血清肿瘤坏死因子受体-6水平对AECOPD合并呼吸衰竭患者转归的影响

Effect of serum tumor necrosis factor receptor-6 level on prognosis of AECOPD patients with respiratory failure

目的研究肿瘤坏死因子受体-6(TR6)[诱骗受体3(DcR3)]在慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者血清中的表达水平,分析其对患者预后转归的影响。方法选取本院2015年3月至2017年3月收治的AECOPD患者134例为研究对象,按照是否并发呼吸衰竭分为呼吸衰竭组65例和非呼吸衰竭组69例,另取同期在本院体检健康志愿者60例为对照组。收集研究对象血清白蛋白(ALB)、C反应蛋白(CRP)水平及第一秒用力呼吸容积占预计值百分比(FEV1%)、第一秒用力呼吸容积占用力肺活量百分比(FEV1/FVC)、动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)数据,采用酶联免疫吸附法测定血清白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、DcR3水平。结果呼吸衰竭组患者ALB、FEV1%、FEV1/FVC、PaO2水平显著低于非呼吸衰竭组和对照组(P<0.05),且非呼吸衰竭组显著低于对照组(P<0.05);呼吸衰竭组患者CRP、PaCO2、IL-8、TNF-α、DcR3水平显著高于非呼吸衰竭组和对照组(P<0.05),且非呼吸衰竭组患者CRP、IL-8、TNF-α、DcR3水平显著高于对照组(P<0.05)。高DcR3水平组生存率显著低于低DcR3水平组生存率(P<0.05)。高TNF-α、DcR3水平是影响AECOPD合并呼吸衰竭患者不良预后发生的独立危险因素(P<0.05)。结论 DcR3在AECOPD合并呼吸衰竭患者血清中高表达,是影响患者不良预后发生的独立危险因素。

Objective To study the expression of serum tumor necrosis factor receptor-6 (TR6)[decoy receptor 3 (DcR3)] in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure,and to analyze its influence on prognosis.Methods 134 patients with AECOPD admitted to our hospital from March 2015 to March 2017 were selected as the study subjects.According to whether or not respiratory failure occurred,they were divided into respiratory failure group (65 cases) and non-respiratory failure group (69 cases).Another 60 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group.Serum albumin (ALB),C-reactive protein (CRP),first-second forced breathing volume (FEV1%),first-second forced breathing volume (FEV1/FVC),arterial partial oxygen pressure (PaO2) and arterial partial carbon dioxide pressure (PaCO2) were collected.Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of interleukin-8 (IL-8),tumor necrosis factor-alpha (TNF-α) and DcR3.Results The levels of ALB,FEV1,FEV1/FVC and PaO2 in respiratory failure group were significantly lower than those in non-respiratory failure group and control group (P<0.05),and those in non-respiratory failure group were significantly lower than those in control group (P<0.05);the levels of CRP,PaCO2,IL-8,TNF-α and DcR3 in respiratory failure group were significantly higher than those in non-respiratory failure group and control group (P<0.05).The survival rate of high DcR3 level group was significantly lower than that of low DcR3 level group (P<0.05).High levels of TNF-α and DcR3 were independent risk factors for adverse prognosis of AECOPD patients with respiratory failure (P<0.05).Conclusions The high expression of DcR3 in serum of AECOPD patients with respiratory failure is an independent risk factor for adverse prognosis.