痰中性粒细胞明胶酶相关脂质运载蛋白作为哮喘-慢阻肺重叠的生物标志物。

Sputum Neutrophil Gelatinase-Associated Lipocalin as a Biomarker in Asthma-COPD Overlap.

机构信息

Resident, Department of Pulmonary Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India.

Professor, Department of Pulmonary Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India.

出版信息

J Assoc Physicians India. 2023 Sep;71(9):34-38. doi: 10.59556/japi.71.0320.

DOI:10.59556/japi.71.0320

PMID:38700299

Abstract

BACKGROUND

Asthma COPD overlap (ACO) is a consensus-based phenotype having characteristics of both COPD and asthma. Distinguishing ACO from other diseases is even more important as it is related to low health-related quality of life, augmented exacerbation rate and hospital admission, a rapid deterioration in lung function, and increased morbidity and mortality. But it cannot be diagnosed explicitly based on spirometry tests, patient demographics, radiology, or by-sputum cytology. There is an unmet need to develop biomarkers.

OBJECTIVES

To assess the role of sputum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker of ACO. To find the correlation between sputum NGAL levels with forced expiratory volume 1 (FEV1) and exacerbation rate in ACO. To find the correlation between sputum NGAL level with sputum neutrophils and eosinophils in ACO.

MATERIALS AND METHODS

In this comparative correlational study, 180 subjects were enrolled into four groups with 45 patients each with asthma, COPD, ACO, and healthy nonsmokers respectively, respectively. After taking detailed history and demographics, sputum was analyzed for the differential count and NGAL.

RESULTS

Asthma COPD overlap (ACO) cases had high sputum NGAL levels; the second was the COPD group, and the last in the case asthma group. Nonsmokers had notably lower readings than the diseased. Out of three, receiver operating characteristic (ROC) figures, the validity of NGAL was best in selecting patients of ACO than COPD and asthma. The area under curve (AUC) was highest for ACO and less than the acceptable limit for the remaining two. NGAL cut-off value of 2473 pg/mL had 80% sensitivity and 50% specificity for ACO.

CONCLUSION

The present study investigated the sputum NGAL levels as a biomarker in ACO identified by the syndromic approach. Sputum NGAL, a biomarker associated with airway inflammation in airway diseases, was supportive of clinically differentiating ACO from asthma to COPD. How to cite this article: Babu A, Narayanswamy H, Baburao A. Sputum Neutrophil Gelatinase-Associated Lipocalin as a Biomarker in Asthma-COPD Overlap. J Assoc Physicians India 2023;71(9):34-38.

摘要

背景

哮喘-COPD 重叠（ACO）是一种基于共识的表型，具有 COPD 和哮喘的特征。由于与健康相关的生活质量降低、加重发作率和住院率增加、肺功能迅速恶化以及发病率和死亡率增加有关，因此将 ACO 与其他疾病区分开来更为重要。但不能根据肺量测定、患者人口统计学、影像学或痰液细胞学明确诊断。因此需要开发生物标志物。

目的

评估痰中性粒细胞明胶酶相关脂质运载蛋白（NGAL）作为 ACO 生物标志物的作用。研究 ACO 患者痰 NGAL 水平与用力呼气量 1（FEV1）和加重发作率的相关性。研究 ACO 患者痰 NGAL 水平与痰中性粒细胞和嗜酸性粒细胞的相关性。

材料和方法

在这项比较相关性研究中，纳入了 180 名受试者，分为 4 组，每组 45 名患者，分别为哮喘、COPD、ACO 和健康非吸烟者。在详细了解病史和人口统计学资料后，对痰液进行了差异计数和 NGAL 分析。

结果

哮喘-COPD 重叠（ACO）患者痰 NGAL 水平较高；其次是 COPD 组，最后是哮喘组。非吸烟者的读数明显低于患病者。在三个受试者中，ROC 图显示 NGAL 对选择 ACO 患者的有效性优于 COPD 和哮喘。ACO 的曲线下面积（AUC）最高，而其余两项均低于可接受范围。痰 NGAL 截断值为 2473pg/mL 时，对 ACO 的敏感性为 80%，特异性为 50%。

结论

本研究通过综合征方法研究了痰 NGAL 水平作为 ACO 的生物标志物。痰 NGAL 是一种与气道疾病中气道炎症相关的生物标志物，有助于从哮喘到 COPD 临床区分 ACO。

如何引用本文

Babu A, Narayanswamy H, Baburao A. Sputum Neutrophil Gelatinase-Associated Lipocalin as a Biomarker in Asthma-COPD Overlap. J Assoc Physicians India 2023;71(9):34-38.