COPD合并肺源性心脏病患者血清ICOS、ICOSL水平变化及临床意义  

Changes in serum ICOS and ICOSL levels and clinical significance in patients with COPD combined with pulmonary heart disease

作　　者：钱王燕 虞鸣娟 陈访 李妍妍 张赛 葛小宁[2] 陈润祥[2] Qian Wangyan;Yu Mingjuan;Chen Fang;Li Yanyan;Zhang Sai;Ge Xiaoning;Chen Runxiang(Department of Laboratory Medicine,Suzhou Jiulong Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 215000,China;不详)

机构地区：[1]上海交通大学医学院苏州九龙医院检验科,215000 [2]上海交通大学医学院苏州九龙医院心内科,215000

出　　处：《疑难病杂志》2024年第3期282-286,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：江苏省卫生健康委科研课题(BJ22074)。

摘　　要：目的观察慢性阻塞性肺疾病(COPD)合并肺源性心脏病(PHD)患者血清诱导性共刺激分子(ICOS)和诱导性共刺激分子配体(ICOSL)水平变化及临床意义。方法选择2020年6月—2023年2月上海交通大学医学院苏州九龙医院心内科收治COPD患者172例,根据患者是否合并PHD分为合并PHD组82例和COPD组90例。根据肺动脉收缩压(PASP)将PHD患者分为轻度亚组(30~50 mmHg,21例)、中度亚组(51~70 mmHg,37例)和重度亚组(≥71 mmHg,24例),再根据纽约心脏病协会(NYHA)分级将PHD患者分为Ⅰ~Ⅱ级亚组(44例)、Ⅲ~Ⅳ级亚组(38例)。酶联免疫吸附试验检测血清ICOS、ICOSL水平,分析ICOS、ICOSL与PASP、NYHA分级之间的相关性,受试者工作特征(ROC)曲线分析ICOS、ICOSL诊断COPD合并PHD的价值。结果合并PHD组血清ICOS、ICOSL水平高于COPD组(t=14.526、34.508,P均<0.001)。重度亚组血清ICOS、ICOSL及PASP水平高于中度亚组和轻度亚组(F/P=125.351/<0.001、163.591/<0.001、84.292/<0.001),Ⅲ~Ⅳ级亚组血清ICOS、ICOSL水平均高于Ⅰ~Ⅱ级亚组(t/P=11.658/<0.001、27.345/<0.001)。PHD患者血清ICOS、ICOSL水平与PASP、NYHA分级均呈正相关(r=0.439、0.416、0.501、0.497,P均<0.001)。血清ICOS、ICOSL及二者诊断COPD患者合并PHD的曲线下面积分别为0.780、0.723、0.926,二者联合高于单独ICOS、ICOSL诊断(Z=4.021、5.194,P均<0.001)。结论COPD合并PHD患者血清ICOS、ICOSL水平显著增高,且与肺动脉高压以及心功能降低有关,联合检测ICOS、ICOSL可有效评估COPD患者PHD风险。Objective To observe the changes of serum levels of inducible co-stimulatory molecules(ICOS)and inducible co-stimulatory molecule ligands(ICOSL)and clinical significance in patients with chronic obstructive pulmonary disease(COPD)combined with pulmonary heart disease(PHD).Methods One hundred and seventy-two COPD patients admitted to the Department of Cardiology,Suzhou Jiulong Hospital,School of Medicine,Shanghai Jiaotong University,from June 2020 to February 2023 were selected and divided into the PHD group(82 patients)and the COPD group(90 patients)according to whether they were combined with PHD or not.PHD patients were divided into mild subgroups(30-50 mmHg,21 cases),moderate subgroups(51-70 mmHg,37 cases),and severe subgroups(≥71 mmHg,24 cases)according to pulmonary artery systolic pressure(PASP),and then PHD patients were divided into subgroups of gradesⅠtoⅡ(44 cases),and gradesⅢtoⅣ(38 cases)according to the New York Heart Association(NYHA)classification.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum ICOS and ICOSL levels and analyze the correlation between ICOS,ICOSL and PASP,NYHA classification,and the value of ICOS and ICOSL in diagnosing COPD combined with PHD was analyzed by the subject's work characteristics(ROC)curve.Results The serum ICOS and ICOSL levels in the PHD group were higher than those in the COPD group(t=14.526,34.508,P<0.001).Serum ICOS and ICOSL levels were higher in the severe subgroup than in the moderate and mild subgroups(F/P=125.351/<0.001,163.591/<0.001,84.292/<0.001),and serum ICOS was higher in the subgroups of grade III-IV,ICOSL levels were higher than those in the subgroups of grades I-II(t/P=11.658/<0.001,27.345/<0.001).The serum ICOS and ICOSL levels of patients with PHD were positively correlated with the PASP and NYHA grading(r=0.439,20.416,0.501,0.497,P<0.001).ICOS,ICOSL and both the area under the curve of combined PHD in patients with COPD diagnosis was 0.780,0.723,0.926,respectively,and the combination of the two was higher than the diagnosis

关 键 词：慢性阻塞性肺疾病 肺源性心脏病 肺动脉高压 诱导性共刺激分子 诱导性共刺激分子配体 

分 类 号：R563.3[医药卫生—呼吸系统] R541.5[医药卫生—内科学]