COPD患者肺感染影响因素与外周血CD_(19)^(+)B细胞PD-1/PD-Ls分子表达及其预测价值

Influencing factors of pulmonary infection,expressions and predictive value of PD-1/PD-Ls in peripheral blood CD_(19)^(+)B cells in COPD patients

目的探究慢性阻塞性肺病(COPD)患者肺感染影响因素及外周血CD_(19)^(+)B细胞程序性细胞死亡受体-1(PD-1)/程序性细胞死亡配体(PD-Ls)分子表达及其预测价值。方法回顾性分析2019年1-12月湖州市中心医院收治的COPD患者612例的临床资料,根据有无发生肺部感染分为感染组(n=288)和未感染组(n=324)。采用流式细胞仪检测所有患者外周血CD_(19)^(+)B细胞PD-1、PD-L1和PD-L2分子表达水平;采用多因素Logistic回归分析COPD患者发生肺部感染的影响因素;受试者工作特征(ROC)曲线分析PD-1、PD-L1和PD-L2分子表达水平对COPD患者发生肺部感染的预测价值。结果感染患者共培养分离病原菌325株,其中革兰阴性菌205株占63.08%,革兰阳性菌107株占32.92%,真菌13株占4.00%,以肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌和肺炎链球菌为主;感染组患者外周血CD_(19)^(+)B细胞PD-1、PD-L1和PD-L2高于未感染组(P<0.05);合并低白蛋白血症(OR=1.958,P=0.023)、合并糖尿病(OR=1.921,P=0.034)和长期使用糖皮质激素(OR=1.874,P=0.044)是COPD患者发生肺部感染的影响因素;COPD患者外周血CD_(19)^(+)B细胞PD-1、PD-L1、PD-L2表达水平以及联合预测COPD患者发生肺部感染的曲线下面积(AUC)分别为0.778、0.764、0.740和0.894。结论PD-1、PD-L1和PD-L2能使COPD患者肺部感染发生与发展,临床可通过检测其水平对患者发生肺部感染进行预测,对肺部感染情况进行评估。

OBJECTIVE To explore the influencing factors of pulmonary infection,expressions and predictive value of programmed cell death 1(PD-1)/programmed cell death ligands(PD-Ls)in peripheral blood CD_(19)^(+)B cells in patients with chronic obstructive pulmonary disease(COPD).METHODS A retrospective analysis was performed on the clinical data of 612 patients with COPD admitted to Huzhou Central Hospital between Jan.and Dec.2019.According to presence or absence of pulmonary infection,they were divided into infection group(n=288)and non-infection group(n=324).The expression levels of PD-1,PD-L1 and PD-L2 in peripheral blood CD_(19)^(+)B cells were detected by flow cytometry.The influencing factors of pulmonary infection were analyzed by multivariate Logistic regression analysis.The predictive value of PD-1,PD-L1 and PD-L2 for pulmonary infection was analyzed by receiver operating characteristic(ROC)curves.RESULTS There were 325 strains of pathogens in infection patients,including 205 strains of Gram-negative bacteria(63.08%),107 strains of Gram-positive bacteria(32.92%)and 13 strains of fungi(4.00%).The main pathogens were Klebsiella pneumonia,Pseudomonas aeruginosa,Staphylococcus aureus and Streptococcus pneumoniae.The levels of PD-1,PD-L1 and PD-L2 in infection group were significently higher than those in non-infection group(P<0.05).Hypoalbuminemia(OR=1.958,P=0.023),diabetes mellitus(OR=1.921,P=0.034)and long-term usage of glucocorticoids(OR=1.874,P=0.044)were influencing factors of pulmonary infection in COPD patients.AUC values of PD-1,PD-L1,PD-L2 and combined detection for predicting pulmonary infection were 0.778,0.764,0.740 and 0.894,respectively.CONCLUSION PD-1,PD-L1 and PD-L2 can promote the occurrence and development of pulmonary infection in COPD patients.Clinically,detecting their levels can predict and evaluate pulmonary infection.