血清suPAR、SDC4水平与重症支气管哮喘患者肺功能和预后的关系

doi:10.3969/j.issn.1673-8640.2025.01.014

摘要/Abstract

摘要：

目的探讨血清可溶性尿激酶型纤溶酶原激活物受体（suPAR）、多配体蛋白聚糖4（SDC4）水平与重症支气管哮喘患者肺功能和预后的关系。方法选取2018年10月—2021年3月仙桃市第一人民医院支气管哮喘患者102例，依据病情分为重症哮喘组（46例）和轻/中症哮喘组（56例）；另选取同期体检健康者60名作为正常对照组。检测所有研究对象血清suPAR、SDC4、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和肺功能指标[第一秒用力呼气容积（FEV1）、用力肺活量（FVC）、最大呼气中段流量（MMEF）、FEV1占FVC的百分比（FEV1/FVC%）]。对重症支气管哮喘患者随访1年，根据是否再发将患者分为预后良好组（29例）和预后不良组（17例）。采用Pearson相关分析评估各项目之间的相关性。采用受试者工作特征（ROC）曲线评价血清suPAR、SDC4判断重症支气管哮喘患者预后不良的效能。结果正常对照组、轻/中症哮喘组、重症哮喘组血清suPAR、IL-6、TNF-α水平依次升高（P<0.001），血清SDC4水平和FEV1、FEV1/FVC%、MMEF依次降低（P<0.001）。Pearson相关分析结果显示，suPAR与IL-6、TNF-α呈正相关（P<0.05），与FEV1、FEV1/FVC%、MMEF呈负相关（P<0.001），SDC4与IL-6、TNF-α呈负相关（P<0.05），与FEV1、FEV1/FVC%、MMEF呈正相关（P<0.001）。与预后良好组相比，预后不良组血清suPAR、IL-6、TNF-α水平升高（P<0.001），SDC4水平降低（P<0.001）。血清suPAR、SDC4单项检测和联合检测判断重症支气管哮喘患者预后不良的曲线下面积（AUC）分别为0.886、0.875、0.949。结论重症支气管哮喘患者血清suPAR、SDC4水平与肺功能密切相关，或可作为重症支气管哮喘患者预后评估的生物标志物。

关键词: 可溶性尿激酶型纤溶酶原激活物受体, 多配体蛋白聚糖4, 肺功能, 重症支气管哮喘

Abstract:

Objective To investigate the relationship between serum levels of soluble urokinase plasminogen activator receptor（suPAR），syndecan-4（SDC4） and lung function and prognosis in patients with severe bronchial asthma. Methods A total of 102 patients with bronchial asthma in Xiantao First People's Hospital from October 2018 to March 2021 were enrolled and classified into severe asthma group（46 cases） and mild/moderate asthma group（56 cases），and 60 healthy subjects were enrolled as healthy control group. Serum suPAR，SDC4，tumor necrosis factor-alpha（TNF-α），interleukin-6（IL-6） and lung function indexes [forced expiratory volume in one second（FEV1），forced vital capacity（FVC），maximum mid-expiratory flow（MMEF）] were determined. FEV1/FVC% was calculated. The patients with severe bronchial asthma were followed up for 1 year and classified into good prognosis group（29 cases） and poor prognosis group（17 cases） according to whether they had recurrent asthma. Pearson correlation analysis was used to evaluate the correlation between indexes. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of serum suPAR and SDC4 in predicting the poor prognosis of patients with severe bronchial asthma. Results Serum suPAR，IL-6 and TNF-α levels in healthy control group，mild/moderate asthma group and severe asthma group were increased in turn（P<0.001），while serum SDC4 levels and FEV1，FEV1/FVC% and MMEF were decreased in turn（P<0.001）. Pearson correlation analysis showed that suPAR was positively correlated with IL-6 and TNF-α（P<0.05），it was negatively correlated with FEV1，FEV1/FVC% and MMEF in turn（P<0.001），and it was negatively correlated with SDC4 and IL-6，TNF-α（P<0.05）. It was positively correlated with FEV1，FEV1/FVC% and MMEF（P<0.001）. Compared with good prognosis group，the levels of suPAR，IL-6 and TNF-α in poor prognosis group were increased（P<0.001），and the levels of SDC4 were decreased（P<0.001）. The areas under curves（AUC） of serum suPAR and SDC4 single and combined determinations to determine the poor prognosis of patients with severe bronchial asthma were 0.886，0.875 and 0.949，respectively. Conclusions Serum suPAR and SDC4 levels are related to lung function in patients with severe bronchial asthma，and may be used as biomarkers for prognosis assessment in patients with severe bronchial asthma.

