血清PCT、IL-13与AECOPD伴气道黏液高分泌患者临床预后的相关性  

Correlation of serum PCT,IL-13 and clinical prognosis in AECOPD patients with airway mucus hypersecretion

作　　者：覃英娇 周向东[1] 李琪[1] 钟有清[1] 王杰[1] 刘峰[1] Qin Yingjiao;Zhou Xiangdong;Li Qi;Zhong Youqing;Wang Jie;Liu Feng(Department of Respiratory Medicine,the First Affiliated Hospital of Hainan Medical University,Hainan Province,Haikou 570102,China)

机构地区：[1]海南医学院第一附属医院呼吸内科,海口570102

出　　处：《疑难病杂志》2022年第9期927-931,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：国家自然科学基金资助项目(81860001、82011530049、82160012);海南省重大科技专项(ZDKJ2021036);海南省重点研发项目(ZDYF2020223);海南省重点研发计划国际科技合作项目(GHYF2022011);海南省创新团队项目(820CXTD448);海南省卫生计生科研项目(18A200141);海南省临床医学中心建设项目基金。

摘　　要：目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)伴气道黏液高分泌患者血清降钙素原(PCT)、白介素-13(IL-13)的表达情况及其与患者临床预后的关系。方法选取2018年4月—2021年3月海南医学院附属第一医院收治的AECOPD伴气道黏液高分泌患者153例作为研究对象,全部患者均接受常规治疗并随访1年,并根据临床预后情况分为存活组与病死组。比较2组患者基线资料、血清PCT、血清IL-13及实验室相关指标。COX回归分析AECOPD伴气道黏液高分泌患者病死的相关因素;绘制受试者工作特征曲线(ROC)分析血清PCT、IL-13对AECOPD伴气道黏液高分泌患者临床预后的预测价值。结果153例AECOPD伴气道黏液高分泌患者1年内病死31例(20.26%),存活122例(79.74%);病死组患者COPD病程长于存活组,初始咳嗽和咯痰评估问卷(CASA-Q)评分低于存活组(t/P=2.667/0.009、3.933/<0.001);病死组初始二氧化碳分压(PaCO_(2))、肿瘤坏死因子-α(TNF-α)、PCT、IL-13高于存活组,Alb水平低于存活组(t/P=4.628/<0.001、3.340/<0.001、6.728/<0.001、6.878/<0.001、5.527/<0.001)。COX回归分析结果显示,初始CASA-Q评分、Alb水平高是AECOPD伴气道黏液高分泌患者预后的保护因素[HR(95%CI)=0.877(0.798~0.962)、0.751(0.647~0.871)],血清PCT、IL-13水平高是其危险因素[HR(95%CI)=1.828(1.074~3.112)、1.065(1.013~1.120)]。ROC曲线分析结果显示,血清PCT、IL-13单独及联合预测AECOPD伴气道黏液高分泌患者病死风险的AUC为0.856、0.815、0.938,具有一定的预测价值。结论血清PCT、IL-13水平与AECOPD伴气道黏液高分泌患者临床预后有关。Objective To investigate the expression of serum procalcitonin(PCT)and interleukin-13(IL-13)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with airway mucus hypersecretion and their relationship with clinical prognosis.Methods A total of 153 patients with AECOPD and airway mucus hypersecretion who were admitted to the First Affiliated Hospital of Hainan Medical College from April 2018 to March 2021 were selected as the research subjects.All patients received routine treatment and were followed up for 1 year.For the survival group and the death group.The baseline data,serum PCT,IL-13 and laboratory-related indexes were compared between the two groups.COX regression analysis was used to analyze the related factors of mortality in patients with AECOPD and airway mucus hypersecretion;receiver operating characteristic curve(ROC)was drawn to analyze the predictive value of serum PCT and IL-13 on clinical prognosis of AECOPD patients with airway mucus hypersecretion.Results Among the 153 patients with AECOPD and airway mucus hypersecretion,31 patients(20.26%)died within 1 year,and 122 patients(79.74%)survived.The duration of COPD in the death group was longer than that in the survival group,and the initial cough and expectoration assessment questionnaire(CASA-Q)score lower than the survival group(t/P=2.667/0.009,3.933/<0.001);the initial partial pressure of carbon dioxide(PaCO_(2)),tumor necrosis factor-α(TNF-α),PCT,IL-13 in the death group were higher than those in the survival group,and the level of Alb was low In the survival group(t/P=4.628/<0.001,3.340/<0.001,6.728/<0.001,6.878/<0.001,5.527/<0.001).COX regression analysis showed that initial CASA-Q score and high Alb level were protective factors for the prognosis of patients with AECOPD and airway mucus hypersecretion,and high serum PCT and IL-13 levels were risk factors[HR(95%CI)=0.877(0.798-0.962),0.751(0.647-0.871),1.828(1.074-3.112),1.065(1.013-1.120)].The results of ROC curve analysis showed that the AUCs of serum PCT an

关 键 词：慢性阻塞性肺疾病 急性加重期 气道黏液高分泌 降钙素原 白介素-13 临床预后 

分 类 号：R563.9[医药卫生—呼吸系统]