血清CX3C基序趋化因子配体1及Ⅰ型纤溶酶原激活抑制物水平与慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者病情严重程度及预后的关系研究

The relationship of serum CX3C chemokine ligand 1 and typeⅠplasmin activator inhibitor levels with the severity and prognosis of chronic obstructive pulmonary disease patients with typeⅡrespiratory failure

目的 研究慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者血清CX3C基序趋化因子配体1(CX3CL1)、Ⅰ型纤溶酶原激活抑制物(PAI-1)水平与病情严重程度及预后的关系。方法 选取2019年1月至2021年1月重庆医科大学附属永川医院收治的COPD合并Ⅱ型呼吸衰竭患者96例为研究对象(呼吸衰竭组)、同期诊治的单纯COPD患者60例为单纯COPD组、同期健康体检的健康人群60例为健康对照组。检测受试者血清CX3CL1、PAI-1水平。比较不同健康状况受试者、不同病情严重程度呼吸衰竭组患者血清CX3CL1、PAI-1水平差异。分析影响COPD合并Ⅱ型呼吸衰竭患者不良预后的因素以及血清CX3CL1、PAI-1对不良预后的预测价值。结果 呼吸衰竭组、单纯COPD组CX3CL1、PAI-1水平均高于健康对照组[(266±29)、(219±35)ng/L比(156±23)ng/L,(15.2±2.3)、(12.3±2.2)μg/L比(8.2±1.8)μg/L],且呼吸衰竭组高于单纯COPD组(均P<0.05)。呼吸衰竭组中轻度组、中度组、重度组血清CX3CL1、PAI-1水平随疾病严重程度加重呈上升趋势(均P<0.05)。COPD合并Ⅱ型呼吸衰竭患者血清CX3CL1、PAI-1水平与第1秒用力呼气容积占预计值百分比(FEV1%)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC比值)呈负相关(均P<0.001)。呼吸衰竭组中预后不良组血清CX3CL1、PAI-1水平均高于预后良好组(均P<0.05)。多因素Logistic回归分析结果显示,血清CX3CL1、PAI-1升高是COPD合并Ⅱ型呼吸衰竭患者不良预后的独立危险因素(均P<0.001)。血清CX3CL1、PAI-1联合检测对COPD合并Ⅱ型呼吸衰竭患者不良预后预测的曲线下面积大于CX3CL1、PAI-1单独诊断(均P<0.001)。结论 COPD合并Ⅱ型呼吸衰竭患者血清CX3CL1、PAI-1水平升高,二者与病情严重程度有关,联合检测有助于评估COPD合并Ⅱ型呼吸衰竭患者的临床预后。

Objective To study the serum levels of CX3C chemokine ligand 1(CX3CL1),typeⅠplasmin activator inhibitor(PAI-1)and their relationship with severity and prognosis in chronic obstructive pulmonary disease(COPD)patients with typeⅡrespiratory failure.Methods Totally 96 patients with COPD combined with typeⅡrespiratory failure admitted to Yongchuan Hospital of Chongqing Medical University from January 2019 to January 2021 were selected(respiratory failure group),60 patients with simple COPD at the same time were selected as the simple COPD group,and 60 healthy individuals undergoing physical examinations at the same time were selected as the healthy control group.Serum levels of CX3CL1 and PAI-1 of subjects were detected.The differences in serum levels of CX3CL1 and PAI-1 in subjects with different health conditions and patients in respiratory failure group with different severity levels were compared.The factors affecting the poor prognosis of COPD patients with typeⅡrespiratory failure and the predictive value of serum CX3CL1 and PAI-1 in poor prognosis of COPD patients with typeⅡrespiratory failure were analyzed.Results The serum levels of CX3CL1 and PAI-1 in the respiratory failure group and the simple COPD group were higher than those in the healthy control group[(266±29),(219±35)ng/L vs(156±23)ng/L;(15.2±2.3),(12.3±2.2)μg/L vs(8.2±1.8)μg/L],and the respiratory failure group was higher than the simple COPD group(all P<0.05).The serum levels of CX3CL1 and PAI-1 in the mild,moderate and severe groups of respiratory failure group showed upward trends(all P<0.05).The serum levels of CX3CL1 and PAI-1 in COPD patients with typeⅡrespiratory failure were negatively correlated with forced expiratory volume in the first second as a percentage of expected value and forced expiratory volume in the first second accounted for forced vital capacity(all P<0.001).The serum levels of CX3CL1 and PAI-1 in the poor prognosis group of respiratory failure group were higher than those in the good prognosis group(both P<0.05).Multivariate Logistic regression analysis showed that elevated levels of serum CX3CL1 and PAI-1 were independent risk factors for poor prognosis in COPD patients with typeⅡrespiratory failure(both P<0.001).The area under the curve of the combination of serum CX3CL1 and PAI-1 for predicting poor prognosis in COPD patients with typeⅡrespiratory failure was larger than serum CX3CL1 and PAI-1 alone(both P<0.001).Conclusions The elevated levels of serum CX3CL1 and PAI-1 in COPD patients with typeⅡrespiratory failure are related to the severity of the condition.The combined detection of serum CX3CL1 and PAI-1 can help to evaluate the clinical prognosis of COPD patients with typeⅡrespiratory failure.