血清TRAIL、MIP-1α、CYR61在嗜酸性粒细胞增多型AECOPD中的临床意义

Clinical significance of serum tumor necrosis factor-related apoptosis-inducing ligand,macrophage inflammatory protein-1α,and cysteine rich 61 in acute exacerbation of chronic obstructive pulmonary disease of eosinophil-increased type

目的探讨嗜酸性粒细胞(EOS)增多型慢性阻塞性肺疾病急性加重(AECOPD)患者血清肿瘤坏死因子相关的凋亡诱导配体(TRAIL)、巨噬细胞炎症蛋白1α(MIP-1α)、半胱氨酸富集蛋白61(CYR61)检测的临床意义。方法本研究为观察性研究,采用非随机抽样法选取2019年1月至2022年3月河北省胸科医院收治的AECOPD患者280例,根据外周血EOS百分比分为EOS增多型组(106例)和EOS正常组(174例)。随访1年根据是否再次因AECOPD入院将EOS增多型AECOPD患者分为再入院亚组(49例)和未再入院亚组(57例),根据再入院患者外周血EOS百分比分为EOS增多型亚组(21例)和EOS正常亚组(28例)。检测血清TRAIL、MIP-1α、CYR61、炎症指标、肺功能指标和血气分析指标。采用Spearman相关性分析EOS增多型AECOPD患者血清TRAIL、MIP-1α、CYR61与炎症指标、肺功能及血气分析指标的相关性。采用受试者操作特征(ROC)曲线分析血清TRAIL、MIP-1α、CYR61水平对EOS增多型AECOPD患者再入院的预测价值。结果EOS增多型组男82例,女24例,年龄(61.00±8.07)岁;EOS正常组男132例,女42例,年龄(61.03±7.36)岁;2组性别构成、年龄比较差异无统计学意义(均P>0.05)。EOS增多型组血清TRAIL、MIP-1α、CYR61、白细胞计数、C反应蛋白和白细胞介素6水平低于EOS正常组[32.14(19.61,45.46)ng/L比53.94(42.84,67.21)ng/L、190.13(128.13,407.98)ng/L比695.47(355.79,1193.53)ng/L、1.09(0.59,2.18)μg/L比2.62(2.09,3.34)μg/L、8.05(6.90,8.98)×10^(9)/L比10.11(8.66,11.61)×10^(9)/L、8.39(5.84,12.24)mg/L比18.04(8.15,29.01)mg/L、10.18(3.58,15.22)ng/L比16.23(9.98,25.39)ng/L;Z值分别为9.68、9.54、9.57、8.19、6.84、5.78,均P<0.001],2组患者第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)、第1秒用力呼气容积(FEV_(1))/用力肺活量(FVC)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))比较差异无统计学意义(均P>0.05)。Spearman相关性分析显示,EOS增多型AECOPD患者血清TRAIL、MIP-1α、CYR61与白细胞计数、C反应蛋白、白细胞介素6水平呈正相关(均P<0.05),与FEV_(1)%pred、FEV_(1)/FVC、PaO_(2)、PaCO_(2)无相关性(均P>0.05)。再入院亚组血清TRAIL、MIP-1α、CYR61水平高于未再入院亚组[44.09(31.49,51.05)ng/L比26.08(16.09,36.75)ng/L、346.11(175.19,541.90)ng/L比149.64(110.76,222.78)ng/L、1.83(0.83,2.49)μg/L比0.74(0.32,1.57)μg/L;Z值分别为5.10、5.04、4.96,均P<0.001]。EOS增多型亚组血清TRAIL、MIP-1α、CYR61水平低于EOS正常亚组[29.40(18.82,36.20)ng/L比44.70(35.04,51.71)ng/L、227.39(59.13,346.58)ng/L比450.82(307.39,589.21)ng/L、1.40(0.49,2.06)μg/L比2.21(1.71,3.28)μg/L;Z值分别为3.90、4.00、3.87,均P<0.001)。ROC曲线分析显示,血清TRAIL、MIP-1α、CYR61水平联合预测EOS增多型AECOPD患者再入院的曲线下面积为0.910,大于血清TRAIL、MIP-1α、CYR61水平单独预测的曲线下面积(分别为0.788、0.784、0.780)。结论EOS增多型AECOPD患者血清TRAIL、MIP-1α、CYR61水平降低,与炎症指标和患者再次AECOPD入院有关,血清TRAIL、MIP-1α、CYR61水平联合检测对EOS增多型AECOPD患者再入院的预测价值较高。

