慢阻肺后呼吸衰竭患者血清hs-CRP/Alb、TLR4表达及临床意义

Serum hs-CRP/Alb and TLR4 expression in patients with post-COPD respiratory failure and their clinical significance

目的:观察慢性阻塞性肺疾病(COPD)后呼吸衰竭患者血清超敏C反应蛋白(hs-CRP)/白蛋白(Alb)、Toll样受体4(TLR4)表达及临床意义。方法:回顾性分析安阳市第二人民医院2021年6月至2023年8月收治的82例COPD后呼吸衰竭患者(呼吸衰竭组)及82例单纯COPD患者(对照组)的临床资料。根据急性生理与慢性健康评估评分将呼吸衰竭患者分为预后不良组(评分≥8分,共21例)与预后良好组(评分<8分,共61例)。比较呼吸衰竭组与对照组一般资料及实验室指标[性别、年龄、体质量指数(BMI)、病程、吸烟、饮酒、COPD家族史、合并基础疾病、白细胞计数(WBC)、白细胞介素-6(IL-6)、hs-CRP/Alb、TLR4、内皮素-1(ET-1)、可溶性髓样细胞触发受体-1(sTREM-1)];采取非条件Logistic逐步回归分析COPD患者发生呼吸衰竭的危险因素;通过ROC曲线分析hs-CRP/Alb、TLR4评估COPD患者发生呼吸衰竭的价值;比较不同预后COPD后呼吸衰竭患者hs-CRP/Alb、TLR4水平。结果:两组性别、年龄、BMI、病程、吸烟、饮酒、COPD家族史、合并基础疾病、WBC方面组间比较差异无统计学意义(P>0.05);呼吸衰竭组IL-6、hs-CRP/Alb、TLR4、ET-1、sTREM-1显著高于对照组(P<0.05)。多因素Logistic回归分析结果显示,IL-6、hs-CRP/Alb、TLR4、ET-1、sTREM-1是COPD患者发生呼吸衰竭的危险因素(P<0.05)。ROC曲线分析结果显示,hs-CRP/Alb、TLR4评估COPD患者发生呼吸衰竭的曲线下面积分别为0.925、0.847,敏感度分别为0.866、0.829,特异度分别为0.878、0.732(P<0.05)。预后不良组hs-CRP/Alb、TLR4水平显著高于预后良好组(P<0.05)。结论:COPD后呼吸衰竭患者血清hs-CRP/Alb、TLR4呈高表达水平,hs-CRP/Alb、TLR4在COPD患者呼吸衰竭的辅助诊断及预后评估中均有一定价值。

Objective:To observe the expression and clinical significance of serum hypersensitive C-reactive protein(hs-CRP)/albumin(Alb),Toll-like receptor 4(TLR4)in patients with respiratory failure after chronic obstructive pulmonary disease(COPD).Methods:The clinical data of 82 patients with post-COPD respiratory failure(respiratory failure group)and 82 patients with simple COPD(control group)admitted to Anyang Second People's Hospital from June 2021 to August 2023 were retrospectively analyzed.Patients with respiratory failure were divided into poor prognosis group(score 8 points,21 patients)and good prognosis group(score<8 points,61 patients).General data and laboratory indicators between the respiratory failure group and the control group[gender,age,body quality index(BMI),disease duration,smoking,alcohol consumption,family history of COPD,underlying disease,white blood cell count(WBC),interleukin-6(IL-6),hs-CRP/Alb,TLR4,endothelin-1(ET-1),soluble myeloid cell-triggered receptor-1(sTREM-1)];Non-conditional Logistic stepwise regression was used to analyze the risk factors of respiratory failure in COPD patients;Analysis of hs-CRP/Alb and TLR4 to evaluate the value of respiratory failure in COPD patients;To compare the levels of hs-CRP/Alb and TLR4,in patients with respiratory failure after different prognosis of COPD.Results:There were no significant differences between gender,age,BMI,disease duration,smoking,alcohol consumption,COPD family history,underlying disease,and WBC(P>0.05);IL-6,hs-CRP/Alb,TLR4,ET-1,sTREM-1 were significantly higher than those in the control group(P<0.05).The results of multivariate Logistic regression analysis showed that IL-6,hs-CRP/Alb,TLR4,ET-1,and sTREM-1 were risk factors for respiratory failure in COPD patients(P<0.05).The results of ROC curve analysis showed that the area under the curve of hs-CRP/Alb and TLR4 was 0.925,0.847,sensitivity of 0.866,0.829,and specificity of 0.878 and 0.732,respectively,and P<0.05.The levels of hs-CRP/Alb and TLR4 in the poor prognosis group were significantly higher than those with good prognosis(P<0.05).Conclusion:Serum hs-CRP/Alb and TLR4 in post-COPD respiratory failure show high expression levels,and hs-CRP/Alb and TLR4 have some value in the auxiliary diagnosis and prognostic evaluation of respiratory failure in COPD patients.