| Background and Purpose:The prevalence and mortality rate of chronic obstructive pulmonary disease(COPD)have been increasing year by year.Patients often require hospitalization for acute exacerbations of COPD(AECOPD)caused by infectious or non-infectious factors,and the treatment plans for the two types of exacerbations are slightly different.The former requires targeted anti-infective therapy.However,the current pathogen diagnosis is still difficult,and the risk of antibiotic abuse is high.Therefore,it is of great significance to find more,faster,and more accurate biomarkers for comprehensive pathogen diagnosis.In recent years,studies have found that apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),and ApoA1/B play important roles in immune regulation and inflammatory response,which may help to evaluate COPD patients from multiple aspects and perspectives.This article aims to study the clinical application value of changes in ApoA1,ApoB,and the ApoA1/B index in COPD,in order to improve the accuracy of treatment.Method:The study group will consist of COPD patients who received diagnosis and treatment in the respiratory department of the First Hospital of Nanchang City from October 2020 to October 2022,either as inpatients or outpatients.The patients will be divided into two groups: COPD with acute lower respiratory tract infection group and COPD without acute lower respiratory tract infection group.Meanwhile,healthy individuals roughly matched in gender and age during the same period will be collected as the control group.Relevant clinical data will be reviewed and collected,and the necessary information and data for the study will be recorded.Statistical analysis of the clinical data collected will be performed using SPSS software.Results:This study included a total of 247 participants,including 41 healthy controls,35 COPD patients without acute lower respiratory tract infection(ALRTI),and 171 COPD patients with ALRTI(42 virus,67 bacterial,and 62 virus-bacteria co-infections).The results showed significant differences in ApoA1,ApoB,and ApoA1/B levels between the control group,COPD without ALRTI group,and COPD with ALRTI group(P<0.01),while there was no significant difference between the control group and COPD without ALRTI group.In the subgroup analysis of COPD with ALRTI,there was no significant difference in ApoB between pure virus and pure bacterial infections,while there were significant differences in ApoA1,ApoA1/B,absolute neutrophil count(NEUT),absolute lymphocyte count(LYMPH),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),and endotoxin levels(P<0.01).In the comparison between pure virus and virus-bacteria co-infections,there were significant differences in ApoA1,ApoB,ApoA1/B,NEUT,LYMPH,CRP,ESR,and endotoxin levels(P<0.05).There was no significant difference between pure bacterial and virus-bacteria co-infections,as well as between Gram-positive and Gram-negative bacterial infections.Age,ApoA1,ApoA1/B,LYMPH,NEUT,CRP,ESR,and endotoxin levels were significantly correlated with the etiological diagnosis of COPD with ALRTI,with ApoA1,ApoA1/B,and LYMPH showing negative correlations and NEUT,CRP,ESR,endotoxin levels,and age showing positive correlations.Binary logistic regression analysis with significantly correlated factors showed that ApoA1(P<0.001)and NEUT(P<0.05)were independent predictors of etiological diagnosis of COPD with ALRTI,and the area under the curve(AUC)of the ROC curve for joint diagnosis was 0.909.In the comparison of the diagnostic value of ApoA1,ApoB,and ApoA1/B for COPD with bacterial infection,ApoA1 had the highest sensitivity(82.9%)and specificity(83.9%),and the AUC of the ROC curve was 0.889.Conclusion:1、ApoA1,ApoB,and ApoA1/B are predictors for acute lower respiratory tract infection in patients with COPD,with ApoA1 having the highest predictive value.2、ApoA1,ApoB,and ApoA1/B are good indicators for predicting the pathogenic microorganisms in acute lower respiratory tract infections in patients with COPD. |
PDF Full Text Request