诱导痰黏蛋白5AC对支气管哮喘和慢性阻塞性肺疾病的鉴别价值

摘要 目的：对支气管哮喘（BA）患者和慢性阻塞性肺疾病（COPD）患者诱导痰黏蛋白5AC（MUC5AC）、炎症细胞和炎症因子水平进行比较以及相关性分析，评估MUC5AC鉴别BA和COPD的价值。方法：选取2018年9月至2019年9月来海南医学院第一附属医院就诊的BA稳定期患者（BA组）60例，同期COPD稳定期（COPD组）患者60例。诱导痰法采样并处理痰液，检测诱导痰MUC5AC、炎症细胞中性粒细胞（Neu）、巨噬细胞（Mac）、嗜酸性粒细胞（Eos）、淋巴细胞（Lym）、炎症因子血管内皮生长因子（VEGF）、细胞间黏附分子-1（ICAM-1）、白介素13（IL-13）和白介素17（IL-17）水平，通过Pearson相关分析对MUC5AC水平与Neu、Mac、Eos、Lym、VEGF、ICAM-1、IL-13、IL-17的关系进行分析。此外，采用受试者工作特征(ROC)曲线分析MUC5AC、炎症细胞及炎症因子鉴别诊断BA及COPD的效能。结果：COPD组诱导痰MUC5AC水平高于BA组，差异有统计学意义（P＜0.05）；COPD组诱导痰Mac和Eos水平均低于BA组，COPD组诱导痰Neu水平高于BA组，差异均有统计学意义（P＜0.05）；COPD组诱导痰VEGF、ICAM-1、IL-13和IL-17水平均低于BA组，差异均有统计学意义（P＜0.05）；Pearson相关分析结果显示，诱导痰MUC5AC与炎症细胞Mac、Eos和炎症因子VEGF、ICAM-1、IL-13和IL-17呈负相关（P＜0.05），与炎症细胞Neu呈正相关（P＜0.05）。经ROC曲线分析可得：诱导痰MUC5AC鉴别BA和COPD的曲线下面积、灵敏度、特异度以及约登指数均高于炎症细胞Neu、Mac、Eos以及炎症因子VEGF、ICAM-1、IL-13、IL-17。结论：COPD患者诱导痰MUC5AC水平高于BA患者，MUC5AC与炎症细胞和炎症因子有关，MUC5AC的检测有助于鉴别BA或COPD，其有望作为临床BA或COPD的监测指标和治疗靶点。

Differential Value of Induced Sputum Mucoprotein 5AC in Bronchial Asthma and Chronic Obstructive Pulmonary Disease

ABSTRACT Objective: To compare and analyze the levels of induced sputum mucoprotein 5AC (MUC5AC), inflammatory cells and inflammatory factors in patients with bronchial asthma (BA) and patients with chronic obstructive pulmonary disease (COPD), and to evaluate the value of MUC5AC in differentiating BA and COPD. Methods: 60 patients with BA stable (BA group) and 60 patients with COPD stable (COPD group) who came to the First Affiliated Hospital of Hainan Medical College from September 2018 to September 2019 were selected. The sputum was sampled and treated by induced sputum method, and the levels of MUC5AC, inflammatory cells neutrophils (Neu), macrophages (Mac), eosinophils (Eos), lymphocyte (Lym), inflammatory factors vascular endothelial growth factor (VEGF), intercellular cell adhesion molecule-1 (ICAM-1), interleukin-13 (IL-13) and interleukin-17 (IL-17) were detected. Pearson correlation analysis was used to analyze the relationship between the level of MUC5AC and Neu, Mac, Eos, Lym, VEGF, ICAM-1, IL-13 and IL-17. In addition, receiver operating characteristic (ROC) curve was used to analyze the efficacy of MUC5AC, inflammatory cells and inflammatory factors in the differential diagnosis of BA and COPD. Results: The level of induced sputum MUC5AC in COPD group was higher than that in BA group, the difference was statistically significant (P<0.05). The levels of induced sputum Mac and Eos in COPD group were lower than those in BA group, and the level of induced sputum Neu in COPD group was higher than that in BA group, the differences were statistically significant (P<0.05). The levels of induced sputum VEGF, ICAM-1, IL-13 and IL-17 in COPD group were lower than those in BA group, the differences were statistically significant (P<0.05). Pearson correlation analysis showed that MUC5AC in induced sputum was negatively correlated with inflammatory cells Mac, Eos and inflammatory factors VEGF, ICAM-1, IL-13 and IL-17 (P<0.05), and positively correlated with inflammatory cell Neu (P<0.05). ROC curve analysis showed that the area under curve, sensitivity, specificity and Yorden index of MUC5AC in the differentiating BA and COPD were higher than those of Neu, Mac, Eos and VEGF, ICAM-1, IL-13 and IL-17. Conclusion: The level of induced sputum MUC5AC in patients with COPD is higher than that of patients with BA. MUC5AC is related to inflammatory cells and inflammatory factors. The detection of MUC5AC is helpful to differentiating BA or COPD, which is expected to be used as a monitoring index and treatment target of clinical BA or COPD.