血清PCT和hs-CRP及IL-17水平对老年COPD合并下呼吸道感染的诊断价值

The diagnostic value of serum PCT,hs-CRP,and IL-17 levels in elderly COPD patients with lower respiratory tract infections

目的探究老年慢性阻塞性肺疾病(COPD)合并下呼吸道感染患者中,血清降钙素原(PCT)、高敏C反应蛋白(hs-CRP)、白细胞介素-17(IL-17)水平,及其对疾病诊断及预后预测的价值。方法回顾性选择宁国市人民医院2019年8月-2023年8月120例老年COPD患者作为研究对象,根据是否合并下呼吸道感染分为合并组(合并下呼吸道感染,n=68)和对照组(未合并下呼吸道感染,n=52),其中合并组患者根据治疗后60 d随访结果分为预后不良组(因疾病复发再次入院接受治疗,n=27)和预后良好组(正常生活且未再次发病,n=41)。入组研究对象均于入院后第2天,检测血清PCT、hs-CRP、IL-17水平,分析上述指标对老年COPD合并下呼吸道感染诊断及预后预测价值。结果合并组血清PCT、hs-CRP、IL-17水平均显著高于对照组,差异均有统计学意义(t=4.345、12.528、8.011,P均<0.001)。受试者工作特征(ROC)曲线分析结果显示:血清PCT、hs-CRP、IL-17对COPD合并下呼吸道感染诊断曲线下面积(AUC)依次为0.721(95%CI:0.631~0.799)、0.750(95%CI:0.663~0.824)、0.759(95%CI:0.672~0.832),上述三者联合诊断的AUC为0.905(95%CI:0.838~0.951),联合指标诊断AUC值高于各项指标单一诊断,差异均有统计学意义(P均<0.05)。预后不良组血清PCT、hs-CRP、IL-17水平均显著高于预后良好组,差异均有统计学意义(t=3.461、3.801、6.326,P均<0.05),ROC曲线分析结果显示:血清PCT、hs-CRP、IL-17对COPD合并下呼吸道感染预后预测AUC依次为0.841(95%CI:0.733~0.919)、0.740(95%CI:0.619~0.839)、0.870(95%CI:0.766~0.939),上述三者联合AUC为0.959(95%CI:0.881~0.992),联合指标诊断AUC值高于各项指标单一诊断(P均<0.05)。结论老年COPD合并下呼吸道感染患者血清PCT、hs-CRP、IL-17水平相对较高,且上述指标联合检测对疾病诊断和预后判断均有一定辅助参考价值。

Objective To investigate the serum levels of procalcitonin(PCT), high sensitivity C-reactive protein(hs-CRP), and interleukin-17(IL-17) in elderly patients with chronic obstructive pulmonary disease(COPD) complicated with lower respiratory tract infection, and analyze the diagnostic and prognostic value of the examination results. Methods A retrospective study was conducted on 120 elderly COPD patients in Ningguo People's Hospital from August 2019 to August 2023. They were divided into merging group(with lower respiratory tract infection, n=68) and control group(without lower respiratory tract infection, n=52) based on whether they were complicated with lower respiratory tract infection. Among them, merging group patients were divided into poor prognosis group(poor prognosis: readmission for treatment due to disease recurrence, n=27) and good prognosis group(good prognosis: normal life without recurrence, n=41) based on the 60 day follow-up results after treatment. On the second day after admission, serum levels of PCT, hs-CRP, and IL-17 were detected in all enrolled study subjects to analyze the diagnostic and prognostic value of these indicators for elderly COPD patients with lower respiratory tract infections. Results The serum levels of PCT, hs-CRP, and IL-17 in merging group were significantly higher than those in control group,the differences were statistically significant(t=4.345,12.528,8.011;all P<0.001). The receiver operating characteristic(ROC) curve analysis showed that the area under curve(AUC) of serum PCT, hs-CRP, and IL-17 for diagnosing COPD complicated with lower respiratory tract infection were 0.721(95%CI: 0.631-0.799), 0.750(95%CI: 0.663-0.824), and 0.759(95%CI: 0.672-0.832), respectively. The combined AUC of the three was 0.905(95%CI:0.838-0.951), and the AUC value of the combined indicator diagnosis was higher than that of the single indicator diagnosis(all P<0.05). The levels of serum PCT, hs-CRP, and IL-17 in poor prognosis group were significantly higher than those in good prognosis group,the differences were statistically significant(t=3.461,3.801,6.326;all P<0.05). The ROC curve analysis results showed that the AUC of serum PCT, hs-CRP, and IL-17 for predicting the prognosis of COPD complicated with lower respiratory tract infection was 0.841(95%CI:0.733-0.919), 0.740(95%CI:0.619-0.839), and 0.870(95%CI:0.766-0.939), respectively. The combined AUC of the three was 0.959(95%CI:0.881-0.992), and the AUC value of the combined indicator diagnosis was higher than that of the single indicator diagnosis(all P<0.05). Conclusion The serum levels of PCT, hs-CRP, and IL-17 were relatively high in elderly COPD patients with lower respiratory tract infections, and the combination of these indicators had certain auxiliary reference value for disease diagnosis and prognosis judgment.