摘要
目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者T淋巴细胞亚群及血清CD64、Toll样受体2(TLR2)与出院后再次发作的关系。方法回顾性分析2020年1月至2023年10月西安市中心医院收治的120例AECOPD患者,其中男70例、女50例,年龄51~84(69.01±11.09)岁,COPD病程6~12(8.95±2.29)年。根据所有患者出院后90 d内电话或门诊随访是否再次发作(急性恶化加重),分为复发组(40例)与未复发组(80例)。比较两组一般资料[性别、年龄、COPD病程、基础疾病、吸烟史、饮酒史、COPD患者自我评估测试(CAT)评分]以及T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、CD64、TLR2水平。通过多因素非条件logistic逐步回归分析明确AECOPD患者出院后再次发作的影响因素,最后通过受试者操作特征曲线(ROC)分析第1秒用力呼气容积/用力肺活量(FEV1/FVC)、T淋巴细胞亚群、CD64、TLR2水平预测AECOPD患者出院后再次发作的价值。采用独立样本t检验、χ^(2)检验。结果复发组FEV1/FVC、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)低于未复发组,CD8^(+)、CD64、TLR2水平高于未复发组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,FEV1/FVC、T淋巴细胞亚群、CD64、TLR2水平是AECOPD患者出院后再次发作的影响因素(均P<0.05)。ROC分析证实,FEV1/FVC、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、CD64、TLR2水平均可用于AECOPD患者出院后再次发作的预测,曲线下面积分别为0.810、0.639、0.912、0.793、0.945、0.632、0.908(均P<0.05)。结论AECOPD患者出院后再次发作受FEV1/FVC、T淋巴细胞亚群、CD64、TLR2水平影响,临床应予以密切关注。
Objective To explore the relationships between T lymphocyte subsets and serum CD64,Toll like receptor 2(TLR2)and recurrence after discharge in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A retrospective analysis was conducted on 120 cases of AECOPD admitted to Xi'an Central Hospital from January 2020 to October 2023.Among them,there were 70 males and 50 females,aged 51-84(69.01±11.09)years,and the course of COPD was 6-12(8.95±2.29)years.All patients were divided into a recurrence group(40 cases)and a non-recurrence group(80 cases)based on whether they had relapsed(acute deterioration worsened)within 90 days of telephone or outpatient follow-up after discharge.The general information[gender,age,COPD course,underlying diseases,smoking history,drinking history,and COPD Patient Self-Assessment Test(CAT)score],T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)),CD64,and TLR2 levels were compared between the two groups.The influencing factors of recurrence in AECOPD patients after discharge were identified by multi-factor unconditional logistic stepwise regression analysis.Finally,the values of forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC),T lymphocyte subsets,CD64,and TLR2 levels in predicting recurrence in AECOPD patients after discharge were analyzed by the receiver operating characteristic curve(ROC).Independent sample t test andχ^(2) test were used.Results The levels of FEV1/FVC,CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the recurrence group were lower than those in the non-recurrence group,and the levels of CD8^(+),CD64,and TLR2 were higher than those in the non-recurrence group,with statistically significant differences(all P<0.05).Multivariate logistic regression analysis showed that the levels of FEV1/FVC,T lymphocyte subsets,CD64,and TLR2 were the influencing factors for recurrence in AECOPD patients after discharge(all P<0.05).ROC analysis confirmed that FEV1/FVC,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),CD64,and TLR2 levels could be used to predict recurrence in AECOPD patients after discharge,with the areas under the curves of 0.810,0.639,0.912,0.793,0.945,0.632,and 0.908(all P<0.05).Conclusion The recurrence of AECOPD patients after discharge is influenced by FEV1/FVC,T lymphocyte subsets,CD64,and TLR2 levels,which should be closely monitored clinically.
作者
张昊
米婷
范亚莉
李效清
李青青
许鹏
Zhang Hao;Mi Ting;Fan Yai;Li Xiaoqing;Li Qingqing;Xu Peng(Department of Critical Care Medicine,Xi'an Central Hospital,Xi'an 710001,China)
出处
《国际医药卫生导报》
2024年第16期2696-2700,共5页
International Medicine and Health Guidance News
基金
陕西省卫生健康科研基金(2021D014)。