COPD患者血清IL-38、sRAGE、TLR4、ANGPTL4变化及与疾病严重程度、预后的关系分析

Changes of serum IL-38,sRAGE,TLR4 and ANGPTL4 in COPD patients and their relationship with disease severity and prognosis

目的探讨慢性阻塞性肺疾病(COPD)患者血清白细胞介素-38(IL-38)、可溶性晚期糖基化终产物受体(sRAGE)、Toll样受体4(TLR4)、血管生成素样蛋白4(ANGPTL4)变化及与疾病严重程度、预后的关系分析。方法选取2019年5月至2021年3月该院收治的136例COPD患者作为病例组,根据不同疾病进展将病例组分为急性期加重期组(n=79)和稳定期组(n=57),另选取同期来该院体检的健康者88例作为对照组。比较各组血清IL-38、sRAGE、TLR4、ANGPTL4水平,分析上述指标与疾病严重程度和预后的关系。结果急性加重期组患者血清IL-38、TLR4、ANGPTL4水平高于稳定期组、对照组,sRAGE水平低于稳定期组、对照组(P<0.05);病例组Ⅲ~Ⅳ级患者血清IL-38、TLR4、ANGPTL4水平高于Ⅰ~Ⅱ级患者,sRAGE水平低于Ⅰ~Ⅱ级患者(P<0.05);死亡组患者血清IL-38、TLR4、ANGPTL4水平高于生存组,sRAGE水平低于生存组(P<0.05);受试者工作特征曲线分析显示,IL-38、sRAGE、TLR4、ANGPTL4联合预测COPD患者预后的曲线下面积为0.952高于IL-38(0.735)、sRAGE(0.812)、TLR4(0.783)、ANGPTL4(0.760)的曲线下面积,差异有统计学意义(P<0.05);采用二元Logistic分析,GOLD分级、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、IL-38表达>61.52 ng/L、sRAGE表达≤272.72 ng/L、TLR4表达>4.24 ng/mL、ANGPTL4表达>1172.50 ng/L均为影响COPD患者预后的独立危险因素。结论COPD患者血清IL-38、sRAGE、TLR4、ANGPTL4可反映病情进展情况,可用于预后评估。

Objective To explore the changes of serum interleukin-38(IL-38),soluble receptor of advanced glycation endproducts(sRAGE),Toll-like receptor 4(TLR4)and angiopoietin-like protein 4(ANGPTL4)in patients with chronic obstructive pulmonary disease(COPD)and their relationship with disease severity and prognosis.Methods A total of 136 patients with COPD were enrolled in a hospital as case group between May 2019 and March 2021.According to different disease progression,they were divided into acute phase exacerbation group(79 cases)and stable phase group(57 cases),while other 88 healthy people who came to the hospital during the same period were enrolled as control group.The levels of serum IL-38,sRAGE,TLR4 and ANGPTL4 were compared among the groups,and the relationship between the above indexes and disease severity and prognosis was analyzed.Results The levels of serum IL-38,TLR4 and ANGPTL4 in acute phase exacerbation group were higher than those in stable phase group and control group,while sRAGE level was lower than that in stable phase group and control group(P<0.05).In the case group,the levels of serum IL-38,TLR4 and ANGPTL4 in gradeⅢ-Ⅳgroup were higher than those in gradeⅠ-Ⅱ,while sRAGE level was lower than that in gradeⅠ-Ⅱ(P<0.05).The levels of serum IL-38,TLR4 and ANGPTL4 in death group were higher than those in survival group,while sRAGE level was lower than that in survival group(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve of IL-38,sRAGE,TLR4 and ANGPTL4 combined to predict the prognosis of COPD patients was 0.952,which was higher than that of IL-38(0.735),sRAGE(0.812),TLR4(0.783)and ANGPTL4(0.760),and the differences were statistically significant(P<0.05).Binary Logistic analysis showed that GOLD grading,APACHEⅡscore,IL-38>61.52 ng/L,sRAGE≤272.72 ng/L,TLR4>4.24 ng/mL and ANGPTL4>1172.50 ng/L were all independent risk factors of prognosis in COPD patients.Conclusion The serum IL-38,sRAGE,TLR4 and ANGPTL4 can reflect the disease progression and evaluate prognosis of COPD patient.