免疫及凝血指标与慢性阻塞性肺疾病严重程度相关性及对其预后的临床价值

Correlation of immune and coagulation indexes with the severity of COPD and its clinical value for prognosis

目的通过检测慢性阻塞性肺疾病(慢阻肺)患者血清免疫及凝血功能变化,分析其与慢阻肺严重程度相关性及对慢阻肺患者预后的临床价值。方法选取2021年6月—2022年12月就诊于安徽医科大学附属安庆第一人民医院呼吸与危重症医学科的稳定期慢阻肺患者371例,根据慢性阻塞性肺疾病基层诊疗指南(2018年)分为预后不良组170例和预后良好组201例,比较两组患者CD3^(+)%、CD4^(+)/CD8^(+)、CD3^(-)CD19^(+)%、CD3^(-)CD16^(+)CD56^(+)%、D^(-)二聚体(D^(-)dimer)、纤维蛋白原(FIB)水平;应用多因素Logistic回归分析慢阻肺患者预后不良的影响因素;绘制ROC曲线评估CD3^(+)%、CD4^(+)/CD8^(+)、CD3^(-)CD19^(+)%、CD3^(-)CD16^(+)CD56^(+)%、D^(-)dimer、FIB对慢阻肺患者预后不良的预测价值。结果两组指标相比,预后不良组的CD3^(+)%、CD4^(+)/CD8^(+)、CD3^(-)CD19^(+)%、CD3^(-)CD16^(+)CD56^(+)%表达水平较低,D^(-)dimer、FIB表达水平较高,差异有显著统计学意义(P<0.001);纳入CD3^(+)%、CD4^(+)/CD8^(+)、CD3^(-)CD19^(+)%等构建多因素Logistic回归方程,结果发现:CD3^(+)%、CD4^(+)/CD8^(+)、CD3^(-)CD19^(+)%、CD3^(-)CD16^(+)CD56^(+)%高水平为慢阻肺患者预后不良的保护因素[OR(95%CI)=0.956(0.935~0.977),0.711(0.507~0.977),0.918(0.873~0.965),0.964(0.944~0.985)],FIB高水平为慢阻肺患者预后不良的危险因素[OR(95%CI)=1.775(1.356~2.325)];ROC曲线结果示CD3^(+)%、CD4^(+)/CD8^(+)、CD3^(-)CD19^(+)%、CD3^(-)CD16^(+)CD56^(+)%、D^(-)dimer、FIB及六项联合预测慢阻肺患者预后的AUC分别为0.626、0.600、0.645、0.608、0.610、0.645、0.767,六项联合检测的AUC大于各自单项预测者(P<0.001)。结论监测免疫指标及D^(-)dimer、FIB的变化,对于评估慢阻肺患者病情进展及预后具有重要指导价值。

Objective To detect the changes of serum immune state and coagulation function in patients with chronic obstructive pulmonary disease(COPD),in order to analyze their correlation with disease severity and their clinical value for prognosis.Methods 371 stable COPD patients were selected.They were divided into two groups:170 cases in the poor prognosis group and 201 cases in the good prognosis group based on the basic diagnosis and treatment guidelines of chronic obstructive pulmonary disease(2018).It compared the levels of CD3^(+)%,CD4^(+)/CD8^(+),CD3^(-)CD19^(+)%,CD3^(-)CD16^(+)CD56^(+)%,D^(-)dimer,and fibrinogen between the two groups.Multivariate logistic regression analysis was applied to analyze the influence factors of poor prognosis in COPD patients.It used ROC curves to evaluate the predictive value of CD3^(+)%,CD4^(+)/CD8^(+),CD3^(-)CD19^(+)%,CD3^(-)CD16^(+)CD56^(+)%,D^(-)dimer,and fibrinogen for poor prognosis of COPD patients.Results Compared with the good prognosis group,the levels of CD3^(+)%CD4^(+)/CD8^(+),CD3^(-)CD19^(+)%,and CD3^(-)CD16^(+)CD56^(+)%in the poor prognosis group decreased,and the levels of D^(-)dimer and fibrinogen increased obviously(P<0.001).The multivariate logistic regression equation was constructed including CD3^(+)%,CD4^(+)/CD8^(+),CD3^(-)CD19^(+)%and so on.The results showed that higher CD3^(+)%,higher CD4^(+)/CD8^(+),higher CD3^(-)CD19^(+)%,and higher CD3^(-)CD16^(+)CD56^(+)%were the protective factors[OR(95%CI)=0.956(0.935^(-)0.977),0.711(0.507~0.977),0.918(0.873~0.965),0.964(0.944~0.985)],and higher FIB was the risk factor[OR(95%CI)=1.775(1.356~2.325)].The AUC of CD3^(+)%,CD4^(+)/CD8^(+),CD3^(-)CD19^(+)%,CD3^(-)CD16^(+)CD56^(+)%,D^(-)dimer,fibrinogen,and the six combined tests for predicting the prognosis of COPD were 0.626,0.600,0.645,0.608,0.610,0.645 and 0.767,respectively.The AUC of the six combined tests was greater than that of the individual predictors(P<0.001).Conclusion There is certain clinical significance in evaluating and judging the progress of chronic obstructive pulmonary disease by frequently observe in immune indicators and D^(-)dimer and fibrinogen.