COPD合并呼吸衰竭患者血清HMGB1、IL-27水平变化及其与预后的关系

Levels of serum HMGB1 and IL-27 in COPD patients with respiratory failure and their relationship with prognosis

目的:研究慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者血清高迁移率族蛋白B1(HMGB1)和白细胞介素27(IL-27)水平变化及其与预后的关系。方法:分别选取102例COPD合并呼吸衰竭患者、100例COPD患者及100名健康体检者设为COPD合并呼衰组、COPD组、健康对照组;检测并比较三组血清HMGB1、IL-27和C反应蛋白(CRP)水平;随访COPD合并呼吸衰竭患者28 d死亡率,并根据结果将患者分为存活组和死亡组,比较两组各项检测结果;分析血清HMGB1和IL-27水平与患者动脉血气指标的相关性及其对COPD合并呼吸衰竭患者28 d死亡率的预测价值。结果:COPD合并呼衰组血清HMGB1、IL-27和CRP水平及外周血单核细胞计数高于COPD组和健康对照组,差异均有统计学意义(P<0.05);102例COPD合并呼吸衰竭患者28 d死亡29例(28.43%),死亡组动脉血氧分压(PaO_(2))低于存活组,而动脉血二氧化碳分压(PaCO_(2))和血清HMGB1、IL-27和CRP水平及外周血单核细胞计数高于存活组,差异均有统计学意义(P<0.05);COPD合并呼吸衰竭患者血清HMGB1和IL-27水平与PaO_(2)具有明显负相关性(P<0.05);HMGB1、IL-27及两者联合诊断预测COPD合并呼吸衰竭患者28 d死亡的AUC分别为0.776、0.787和0.863,灵敏度分别为63.01%、45.21%和64.38%,特异度分别为86.21%、96.55%和96.55%。结论:HMGB1和IL-27可能通过调节肺部炎症反应影响COPD合并呼吸衰竭患者病情进展和预后。

Objective:To study the levels of serum high mobility group protein B1(HMGB1)and interleukin 27(IL-27)in patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure and their relationship with prognosis.Methods:102 patients with COPD and respiratory failure(COPD with respiratory failure group),100 patients with COPD(COPD group)and 100 healthy subjects with physical examination(healthy control group)were selected for the study.The levels of serum HMGB1,IL-27 and C-reactive protein(CRP)were detected and compared among the three groups.The 28d mortality rate was followed up among patients with COPD and respiratory failure,according to the results,the patients were divided into survival group and death group,the detection results of the two groups were compared.The correlation between levels of serum HMGB1 and IL-27 and arterial blood gas indicators and their predictive value on 28 d death of COPD patients with respiratory failure were analyzed.Results:The levels of serum HMGB1,IL-27,CRP and the count of peripheral blood monouclear cells in COPD with respiratory failure group were higher than those in COPD group and control group(P<0.05).There were 29 cases(28.43%)with 28 d death among 102 patients with COPD and respiratory failure,and the partial pressure of arterial blood oxygen(PaO_(2))in death group was lower than that in survival group,while the partial pressure of arterial blood carbon dioxide(PaCO_(2)),levels of serum HMGB1,IL-27 and CRP and the count of peripheral blood monouclear cells were higher than those in survival group(P<0.05).The levels of serum HMGB1 and IL-27 in patients with COPD and respiratory failure were significantly negatively correlated with PaO_(2)(P<0.05).The AUCs of HMGB1,IL-27 and their combined diagnosis in predicting the 28d death of patients with COPD and respiratory failure were 0.776,0.787 and 0.863 respectively,and the sensitivities were 63.01%,45.21%and 64.38%respectively,and the specificities were 86.21%,96.55%and 96.55%,respectively.Conclusion:HMGB1 and IL-27 can affect the progression and prognosis of patients with COPD and respiratory failure by regulating the pulmonary inflammatory response.