,NEU%,ESR,FEV1 levels of COPD patients can well evaluate the disease situation of COPD patients,judge the prognosis and guide treatment.2.HCY,MPO and Lp-PLA2 collectively take part in the path physiological process of COPD.For COPD patients with cardiovascular and cerebrovascular diseases,we should pay more attention in the changes of these indicators.