Objective To investigate the clinical significance of serum tumor necrosis factor-related apoptosis-inducing ligand(TRAIL),macrophage inflammatory protein 1-α(MIP-1α),and cysteine rich 61(CYR61)detection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)of eosinophil(EOS)-increased type.Methods This was an observational study using non random sampling method.A total of 280 AECOPD patients admitted to Hebei Chest Hospital from January 2019 to March 2022 were selected and divided into EOS-increased group(106 cases)and EOS-normal group(174 cases)according to the percentage of peripheral blood EOS.Patients in EOS-increased group were further classified into readmission subgroup(49 cases)and non-readmission subgroup(57 cases)according to whether they were admitted to hospital again due to AECOPD in the one-year follow-up.According to the peripheral blood EOS percentage,patients readmitted were further divided into EOS-increased subgroup(21 cases)and EOS-normal subgroup(28 cases).Serum TRAIL,MIP-1α,CYR61,inflammatory indicators,pulmonary function indicators,and blood gas analysis indicators were measured.Spearman′s correlation was used to analyze the correlation between serum TRAIL,MIP-1α,CYR61 and inflammatory indicators,pulmonary function indicators,blood gas analysis indicators in patients with AECOPD of EOS-increased type.The predictive value of serum TRAIL,MIP-1α,and CYR61 levels for readmission in patients with AECOPD of EOS-increased type was analyzed by receiver operating characteristic(ROC)curve.Results There were 82 males and 24 females in the EOS-increased group,aged(61.00±8.07)years old.There were 132 males and 42 females in the EOS-normal group,aged(61.03±7.36)years old.There was no statistically significant difference in gender composition and age between the two groups(both P>0.05).Serum TRAIL,MIP-1α,white blood cell count,C-reactive protein,and interleukin-6(IL-6)levels in the EOS-increased type group were lower than those in the EOS-normal group(32.14[19.61,45.46]ng/L vs53.94[42.84,67.21]ng/L,190.13[128.13,407.98]ng/L vs695.47[355.79,1193.53]ng/L,1.09[0.59,2.18]μg/L vs2.62[2.09,3.34]μg/L,8.05[6.90,8.98]×10^(9)/L vs10.11[8.66,11.61]×10^(9)/L,8.39[5.84,12.24]mg/L vs18.04[8.15,29.01]mg/L,10.18[3.58,15.22]ng/L vs16.23[9.98,25.39]ng/L;Z value was 9.68,9.54,9.57,8.19,6.84,5.78,all P<0.001).There was no statistical difference in the forced expiratory volume in one second%predicted(FEV_(1)%pred),forced expiratory volume in one second(FEV_(1))/forced vital capacity(FVC),arterial partial pressure of oxygen(PaO_(2)),and arterial partial pressure of carbon dioxide(PaCO_(2))between the two groups(all P>0.05).Spearman correlation analysis showed that serum TRAIL,MIP-1α,and CYR61 were positively correlated with white blood cell count,C-reactive protein,and IL-6 levels in patients with AECOPD of EOS-increased type(44.09[31.49,51.05]ng/L vs26.08[16.09,36.75]ng/L,346.11[175.19,541.90]ng/L vs149.64[110.76,222.78]ng/L,1.83[0.83,2.49]μg/L vs0.74[0.32,1.57]μg/L;Z value was 5.10,5.04,4.96,all P<0.001),but not correlated with FEV_(1)%pred,FEV_(1)/FVC,PaO_(2),and PaCO_(2)(all P>0.05).The serum TRAIL,MIP-1α,and CYR61 levels in the readmission subgroup were higher than those in the non-readmission subgroup(all P<0.05).Serum TRAIL,MIP-1α,and CYR61 levels were lower in the EOS-increased subgroup than in the EOS-normal subgroup(29.40[18.82,36.20]ng/L vs44.70[35.04,51.71]ng/L,227.39[59.13,346.58]ng/L vs450.82[307.39,589.21]ng/L,1.40[0.49,2.06]μg/L vs2.21[1.71,3.28]μg/L;Z value was 3.90,4.00,3.87,all P<0.05).ROC curve analysis showed that the area under the curve of serum TRAIL,MIP-1α,and CYR61 levels combined to predict readmission in AECOPD patients with increased EOS was 0.910,which was larger than that predicted by serum TRAIL,MIP-1α,and CYR61 levels alone(0.788,0.784,and 0.780 respectively).Conclusions Reduced serum TRAIL,MIP-1α,and CYR61 levels in patients with AECOPD of EOS-increased typ are related to inflammatory indicators and patients′readmission to the hospital for AECOPD.The combined application of serum TRAIL,MIP-1α,and CYR61 levels has a high predictive value for readmission to the hospital of patients with AECOPD of EOS-increased type.