慢性阻塞性肺疾病合并肺部感染患者血浆C3、C4、PCT、免疫球蛋白水平的变化及易感因素分析

Changes in levels of plasma C3,C4,procalcitonin,and immunoglobulins in patients with chronic obstructive pulmonary disease complicated with pulmonary infection and analysis of predisposing factors

目的 观察慢性阻塞性肺疾病(COPD)合并肺部感染患者血浆补体(C3、C4)、降钙素原(PCT)及免疫球蛋白水平,并分析COPD患者合并肺部感染的易感因素。方法 回顾性分析2021年3月至2021年9月期间于陕西省核工业二一五医院呼吸内科就诊的88例COPD患者的临床资料,根据是否合并肺部感染情况将其分为感染组38例和未感染组50例。比较两组患者的基线资料和血浆C3、C4、炎症因子[PCT、C反应蛋白(CRP)]、免疫功能[免疫球蛋白A (IgA)、免疫球蛋白G (IgG)、免疫球蛋白M (IgM)]水平,并采用多因素Logistic回归方程分析COPD合并肺部感染的危险因素。结果 两组患者的性别、年龄、肺功能分级、高血压合并情况、机械通气情况等基线资料比较差异均无统计学意义(P>0.05),而两组患者的糖尿病合并情况、吸烟、抗生素使用时间、糖皮质激素使用时间等基线资料比较,差异均有统计学意义(P<0.05);感染组患者的血浆C3、C4及血清PCT、CRP水平分别为(1.24±0.17) g/L、(0.34±0.13) g/L、(1.62±0.41)μg/L、(72.95±13.20) mg/L,明显高于未感染组的(0.88±0.15) g/L、(0.23±0.08) g/L、(0.37±0.11)μg/L、(34.02±5.46) mg/L,而IgA、IgG、IgM水平分别为(0.81±0.27) g/L、(8.23±2.05) g/L、(1.08±0.19) g/L,明显低于未感染组的(1.20±0.42) g/L、(9.36±2.31) g/L、(1.24±0.17) g/L,差异均具有统计学意义(P<0.05);经多因素Logistic回归方程分析结果显示,C3>1.05 g/L、C4>0.28 g/L、PCT>1.02μg/L、IgA<0.97 g/L、合并糖尿病、抗生素使用时间≥2周、糖皮质激素使用时间≥1周均为COPD患者合并肺部感染的独立危险因素(P<0.05)。结论 COPD患者合并肺部感染后可出现血浆补体、炎症因子水平及免疫功能的显著变化,且此类患者并发肺部感染的危险因素较多,临床需重点监测易感群体,做好肺部感染预防工作。

Objective To observe the levels of plasma complements(C3,C4),procalcitonin(PCT),and immunoglobulins in patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary infection,and to analyze the predisposing factors of the patients.Methods The clinical data of 88 patients with COPD treated in Department of Respiratory Medicine,No.215 Hospital of Shaanxi Nuclear Industry were retrospectively analyzed from March 2021 to September 2021.All patients were divided into infected group(n=38) and non-infected group(n=50) according to whether were complicated with pulmonary infection.The baseline data and levels of plasma C3,C4,inflammatory factors [PCT,C-reactive protein(CRP)],and immune function [immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM)] were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the risk factors of COPD with pulmonary infection.Results There were no statistically significant differences in the baseline data such as gender,age,pulmonary function classification,combination of hypertension,and mechanical ventilation between the two groups(P>0.05),but there were statistically significant differences in the combination of diabetes mellitus,smoking,antibiotic use time,and glucocorticoid use time between the two groups(P1.05 g/L,C4>0.28 g/L,PCT>1.02 μg/L,IgA<0.97 g/L,combination of diabetes mellitus,antibiotic use time≥2 weeks,and glucocorticoid use time≥1 week were independent risk factors for pulmonary infection in patients with COPD(P<0.05).Conclusion Patients with COPD complicated with pulmonary infection may have significant changes in plasma complements,inflammatory factors,and immune function.In addition,there are many risk factors for pulmonary infection in such patients,so it is necessary to focus on monitoring susceptible groups and preventing the pulmonary infection in clinical practice.