CT肺血管定量指标对慢性阻塞性肺疾病急性加重期患者预后有评估价值

Relationship between CT pulmonary blood vessel quantitative index and airway immunoinflammatory response in AECOPD patients and its prognostic value analysis

目的:探讨CT肺血管定量指标与慢性阻塞性肺疾病急性加重期(AECOPD)患者气道免疫炎性反应的关系及其预测预后的价值。方法:回顾性选取96例AECOPD患者,根据入院30 d的预后,分为死亡组17例与生存组79例。比较2组患者CT肺血管定量指标[主肺动脉直径(mPAD)、左肺动脉直径(LPAD)、右肺动脉直径(RPAD)、升主动脉直径(AAD)、矢状位、冠状位、轴位斜mPAD、主肺动脉与升主动脉直径比(rPA)]和气道免疫炎性指标[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-8、干扰素(IFN-γ)、IL-4],分析CT肺血管定量指标与气道免疫炎性指标的相关性及这2类指标与AECOPD患者预后的关系,绘制受试者工作特征(ROC)曲线,评价CT肺血管定量指标、气道免疫炎性指标及2类联合对AECOPD患者预后的预测价值。结果:死亡组患者mPAD、轴位斜、冠状位、矢状位mPAD、RPAD、LPAD、AAD、rPA、TNF-α、IL-8、IL-4水平高于生存组,IFN-γ水平低于生存组(P均<0.05);AECOPD患者mPAD、轴位斜、冠状位、矢状位mPAD、RPAD、LPAD、AAD、rPA与TNF-α、IL-8、IL-4水平呈正相关,与IFN-γ水平呈负相关(P均<0.05);Logistic回归分析结果显示,mPAD、轴位斜、冠状位、矢状位mPAD、RPAD、LPAD、AAD、rPA、TNF-α、IL-8、IL-4、IFN-γ水平均为AECOPD患者预后独立影响因素(P均<0.05);ROC曲线显示,联合2类指标预测AECOPD患者预后的曲线下面积为0.892;联合检测预后不佳患者的30 d生存率更低(P<0.05)。结论:AECOPD患者CT肺血管定量指标与气道免疫炎性反应密切相关,且联合检测对患者预后有预测价值。

Objective:To explore the relationship between CT pulmonary vascular quantitative indicators and the airway immune inflammatory response in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and its prognostic value.Methods:In total,96 AECOPD patients in our hospital from January 2020 to January 2021 were selected as the research objects.The patients were divided into groups according to the 30-day prognosis:death group(n=17)and survival group(n=79).CT pulmonary vascular quantitative indicators in patients with different prognosis[main pulmonary artery diameter(mPAD),left pulmonary artery diameter(LPAD),right pulmonary artery diameter(RPAD),ascending aorta diameter(AAD),sagittal mPAD,coronary mPAD,axial Oblique mPAD,diameter ratio of main pulmonary artery to ascending aorta(rPA)],airway immune inflammatory response index[tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),interferon-γ(IFN-γ),IL-4]were compared.The correlation between CT pulmonary vascular quantitative indicators and airway immune inflammatory response indicators,CT pulmonary vascular quantitative indicators,airway immune inflammatory response indicators and AECOPD was analyzed.The receiver operating characteristic(ROC)curve was drawn,the predictive value of CT pulmonary vascular quantitative indicators and airway immune inflammatory response indicators and their combined detection in the prognosis of AECOPD patients was evaluated.Results:The mPAD,axial oblique mPAD,coronal mPAD,sagittal mPAD,RPAD,LPAD,AAD,rPA,TNF-α,IL-8,IL-4 levels in the death group were significantly higher than those in the survival group,and IFN-γlevels were significantly lower in the survival group than in the death group(P<0.05).The mPAD,axial oblique mPAD,coronal mPAD,sagittal mPAD,RPAD,LPAD,AAD,rPA were positively correlated with TNF-α,IL-8,IL-4 levels in AECOPD patients,and negatively correlated with IFN-γlevels(P<0.05).Logistic regression analysis showed that mPAD,axial oblique mPAD,coronal mPAD,sagittal mPAD,RPAD,LPAD,AAD,the levels of rPA,TNF-α,IL-8,IL-4,and IFN-γwere all independent factors affecting the prognosis of AECOPD patients(P<0.05).The combined predictive value of CT pulmonary vascular quantitative indicators and airway immune inflammatory response indicators for the prognosis of AECOPD patients had an AUC of 0.892.The 30-day survival rate of patients with poor prognosis evaluated by joint testing is lower.Conclusion:CT pulmonary vascular quantitative indicators of AECOPD patients are closely related to airway immune inflammatory response,and clinical detection of CT pulmonary vascular quantitative indicators and airway immune inflammatory indicators can predict the prognosis of patients and guide the formulation of clinical diagnosis and treatment plans.