Key words: Soluble urokinase plasminogen activator receptor, Syndecan-4, Lung function, Severe bronchial asthma

中图分类号:

R446.1

李德仲, 王志为, 许文娟, 舒品源. 血清suPAR、SDC4水平与重症支气管哮喘患者肺功能和预后的关系[J]. 检验医学, 2025, 40(1): 79-83.

LI Dezhong, WANG Zhiwei, XU Wenjuan, SHU Pinyuan. Serum suPAR and SDC4 levels in patients with severe bronchial asthma and their relationship with lung function and prognosis[J]. Laboratory Medicine, 2025, 40(1): 79-83.

图/表 5

参考文献 22

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组别	例数	FEV1/L	FEV1/FVC%/%	MMEF/（L·s^-1）
正常对照组	60	5.82±0.79	93.69±11.08	4.14±0.72
轻/中症哮喘组	56	3.98±0.58^*	61.08±7.53^*	2.16±0.42^*
重症哮喘组	46	2.06±0.33^*#	54.62±6.86^*#	1.46±0.25^*#
F值		488.029	31.408	390.066
P值		<0.001	<0.001	<0.001
组别	suPAR/（ng·L^-1）	SDC4/（ng·mL^-1）	IL-6/（ng·L^-1）	TNF-α/（ng·L^-1）
正常对照组	6.52±1.62	8.11±1.28	7.56±1.34	37.82±5.67
轻/中症哮喘组	9.34±2.56^*	6.25±0.98^*	20.18±4.52^*	76.73±12.85^*
重症哮喘组	17.52±4.84^*#	5.43±0.62^*#	29.16±6.24^*#	96.42±15.86^*#
F值	166.676	97.626	334.187	342.528
P值	<0.001	<0.001	<0.001	<0.001

组别	例数	FEV1/L	FEV1/FVC%/%	MMEF/（L·s^-1）
正常对照组	60	5.82±0.79	93.69±11.08	4.14±0.72
轻/中症哮喘组	56	3.98±0.58^*	61.08±7.53^*	2.16±0.42^*
重症哮喘组	46	2.06±0.33^*#	54.62±6.86^*#	1.46±0.25^*#
F值		488.029	31.408	390.066
P值		<0.001	<0.001	<0.001
组别	suPAR/（ng·L^-1）	SDC4/（ng·mL^-1）	IL-6/（ng·L^-1）	TNF-α/（ng·L^-1）
正常对照组	6.52±1.62	8.11±1.28	7.56±1.34	37.82±5.67
轻/中症哮喘组	9.34±2.56^*	6.25±0.98^*	20.18±4.52^*	76.73±12.85^*
重症哮喘组	17.52±4.84^*#	5.43±0.62^*#	29.16±6.24^*#	96.42±15.86^*#
F值	166.676	97.626	334.187	342.528
P值	<0.001	<0.001	<0.001	<0.001

组别	例数	suPAR/（ng·L^-1）	SDC4/（ng·mL^-1）	IL-6/（ng·L^-1）	TNF-α/（ng·L^-1）
预后不良组	17	34.07±9.25	2.98±0.32	49.67±9.81	148.81±22.06
预后良好组	29	7.82±2.26	6.87±0.80	17.14±4.15	65.71±12.23
t值		14.660	19.101	15.710	16.491
P值		<0.001	<0.001	<0.001	<0.001

组别	例数	suPAR/（ng·L^-1）	SDC4/（ng·mL^-1）	IL-6/（ng·L^-1）	TNF-α/（ng·L^-1）
预后不良组	17	34.07±9.25	2.98±0.32	49.67±9.81	148.81±22.06
预后良好组	29	7.82±2.26	6.87±0.80	17.14±4.15	65.71±12.23
t值		14.660	19.101	15.710	16.491
P值		<0.001	<0.001	<0.001	<0.001

项目	AUC（95%可信区间）	最佳临界值	敏感性/%	特异性/%	Youden指数
suPAR	0.886（0.784~0.989）	12.57 ng·L^-1	82.40	86.20	0.686
SDC4	0.875（0.774~0.976）	4.73 ng·mL^-1	86.20	82.40	0.686
联合检测	0.949（0.893~1.000）	0.43	82.40	89.70	0.721