急性加重期慢性阻塞性肺疾病患者血清CXCL10和CXCL11水平变化及临床意义  

Changes and clinical significance of serum CXCL10 and CXCL11 levels in patients with chronic obstructive pulmonary disease during acute exacerbation

作　　者：苏睿[1] 张丽艳[1] 高志利[1] 王颖[1] 吴文秀[1] Su Rui;Zhang Liyan;Gao Zhili;Wang Ying;Wu Wenxiu(Respiratory of Medicine, Shenyang Fifth People's Hospital, Liaoning Province,Shenyang 110023,China)

机构地区：[1]辽宁省沈阳市第五人民医院呼吸内科,110023

出　　处：《疑难病杂志》2022年第4期383-388,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：辽宁省自然科学基金计划项目(20180450167)。

摘　　要：目的分析急性加重期慢性阻塞性肺疾病(AECOPD)患者血清CXC趋化因子配体10(CXCL10)、CXCL11水平变化及其与AECOPD临床结局的关系。方法选择2019年1月—2020年12月沈阳市第五人民医院呼吸内科收治AECOPD患者104例为病例组,根据病情将患者分为Ⅰ级亚组38例、Ⅱ级亚组42例、Ⅲ级亚组24例,根据临床结局将其分为病情恶化亚组26例和病情缓解亚组78例,另选择于门诊体检志愿者53例为对照组。检测各组血清CXCL10、CXCL11水平,分析血清CXCL10、CXCL11与AECOPD临床结局的关系,多因素Logistic回归分析影响AECOPD患者临床结局的因素,绘制受试者工作特征曲线(ROC)评估血清CXCL10、CXCL11预测AECOPD患者临床结局的价值。结果病情恶化亚组COPD病程、合并休克、机械通气、近1年急性发作次数、mMRC分级3~4级、AECOPD病情严重程度Ⅲ级比例、WBC、CRP水平高于病情缓解亚组(P<0.05)。血清CXCL10、CXCL11水平比较,Ⅲ级亚组>Ⅱ级亚组>Ⅰ级亚组(F/P=36.025/<0.001、29.028/<0.001),病情恶化亚组>病情缓解亚组>对照组(F/P=53.208/<0.001、62.084/<0.001)。病情恶化亚组第1秒用力呼气容积(FEV_(1))、FEV_(1)与用力肺活量(FVC)比值(FEV_(1)/FVC)、FEV_(1)占预计值百分数(FEV_(1)%)均显著低于病情缓解亚组(t/P=8.055/<0.001、3.732/<0.001、5.045/<0.001)。多因素Logistic回归分析结果显示,近1年AECOPD发作次数高、合并休克及高水平血清CXCL10、CXCL11是AECOPD患者病情恶化的危险因素[OR(95%CI)=1.640(1.144~2.353)、1.881(1.254~2.823)、1.657(1.192~2.303)、1.614(1.261~2.067)]。血清CXCL10、CXCL11及二者联合预测AECOPD患者病情恶化的曲线下面积为0.715、0.680、0.938,二者联合高于单独预测(Z=4.047、4.544,P均<0.05)。结论AECOPD患者血清CXCL10、CXCL11水平升高,高血清CXCL10、CXCL11水平与AECOPD病情加重及病情恶化均有关。Objective To analyze the changes of serum CXC chemokine ligand 10(CXCL10)and CXCL11 levels in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and their relationship with clinical outcomes of AECOPD.Methods A total of 104 patients with AECOPD admitted to the Department of Respiratory Medicine of Shenyang Fifth People's Hospital from January 2019 to December 2020 were selected as the case group.According to the disease,the patients were divided into grade I subgroup of 38 cases,grade II subgroup of 42 cases,and grade Ⅲ subgroup of 24 cases.According to the clinical outcome,they were divided into 26 cases of disease progression subgroup and 78 cases of disease remission subgroup.Another 53 volunteers who underwent physical examination in outpatient clinics were selected as the control group.The levels of serum CXCL10 and CXCL11 in each group were detected,the relationship between serum CXCL10 and CXCL11 and the clinical outcome of AECOPD was analyzed,the factors affecting the clinical outcome of AECOPD patients were analyzed by multivariate Logistic regression,and the receiver operating characteristic curve(ROC)was drawn to evaluate the prediction of serum CXCL10 and CXCL11.The value of clinical outcomes in patients with AECOPD.Results The course of COPD,combined shock,mechanical ventilation,the number of AECOPD episodes in the past 1 year,mMRC grades 3-4,the proportion of AECOPD severity grade Ⅲ,WBC and CRP levels in the worsening subgroup were higher than those in the remission subgroup(P<0.05).Comparison of serum CXCL10 and CXCL11 levels,grade Ⅲ subgroup>grade Ⅱ subgroup>grade Ⅰ subgroup(F/P=36.025/<0.001,29.028/<0.001),disease progression subgroup>disease remission subgroup>control group(F/P=53.208/<0.001,62.084/<0.001).The forced expiratory volume in 1 second(FEV_(1)),the ratio of FEV_(1) to forced vital capacity(FVC)(FEV_(1)/FVC),and the percentage of predicted FEV_(1)(FEV_(1)%pred)in the worsening subgroup were lower than those in the remission subgroup(t/P=8.055/<0.

关 键 词：急性加重期慢性阻塞性肺疾病 CXC趋化因子配体10 CXC趋化因子配体11 临床结局 

分 类 号：R563.9[医药卫生—呼吸系统]