COPD合并Ⅱ型呼吸衰竭患者外周血HMGB1 IL-17及呼出气一氧化氮浓度对预后的预测价值

Predictive Value of HMGB1 IL-17 and Exhaled Nitric Oxide Concentrations in Peripheral Blood of Patients with COPD Combined with Respiratory Failure Type Ⅱ

目的:探讨慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者外周血高迁移率族蛋白B1(HMGB1)、白细胞介素-17(IL-17)及呼出气一氧化氮(FeNO)浓度变化,分析其对预后的预测价值。方法:选取2021年1月至2022年12月本院100例COPD合并Ⅱ型呼吸衰竭患者作为观察组,另选取同期COPD未合并呼吸衰竭患者60例作为对照组,健康体检者60例作为健康组。采集入院时外周血HMGB1、IL-17及FeNO。依据住院28d生存情况分为病死、存活患者,并分析外周血HMGB1、IL-17及FeNO。采用Lasso-Logistic回归分析预后的临床影响因素。分析FeNO与外周血HMGB1、IL-17交互作用对患者预后的影响及其对预后的预测价值。结果:观察组外周血HMGB1、IL-17及FeNO高于对照组、健康组,且对照组高于健康组(P<0.05);外周血HMGB1、IL-17与FeNO呈正相关(P<0.05);急性加重次数≥2次比例、APACHEⅡ评分、外周血HMGB1、IL-17与FeNO为预后的独立危险因素(P<0.05);HMGB1、IL-17、FeNO高表达与预后不良存在交互作用(P<0.05);HMGB1、IL-17、FeNO联合预测预后的AUC高于单独指标预测(P<0.05)。结论:COPD合并Ⅱ型呼吸衰竭患者外周血HMGB1、IL-17及FeNO浓度升高,且在预后不良中具有协同作用,联合检测其水平预测预后具有临床应用价值。

Objective:To investigate the changes of high mobility group protein B1(HMGB1),interleukin-17(IL-17)and exhaled nitric oxide(FeNO)levels in peripheral blood of patients with chronic obstructive pulmonary disease(COPD)combined with respiratory failure typeⅡ,and to analyze its predictive value for prognosis.Methods:A total of 100 patients with COPD combined with respiratory failure typeⅡin our hospital from January 2021 to December 2022 were selected as the observation group,60 patients with COPD but without respiratory failure during the same period were selected as the control group,and 60 patients with healthy physical examination were selected as the healthy group.Peripheral blood HMGB1,IL-17 and FeNO were collected upon admission.Patients were classified as dead or alive based on survival at 28 days of hospitalization,and peripheral blood was analyzed for HMGB1,IL-17,and FeNO.The clinical influencing factors of prognosis were analyzed by Lasso-Logistic regression.To analyze the effect of FeNO interaction with peripheral blood HMGB1 and IL-17 on the prognosis of patients and its predictive value for prognosis.Results:Peripheral blood HMGB1,IL-17 and FeNO were higher in the observation group than in the control group and the healthy group,and the control group was higher than the healthy group(P<0.05);there was a positive correlation between peripheral blood HMGB1,IL-17 and FeNO(P<0.05);the proportion of acute exacerbations≥2,the APACHE II score,peripheral blood HMGB1,IL-17 and FeNO were independent prognostic risk factors(P<0.05);there was an interaction between high expression of HMGB1,IL-17,and FeNO and poor prognosis(P<0.05);and the AUC of the combination of HMGB1,IL-17,and FeNO in predicting prognosis was higher than that predicted by the index alone(P<0.05).Conclusion:The peripheral blood concentrations of HMGB1,IL-17 and FeNO were elevated in patients with COPD combined with typeⅡrespiratory failure and had synergistic effects in poor prognosis,and the combined detection of their levels to predict prognosis has clinical application value.