外周血T淋巴细胞亚群和基质金属蛋白酶-9可预测慢性心力衰竭发生肺部感染

Predictive value of peripheral blood T lymphocyte subsets and matrix metalloproteinase-9 in pulmonary infection in chronic heart failure

目的:探讨外周血T淋巴细胞亚群和基质金属蛋白酶-9(MMP-9)水平在慢性心力衰竭合并肺部感染患者中的变化情况。方法:选择2017年1月-2019年6月空军军医大学第一附属医院治疗的慢性心力衰竭患者360例,根据检查结果分为感染组(156例)和未感染组(204例),比较2组实验室检查指标;多因素logistic回归分析慢性心力衰竭患者合并肺部感染的危险因素;Spearman相关性分析左心室射血分数值(LVEF)、左心室舒张末期内径(LVEDD)、N末端脑钠肽(NT-proBNP)与T淋巴细胞亚群、MMP-9间的相关性;通过受试者工作特征(ROC)曲线探讨T淋巴细胞亚群及MMP-9对评估慢性心力衰竭患者发生肺部感染的最佳临界值。结果:感染组白细胞计数、LVEDD、NT-proBNP、MMP-9水平和CD8^(+)T淋巴细胞比例高于未感染组,而LVEF、CD4^(+)T淋巴细胞比例和CD4^(+)/CD8^(+)比值显著低于未感染组(P均<0.05)。LVEF<46.00%、LVEDD≥53.50 mm、NT-proBNP≥580.00 pg/mL、MMP-9≥155.00μg/L、CD4^(+)T淋巴细胞<28.00%、CD8^(+)T淋巴细胞≥21.00%和CD4^(+)/CD8^(+)<1.35为慢性心力衰竭患者合并肺部感染的独立危险因素(P均<0.05)。患者CD4^(+)T淋巴细胞比例及CD4^(+)/CD8^(+)比值与LVEF呈正相关;与LVEDD和NT-proBNP水平呈负相关(P均<0.05),MMP-9水平和CD8^(+)T淋巴细胞与LVEF呈负相关;与LVEDD和NT-proBNP水平呈正相关(P<0.05)。MMP-9、CD4^(+)/CD8^(+)比值预测慢性心力衰竭患者发生肺部感染的最佳临界值分别为161.27μg/L、1.41。结论:合并肺部感染的慢性心力衰竭患者免疫功能下降,MMP-9水平升高,T淋巴细胞亚群和MMP-9的水平变化能在一定程度上反映心功能状态和疾病严重程度,并可用作预测肺部感染发生的辅助指标。

Objective:To investigate the changes of peripheral blood T lymphocyte subsets and matrix metalloproteinase-9(MMP-9)in patients with chronic heart failure complicated with pulmonary infection.Methods:A total of 360 patients with chronic heart failure treated in The First Affiliated Hospital of Air Force Military from January 2017 to June 2019 were selected.According to the examination results,the patients were divided into infection group(156 cases)and non-infection group(204 cases),and the laboratory examination indexes of the two groups were compared.Multivariate logistic regression was used to analyze the risk factors of pulmonary infection in patients with chronic heart failure.Spearman correlation analysis was conducted to analyze the correlation between left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),N-terminal brain natriuretic peptide(NT-proBNP),T lymphocyte subpopulation and MMP-9.The receiver operating characteristic(ROC)curve was used to evaluate the optimal thresholds of T lymphocyte subsets and MMP-9 for pulmonary infection in patients with chronic heart failure.Results:The white blood cell(WBC)count,LVEDD,NT-proBNP,MMP-9 and CD8^(+)T lymphocyte ratio in infection group were increased,while LVEF,CD4^(+)T lymphocyte ratio and CD4^(+)/CD8^(+)ratio were significantly decreased as compared with those in non-infection group(P<0.05).LVEF<46.00%,LVEDD≥53.50 mm,NT-proBNP≥580.00 pg/mL,MMP-9≥155.00μg/L,CD4^(+)T lymphocytes<28.00%,CD8^(+)T lymphocytes≥21.00%and CD4^(+)/CD8^(+)<1.35 were independent risk factors for pulmonary infection in patients with chronic heart failure(P<0.05).The proportion of CD4^(+)T lymphocytes and CD4^(+)/CD8^(+)ratio were positively correlated with LVEF and negatively correlated with LVEDD and NT-proBNP(P<0.05).MMP-9 and CD8^(+)T lymphocyte were negatively correlated with LVEF and positively correlated with LVEDD and NT-proBNP(P<0.05).The optimal critical values of MMP-9 and CD4^(+)/CD8^(+)ratio for predicting pulmonary infection in patients with chronic heart failure were 161.27μg/L and 1.41,respectively.Conclusion:In patients with chronic heart failure complicated with pulmonary infection,the immune function decreased and the level of MMP-9 increased.The changes of T lymphocyte subsets and MMP-9 levels can reflect the cardiac function status and disease severity to a certain extent,and can be used as an auxiliary indicator to predict the occurrence of pulmonary infection.