炎症因子、免疫细胞和纤维蛋白原检测在COPD诊断和预后判断中的价值

Laboratory indicators for diagnosis and prognosis of chronic obstructive pulmonary disease

目的探讨炎症因子、免疫细胞、纤维蛋白原(Fib)在慢性阻塞性肺疾病(COPD)诊断和预后判断中的价值。方法选取COPD患者140例,根据COPD诊断和分期标准将其分为急性加重组和稳定组,另择40例健康体检者作为对照组。入组对象均行肺功能检查[第1秒用力呼气容积占预计值百分比(FEV_1%pre)和第1秒用力呼气容积占用力肺活量百分比(FEV_1/FVC)、BODE指数测定和动脉血气分析;检测外周血中TNF-α、IL-6、IL-8、Th_(17)细胞比例、Treg细胞比例和血浆Fib;分析各检测指标与肺功能、PaO_2和BODE指数的相关性;选取与BODE指数相关性最强的3个指标并判断其对COPD急性加重期的诊断价值。结果急性加重组FEV_1%pre、FEV_1/FVC和PaO_2均低于稳定组和对照组,而BODE指数则高于稳定组和对照组(均P<0.05)。急性加重组的TNF-α、IL-6、、IL-8、Fib、Th_(17)细胞比例和Th_(17)/Treg比值均高于稳定组和对照组,Treg细胞比例则降低(均P<0.05)。COPD组Ⅲ级者TNF-α、IL-6、和Th_(17)/Treg比值高于Ⅱ级者,而Treg比例则低于Ⅱ级者(均P<0.05)。COPDⅣ级者的TNF-α、IL-8、Th_(17)细胞比例、Th_(17)/Treg比值和Fib高于Ⅲ级者,而Treg比例则低于Ⅲ级者(均P<0.05)。TNF-α、Th_(17)/Treg比值和Fib与FEV_1%pre、FEV_1/FVC、PaO_2和BODE指数存在相关性,且与BODE指数相关性最强的指标为TNF-α、Th_(17)/Treg和Fib(均P<0.05)。联合检测TNF-α+Th_(17)/Treg+Fib对诊断COPD急性加重的灵敏度(96.25%)和准确度(94.29%)最高。结论COPD患者存在血液高凝、炎症因子含量偏高、Th_(17)/Treg比例失衡和机体免疫过度的状态,且这些指标的异常均有可能是诱发COPD急性加重的危险因素。联合检测TNF-α+Th_(17)/Treg+Fib对诊断COPD急性加重具有较高的灵敏度和准确度,对监测病情和判断预后具有重要意义。

Objective To investigate the laboratory indicators for diagnosis and prognosis of acute exacerbation of chronic obstructive pulmonary disease（COPD）.Methods One hundred and forty patients with COPD were diagnosed in our department and classified as acute exacerbation group and stable groups,40 healthy subjects served as control group.The pulmonary function were tested,BODE index was assessed and arterial blood gas analysis was performed in all patients.Serum TNF-α,IL-6,IL-8 levels,the proportion of Th17 and Treg cells,plasma fibrinogen（Fib） in the peripheral blood were measrued and compared.The correlation between above-mentioned indexes and pulmonary function,arterial partial pressure of oxygen,BODE index were analyzed.Results The FEV1% pre,FEV1/FVC and PaO2 of COPD patients in acute exacerbation were significantly lower than those in stable group and healthy control group,while the BODE index was significantly higher than that in stable group and control group.TNF-α,IL-6,IL-8,Fib,the proportion of Th17 cells and Th17/Treg ratio in acute exacerbation group were significantly higher than those in stable group and control group,while the proportion of Treg cells was significantly lower than that in stable group and control group（P〈0.05）.TNF-α,IL-6,and Th17/Treg ratio in Grade III COPD patients were significantly higher than those in grade II group,while the proportion of Treg cells was significantly lower than that of grade II COPD patients（P〈0.05）.TNF-α,IL-8,the proportion of Th17 cells,Th17/Treg ratios and Fib in Grade IV COPD patients were significantly higher than those in Grade III group,while the proportion of Treg cells was significantly lower than that in Grade III group（P〈0.05）.Spearman correlation analysis showed that,only TNF-α,Th17/Treg ratios and Fib had significant correlation withFEV1% pre,FEV1/FVC,PaO2 and the BODE index,and the TNF-α,Th17/Treg and Fib had the strongest correlation with BODE index（P〈0.05）.The combination of TNF-α,Th17/Treg and Fib had the highest sensitivity and accuracy in the diagnosis of acute exacerbation（P〈0.05）.Conclusion COPD patients have high blood coagulation and inflammation factor content,and imbalanced Th17/Treg ration and immune excessive state.Combined detection of TNF-α,Th17/Treg and Fib has higher sensitivity and accuracy in diagnosis of acute exacerbations and prognosis of COPD patients.