炎症因子、凝血功能和免疫功能检验对评估COPD患者病情严重程度的临床价值

The clinical value of inflammatory factors,coagulation function and immune function tests in assessing the severity of COPD patients

目的探讨炎症因子、凝血功能和免疫功能异常对评估慢性阻塞性肺疾病(COPD)患者病情严重程度的临床价值。方法选取该院2018年3月至2020年2月收治的COPD患者179例,根据病情严重程度分为COPD急性加重组(103例)、COPD稳定组(76例),另选同期体检健康者80例作为对照组。检测3组的白细胞(WBC)、中性粒细胞百分比、C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α、凝血酶原时间、活化部分凝血活酶时间、D-二聚体、纤维蛋白原、清蛋白(ALB)、CD3^+、CD4^+、CD8^+细胞水平,并进行统计学处理。结果3组间WBC、CRP、IL-6、D-二聚体、CD4^+细胞和CD4^+/CD8^+水平比较差异有统计学意义(P<0.05),WBC、CRP、IL-6和D-二聚体水平随COPD病情加重而逐渐增高,CD4^+细胞和CD4^+/CD8^+水平则逐渐降低。急性加重组患者治疗后CRP、IL-6和D-二聚体水平降低,而ALB、CD4^+细胞和CD4^+/CD8^+水平增高(P<0.05)。受试者工作特征(ROC)曲线分析显示,曲线下面积(AUC)IL-6最大(0.732),CRP次之(0.682)。结论COPD患者存在明显炎性反应、凝血功能异常和免疫功能低下,IL-6和CRP可作为评价COPD患者急性加重的潜在标志物。

Objective To explore the clinical value of abnormal inflammatory factors,coagulation function and immune function in evaluating the severity of chronic obstructive pulmonary disease(COPD)patients.Methods A total of 179 patients with COPD admitted to the hospital from March 2018 to February 2020 were selected and divided into 103 cases of acute exacerbation of COPD group and 76 cases of stable COPD group according to the severity of the disease,another 80 cases of healthy people during physical examination in the same period as the control group.The levels of white blood cells(WBC),neutrophils,C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α,prothrombin time,activated partial thromboplastin time,D-dimer,fibrinogen,serum Protein(ALB),CD3+,CD4+and CD8+cell were detected,and statistically processed.Results There were statistically significant differences in the levels of WBC,CRP,IL-6,D-dimer,CD4+cells and CD4+/CD8+among the three groups(P<0.05),and the levels of WBC,CRP,IL-6 and D-dimer gradually increased with the worsening of COPD,the levels of CD4+cells and CD4+/CD8+gradually decreased.After treatment,the levels of CRP,IL-6,and D-dimer decreased in the acute exacerbation of COPD group,while the levels of ALB,CD4+cells and CD4+/CD8+increased(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of IL-6 was the largest(0.732),followed by CRP(0.682).Conclusion Patients with COPD have obvious inflammatory reaction,abnormal coagulation function and low immune function.IL-6 and CRP can be used as potential markers for evaluating the acute exacerbation of COPD patients.