慢性阻塞性肺病合并细菌感染患者CD4^(+)CD25^(+)T调节细胞及相关细胞因子表达水平及意义

Expression Levels and Significance of CD4^(+)CD25^(+)T Regulatory Cell and Related Cytokines in Patients with COPD Complicated with Bacterial Infection

目的:研究慢性阻塞性肺病(COPD)合并细菌感染患者CD4^(+)CD25^(+)T调节细胞及其相关细胞因子白介素-4(IL-4)、IL-12和γ-干扰素(IFN-γ)表达水平及临床意义。方法:纳入2020年8月至2022年8月间收治的108例COPD患者作为研究对象,根据是否合并细菌感染分为感染组(n=53)和对照组(n=55)。检测外周血标本CD4^(+)CD25^(+)调节性T细胞以及IL-4、IL-12和IFN-γ表达水平,对比两组差异,并分析相关指标水平与COPD合并感染的关系;统计患者28d预后情况,分析上述指标对患者预后预测价值。结果:感染组COPD患者血清IL-4、IL-12水平高于对照组,IFN-γ/IL-4低于对照组,差异有统计学意义(P<0.05);随访结果显示28d内死亡15例,病死率13.89%;死亡组COPD患者血清IL-4水平高于对照组,CD4^(+)CD25^(+)、IL-12、IFN-γ和IFN-γ/IL-4低于对照组,差异有统计学意义(P<0.05);logistics回归分析结果显示,血清IL-4和IL-12水平与COPD合并肺部感染存在关联(P<0.05),CD4^(+)CD25^(+)、IL-12和IFN-γ/IL-4与COPD患者预后存在关联(P<0.05);ROC曲线显示,CD4^(+)CD25^(+)、IL-12、IFN-γ/IL-4及三者联合检测对COPD患者预后判断的AUC分别为0.747、0.827、0.709和0.924。结论:CD4^(+)CD25^(+)Treg及相关细胞因子与COPD感染和病情进展有关,检测CD4^(+)CD25^(+)Treg分布以及IL-4、IL-12和IFN-γ可为COPD患者肺部感染诊断和预后评估提供参考信息。

Objective:To study the expression levels and clinical significance of CD4^(+)CD25^(+)T regulatory cell and related cytokines of interleukin-4(IL-4),IL-12 and interferon-γ(IFN-γ)in patients with chronic obstructive pulmonary disease(COPD)complicated with bacterial infection.Methods:A total of 108 patients with COPD admitted between August 2020 and August 2022 were included as the research subjects,and they were divided into infected group(n=53)and control group(n=55)according to whether the patients were complicated with bacterial infection.The expression levels of CD4^(+)CD25^(+)regulatory T cell and IL-4,IL-12 and IFN-γwere detected in the peripheral blood samples,and the differences between the two groups were compared,and the relationship between levels of related indicators and COPD with infection was analyzed.The 28-d prognosis of patients was statistically analyzed,and the predictive value of the above indicators on prognosis was analyzed.Results:The levels of serum IL-4 and IL-12 of COPD patients in infected group were higher than those in control group while the IFN-γ/IL-4 was lower than that in control group(P<0.05).Follow-up results showed that 15 patients died within 28 d,with a mortality rate of 13.89%.The level of serum IL-4 of COPD patients in death group was higher than that in control group while the levels of CD4^(+)CD25^(+),IL-12,IFN-γand IFN-γ/IL-4 were lower than those in control group(P<0.05).Logistics regression analysis showed that serum levels of IL-4 and IL-12 were associated with COPD with pulmonary infection(P<0.05),and CD4^(+)CD25^(+),IL-12 and IFN-γ/IL-4 were associated with the prognosis of COPD patients(P<0.05).ROC curve showed that the AUC values of CD4^(+)CD25^(+),IL-12,IFN-γ/IL-4 and the combination of the three were 0.747,0.827,0.709,and 0.924 respectively in judging prognosis of COPD patients.Conclusion:CD4^(+)CD25^(+)Treg cell and related cytokines are related to COPD infection and disease progression.Detection of CD4^(+)CD25^(+)Treg distribution as well as IL-4,IL-12 and IFN-γcan provide reference information for diagnosis of pulmonary infection and evaluation of prognosis in patients with COPD.