CX3CL1和FIB及MPV/PLT表达水平对慢性阻塞性肺疾病急性加重期患者的预后价值

Prognostic value of CX3CL1,FIB and MPV/PLT in patients with acute exacerbation of chronic obstructive pulmonary disease

目的检测CX3趋化因子配体1(CX3CL1)、纤维蛋白原(FIB)、平均血小板体积/血小板计数(MPV/PLT)表达,探讨其对慢性阻塞性肺疾病急性加重期(AECOPD)患者的预后价值。方法选取2021年6月-2023年6月广东药科大学附属第一医院收治的114例AECOPD患者为研究对象,根据患者生存情况分为存活组91例和死亡组23例。单因素及多因素分析影响AECOPD患者预后的独立影响因素,分析CX3CL1、FIB、MPV/PLT对AECOPD患者的预后价值及对患者生存期的影响。结果死亡组机械通气率、C反应蛋白(CRP)、中性粒细胞计数(NEU)、CX3CL1、MPV、FIB水平高于存活组,PLT水平低于存活组,差异均有统计学意义(χ^(2)/t=7.992、5.542、3.240、5.762、3.188、4.545、4.309,P均<0.05)。死亡组MPV/PLT水平为(0.07±0.01),高于存活组(0.04±0.01),差异有统计学意义(t=7.904,P<0.001)。Logistic分析显示,机械通气、CRP、NEU、MPV、CX3CL1、MPV/PLT、FIB是AECOPD患者死亡的危险因素,PLT为AECOPD患者死亡的保护因素(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,CX3CL1、FIB、MPV/PLT单一及联合检测对AECOPD患者预后预测的AUC分别为0.870、0.754、0.832、0.957,联合预测优于单一预测,差异有统计学意义(P<0.001);CX3CL1(Log-rankχ^(2)=34.872,P<0.001)、FIB(Log-rankχ^(2)=16.543,P<0.001)、MPV/PLT(Log-rankχ^(2)=28.750,P<0.001)高表达患者累计生存率均低于低表达患者,差异均有统计学意义。结论CX3CL1、FIB、MPV/PLT联合检测对AECOPD患者预后情况具有较高的预测价值,三者表达水平与患者生存期及生存率有关。

Objective To investigate the prognostic value of CX3 chemokine ligand 1(CX3CL1),fibrinogen(FIB)and mean platelet volume/platelet count(MPV/PLT)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 114 patients with AECOPD admitted to the First Affiliated Hospital of Guangdong Pharmaceutical University from June 2021 to June 2023 were selected as the study objects,and were divided into a survival group(91 cases)and a death group(23 cases)according to their prognosis.The independent influencing factors of AECOPD patients'prognosis were analyzed by univariate and multivariate analysis,and the predictive value of CX3CL1,FIB,MPV/PLT on the prognosis of AECOPD patients and their influence on the survival of patients were analyzed.Results In the death group,mechanical ventilation rate,C⁃reactive protein(CRP),neutrophil count(NEU),CX3CL1,MPV,FIB levels were higher than those of the survival group;PLT level was lower than that of the survival group;the differences were statistically significant(χ^(2)/t=7.992,5.542,3.240,5.762,3.188,4.545,4.309;all P<0.05).MPV/PLT level in the death group(0.07±0.01)was significantly higher than that in the survival group(0.04±0.01),the differences were statistically significant(t=7.904,P<0.001).Logistic analysis showed that mechanical ventilation,CRP,NEU,MPV,CX3CL1,MPV/PLT and FIB levels were the risk factors for death in AECOPD patients,and PLT level was the protective factor for death in AECOPD patients(P<0.05).Receiver operating characteristic(ROC)analysis results showed that the AUC of CX3CL1,FIB and MPV/PLT single and combined detection for prognosis of AECOPD patients were 0.870,0.754,0.832 and 0.957,respectively,and combined prediction was better than single prediction,the differences were statistically significant(P<0.001).The cumulative survival rates of patients with high expression levels of CX3CL1(Log⁃rankχ^(2)=34.872,P<0.001),FIB(Log⁃rankχ^(2)=16.543,P<0.001),and MPV/PLT(Log⁃rankχ^(2)=28.750,P<0.001)were lower than those with low expression levels,the differences were statistically significant.Conclusion CX3CL1,FIB,MPV/PLT levels combined detection had high prognostic value in AECOPD patients,and the expression levels of CX3CL1,FIB,MPV/PLT were related to the survival time and survival rate of patients.