血清β2-微球蛋白与慢性阻塞性肺疾病加重住院患者的死亡率相关。
Serum β2-Microglobulin is Associated with Mortality in Hospitalized Patients with Exacerbated Chronic Obstructive Pulmonary Disease.
机构信息
Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, People's Republic of China.
Beijing Institute of Respiratory Medicine, Beijing 100020, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2020 Apr 7;15:723-732. doi: 10.2147/COPD.S243905. eCollection 2020.
PURPOSE
We hypothesized that increased level of serum β2-microglobulin (β2M) is an independent factor associated with higher mortality in hospitalized patients with exacerbated chronic obstructive pulmonary disease (COPD).
PATIENTS AND METHODS
We retrospectively analyzed 488 hospitalized patients with exacerbated COPD as the first diagnosis at Beijing Chao-Yang hospital, P. R. China between December 31st, 2012 and December 28th, 2017. Concentrations of serum β2M and other clinical indexes were measured or collected on admission, and all patients were followed up to 90 days. The relationship between β2M and 30- and 90-day all-cause mortality was explored by Cox regression analysis adjusted for age, C-reactive protein values, N-terminal pro-brain natriuretic peptide/100, respiratory failure [RF, defined as partial arterial oxygen pressure (PaO) <60 mmHg on room air or PaO over the fraction of inspired oxygen (PaO/FiO) < 300], eosinopenia, consolidation, and acidaemia.
RESULTS
Median concentrations of β2M were significantly higher in non-survivals compared to survivals within 30 days (4.11 mg/L (IQR 3.10-6.60) vs 2.79mg/L (IQR 2.13-3.76), < 0.001) and 90 days (3.79 mg/L (IQR 2.61-6.69) vs 2.79 mg/L (IQR 2.13-3.73), < 0.001). Serum levels of β2M were correlated with 30-day and 90-day mortality in overall exacerbated COPD patients, with hazard ratios (HRs) of 1.09 (95% CI 1.04-1.14, = 0.001) and 1.09 (95% CI 1.05-1.14, < 0.001). In exacerbated COPD patients without RF and with RF, the HRs were 1.06 (95% CI 0.995-1.137, = 0.069) and 1.14 (95% CI 1.02-1.27, = 0.021) for 30-day mortality, 1.09 (95% CI 1.02-1.15, = 0.010) and 1.14 (95% CI 1.03-1.26, = 0.014) for 90-day mortality, respectively.
CONCLUSION
Our data showed that concentrations of serum β2M were associated with an increased risk of mortality, suggesting that β2M might be a valuable predictor of poor prognosis for hospitalized patients with exacerbated COPD.
目的
我们假设血清β2-微球蛋白（β2M）水平升高是与住院加重期慢性阻塞性肺疾病（COPD）患者死亡率升高相关的独立因素。
方法
我们回顾性分析了 2012 年 12 月 31 日至 2017 年 12 月 28 日期间在北京朝阳医院住院治疗的首次诊断为加重期 COPD 的 488 例患者。入院时测量或收集血清β2M 及其他临床指标，所有患者均随访 90 天。通过 Cox 回归分析调整年龄、C-反应蛋白值、N-末端脑利钠肽前体/100、呼吸衰竭[定义为在空气环境下的部分动脉氧分压（PaO）<60mmHg 或动脉氧分压/吸入氧分数（PaO/FiO）<300]、嗜酸性粒细胞减少症、实变和酸中毒，探讨β2M 与 30 天和 90 天全因死亡率的关系。
结果
30 天内非存活者的β2M 中位数浓度明显高于存活者（4.11mg/L（IQR 3.10-6.60）比 2.79mg/L（IQR 2.13-3.76），<0.001），90 天内非存活者的β2M 中位数浓度也明显高于存活者（3.79mg/L（IQR 2.61-6.69）比 2.79mg/L（IQR 2.13-3.73），<0.001）。β2M 血清水平与总体加重期 COPD 患者的 30 天和 90 天死亡率相关，危险比（HRs）分别为 1.09（95%CI 1.04-1.14，=0.001）和 1.09（95%CI 1.05-1.14，<0.001）。在无呼吸衰竭和有呼吸衰竭的加重期 COPD 患者中，30 天死亡率的 HRs 分别为 1.06（95%CI 0.995-1.137，=0.069）和 1.14（95%CI 1.02-1.27，=0.021），90 天死亡率的 HRs 分别为 1.09（95%CI 1.02-1.15，=0.010）和 1.14（95%CI 1.03-1.26，=0.014）。
结论
我们的数据表明，血清β2M 浓度与死亡率升高相关，提示β2M 可能是住院加重期 COPD 患者预后不良的有价值的预测指标。
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