血清CXCL9、sCD163、SP-D含量在老年慢性阻塞性肺疾病急性加重期近期预后中的预测价值

Predictive value of serum CXCL9,sCD163 and SP-D in the short-term prognosis of acute exacerbation of chronic obstructive pulmonary disease in the elderly.

目的分析血清CXC趋化因子配体9(CXCL9)、可溶性血红蛋白清道夫受体163(sCD163)、肺表面活性蛋白D(SP-D)含量在老年慢性阻塞性肺疾病急性加重期(AECOPD)近期预后中的预测价值。方法回顾性分析2021年4月至2023年4月在榆林市第一医院进行治疗的110例老年AECOPD患者的临床资料。依据随访3个月的预后情况,分为预后良好组(n=75)、预后不良组(n=35)。比较两组基线资料,通过多因素Logistic回归分析老年AECOPD近期预后不良的危险因素,采取非条件Logistic逐步回归分析受试者操作特征(ROC)曲线预测急性生理与慢性健康评分Ⅱ(APACHEⅡ)、血清CXCL9、sCD163、SP-D老年AECOPD近期预后的价值。结果预后不良组APACHEⅡ评分、血清CXCL9、sCD163、SP-D水平分别为(25.47±6.52)分、(12.16±3.21)pmol/L、(145.56±30.12)pg/mL、(137.21±35.47)μg/L,均高于预后良好组[(17.42±5.84)分、(9.45±3.12)pmol/L、(104.54±25.37)pg/mL、(113.45±30.67)μg/L],差异均有统计学意义(P<0.05)。多因素Logistic回归分析证实,APACHEⅡ评分、血清CXCL9、sCD163、SP-D是老年AECOPD近期预后不良的危险因素,均有P<0.05;经ROC曲线分析证实APACHEⅡ评分、血清CXCL9、sCD163、SP-D均可用于老年AECOPD近期预后的预测,曲线下面积分别为0.723、0.821、0.815、0.840,均有较高预测价值(P<0.05)。结论血清CXCL9、sCD163、SP-D水平升高将增加老年AECOPD患者近期预后不良风险,可将以上指标用于预测老年AECOPD患者近期预后,可获得较高敏感度与特异度。

Objective To analyze the predictive value of serum CXC chemokine ligand 9 soluble hemoglobin scavenger receptor(CXCL9),soluble hemoglobin scavenger receptor 163(sCD163),pulmonary surfactant protein D(SP-D)content in the elderly with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)in the recent prognosis.Methods The clinical data of 110 elderly patients with AECOPD treated in Yulin First Hospital from April 2021 to April 2023 were retrospectively analyzed.According to the prognosis of 3-month follow-up,they were divided into the good prognosis group(n=75)and the poor prognosis group(n=35).The baseline data of the two groups were compared.The risk factors of poor short-term prognosis of elderly AECOPD were analyzed by multivariate logistic regression analysis.The value of receiver operating characteristic(ROC)curve in predicting the short-term prognosis of acute physiology and chronic health evaluationⅡ(APACHEⅡ),serum CXCL9,sCD163 and SP-D in elderly patients with AECOPD was analyzed by unconditional Logistic stepwise regression analysis.Results The APACHE II score,serum CXCL9,sCD163,and SP-D levels in the poor prognosis group were(25.47±6.52)points,(12.16±3.21)pmol/L,(145.56±30.12)pg/mL,and(137.21±35.47)μg/L,respectively,which were higher than those in the good prognosis group[(17.42±5.84)points,(9.45±3.12)pmol/L,(104.54±25.37)pg/mL,(113.45±30.67)μg/L],the differences were statistically significant(P<0.05).Multiple Logistic regression analysis confirmed that APACHEⅡscore,serum CXCL9,sCD163 and SP-D were the risk factors for poor prognosis of elderly AECOPD in the near future(P<0.05).ROC analysis proved that age,APACHEⅡscore,serum CXCL9,sCD163 and SP-D could be used to predict the short-term prognosis of elderly AECOPD,and the area under the curve were 0.723,0.821,0.815 and 0.840,respectively,all had high predictive value(P<0.05).Conclusion Elevated levels of serum CXCL9,sCD163 and SP-D will increase the risk of poor recent prognosis in elderly patients with AECOPD.These indicators can be used to predict the prognosis of elderly patients with AECOPD,and high sensitivity and specificity can be obtained.