Study On The Diagnostic Value Of SP-A,TNF-? And GDF-15 In Patients With AECOPD

Objective: To detect serum SP-A(pulmonary surfactant-A),TNF-?(tumor necrosis factor-?)and GDF-15(growth differentiation factor-15)in serum of patients with chronic obstructive pulmonary disease during the acute exacerbation stage(including A1 and A2 stages)and the remission stage expression levels,to explore its clinical significance,to predict effective serum biological indicators for the evaluation of AECOPD.Methods:(1)Collect 60 patients with acute exacerbation of chronic obstructive pulmonary disease(recombination),including 30 patients with lung function grade I and II(group A1),and 30 patients with lung function grade III and IV(group A2),and 30 patients in remission period(remission group).(2)Collect the general data of each group and test the blood routine and biochemical indicators of each group;use the pulmonary function meter to measure the pulmonary function parameters of COPD patients in the first second of forced breathing volume as a percentage of the expected value(FEV1%pred);use enzyme-linked immunosorbent assay the concentrations of SP-A,TNF-? and GDF-15 in peripheral blood of each group were detected by adsorption method(ELISA).(3)Univariate analysis of variance was used to analyze the expression levels of SP-A,TNF-? and GDF-15 in peripheral blood of each group;Pearson correlation analysis was used to analyze the correlation of SP-A,TNF-? and GDF-15 levels and correlation between these three biomarkers and FEV1% pred;Describe receiver operating characteristic(ROC)curves,and evaluate the effects of SP-A,TNF-? and GDF-15 alone and combined on AECOPD Clinical diagnostic value.result:(1)The differences in WBC,PCO2,PO2,FEV1/pred(%)in the data of the remission group,A1 group and A2 group were statistically significant(P <0.001).(2)The expression levels of SP-A,TNF-? and GDF-15 in peripheral blood showed an upward trend in the remission group,A1 group,and A2 group,with significant differences between the groups(P <0.001);The expression levels of SP-A,TNF-? and GDF-15 in AECOPD patients were higher than those in the remission group,and the A2 group was higher than the A1 group.The differences between the groups were statistically significant(P <0.001).(3)The serum SP-A level with recombinant protein was weakly positively correlated with TNF-? level(r = 0.244,P <0.05),and it was weakly positively correlated with GDF-15 level(r = 0.216,P <0.05),The level of TNF-? plus recombinant GDF-15 was also weakly positively correlated(r = 0.340,P <0.05).The levels of TNF-?,GDF-15 and SP-A in peripheral blood plus recombination showed a weak negative correlation with FEV1% pred(r =-0.306,-0.174,-0.203;all P <0.05).(4)The areas under the ROC curve of SP-A,TNF-?,and GDF-15 alone in the diagnosis of AECOPD patients were 0.896,0.877,and 0.888,respectively.The sensitivity of SP-A to the diagnostic value of AECOPD patients was better than that of TNF-? and GDF-15,but GDF-15 is better than SP-A and TNF-? in the diagnostic value of AECOPD patients.(5)The area under the ROC curve of SP-A combined with TNF-?,SP-A combined with GDF-15,TNF-? combined with GDF-15,and the three in the diagnosis of AECOPD were 0.951,0.959,0.952,and 0.978,respectively.SP-A combined with GDF-15 can improve the diagnostic efficacy of AECOPD patients,mainly improve the sensitivity of AECOPD diagnosis,and better detect the patients.The combination of the three is not better than the evaluation of the diagnostic efficacy of AECOPD patients.The combination of two pairs can significantly improve the sensitivity of diagnosing AECOPD patients,but it has little effect on specificity.The specificity of GDF-15 alone is high,and the specificity is not significantly improved after the combination of two pairs or even three.conclusion:(1)The expression levels of SP-A,TNF-? and GDF-15 in peripheral blood may reflect the severity of the disease in patients with AECOPD.As the GOLD grade increases,the expression levels of SP-A,TNF-? and GDF-15 are higher.(2)SP-A combined with GDF-15 can improve the diagnostic efficacy of patients with AECOPD,and has certain significance for evaluating the acute exacerbation of COPD.