血常规指标和炎症因子水平与慢性阻塞性肺疾病继发真菌感染的关系

Relationship of levels of routine blood biochemical indexes and inflammatory factors with secondary fungal infection in COPD

目的探究血常规指标和炎症因子水平与慢性阻塞性肺疾病(COPD)患者继发真菌感染的关系。方法回顾性分析2017年1月至2020年1月宁波市北仑区人民医院收治的98例COPD急性加重期患者,按照是否继发真菌感染将患者分为研究组(n=47,继发真菌感染)和对照组(n=51,未继发真菌感染)。采用血常规分析仪检测血常规指标(WBC,NEU,PLT,RDW,MPV)水平,采用ELISA检测血清炎症因子(TNF-α,IL-6,IL-2)水平。分析血常规指标和炎症因子水平与继发真菌感染的关系及对预测继发真菌感染的价值,并检测COPD继发真菌感染患者肺部真菌分布。结果研究组患者静脉血中RDW、MPV水平均高于对照组,PLT计数低于对照组(均P<0.05)。两组患者WBC计数和NEU水平比较差异无统计学意义(均P>0.05)。研究组患者血清TNF-α、IL-6、IL-2水平均高于对照组(均P<0.05)。多因素Logistic回归分析显示,RDW>12.26%、PLT>162.61×10^(9)个/L、IL-2>239.25 pg/mL是COPD患者继发真菌感染的危险因素(均P<0.05)。ROC曲线显示,RDW、PLT、IL-2预测COPD患者继发真菌感染的AUC分别为0.638、0.680、0.712,3项指标联合检测的AUC为0.809。47例COPD继发真菌感染患者共检测出肺部感染真菌69株,包括白假丝酵母(50.73%)、烟曲霉(23.19%)、黄曲霉(14.49%)、其他假丝酵母(11.59%)。结论血常规指标中RDW、PLT及炎症因子IL-2是影响COPD患者继发真菌感染的危险因素,且对COPD患者继发真菌感染具有一定预测价值。

Objective To explore the relationship of the levels of routine blood biochemical indexes and inflammatory factors with secondary fungal infections in patients with chronic obstructive pulmonary disease(COPD). Methods A retrospective analysis was performed on 98 patients with acute exacerbation of COPD in our hospital from January 2017 to January 2020. The patients were divided into the observation group(n=47, secondary fungal infection) or control group(n=51, no secondary fungal infection). The routine blood biochemical indexes(WBC, NEU, PLT, RDW, MPV) were measured using a routine blood chemistry analyzer, and the levels of serum inflammatory factors(TNF-α, IL-6, IL-2) by using ELISA. The relationship of routine blood biochemical indexes and inflammatory factors with secondary fungal infections and their predictive value for predicting secondary fungal infections were analyzed;the distribution of fungi in the lungs of patients with COPD secondary fungal infection was detected. Results The levels of RDW and MPV in the venous blood in the observation group were higher, while the PLT counts was lower than those in the control group, respectively(all P<0.05). There were no significant differences in WBC counts and NEU(%) between the two groups(all P>0.05);the serum levels of TNF-α, IL-6 and IL-2 in the observation group were higher than those in the control group respectively(all P<0.05). Logistic multivariate regression analysis showed that RDW>12.26%,PLT>162.61×10^(9)/L,IL-2>239.25 pg/mL were the risk factors for secondary fungal infections in patients with COPD(all P<0.05). ROC curves showed that the AUGs of RDW, PLT and IL-2 for predicting secondary fungal infections in patients with COPD were 0.638, 0.680 and 0.712 respectively, and that of the combined detection of the three indexes was 0.809. A total of 69 strains of fungi were detected in 47 patients with COPD secondary fungal infection, including Candida albicans(50.73%), Aspergillus fumigatus(23.19%), Aspergillus flavus(14.49%), and other Candida(11.59%). Conclusion Routine blood biochemical indexes RDW and PLT and inflammatory factor IL-2 are the risk factors affecting secondary fungal infection in COPD, which has a certain predictive value for secondary fungal infection in COPD patients.