老年结核合并慢性阻塞性肺疾病患者血清免疫状态与预后的关系及其预测效果  

Changes of serum immune status in senile patients with tuberculosis complicated with COPD and its prognostic value

作　　者：黎希 刘丽君 郭美华[1] 邹建军[2] 胡秋桂 Li Xi;Liu Lijun;Guo Meihua;Zou Jianjun;Hu Qiugui(Department of Respiratory and Critical Care Medicine,Guangzhou Chest Hospital/Guangzhou Key Laboratory of Tuberculosis Research/State Key Laboratory of Respiratory Disease/Institute of Tuberculosis,Guangzhou Medical University,Guangzhou Guangdong 510095,China;Department of Oncology,Guangzhou Chest Hospital,Guangzhou Guangdong 510095,China)

机构地区：[1]广州医科大学结核病防治院,呼吸疾病全国重点实验室,广州市结核病研究重点实验室,广州市胸科医院呼吸与危重症医学科,广东广州510095 [2]广州市胸科医院肿瘤科,广东广州510095

出　　处：《中国医刊》2024年第5期509-513,共5页Chinese Journal of Medicine

基　　金：广东省医学科学技术研究基金(A2022468)。

摘　　要：目的 探讨老年肺结核合并慢性阻塞性肺疾病(COPD)患者血清免疫状态与预后的关系及其对预后的预测价值。方法 选择2019年1月至2023年1月于广州市胸科医院诊断为肺结核合并COPD的314例老年患者,根据预后情况分为预后良好组(155例)和预后不良组(159例)。比较两组患者的一般资料以及血清免疫状态指标,包括免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)。采用多因素logistic回归分析确定老年肺结核合并COPD患者预后不良的独立危险因素,构建列线图预测模型并进行评价。结果 预后不良组肺源性心脏病患者比例及γ干扰素、可溶性白介素-2受体、D-二聚体、纤维蛋白原、血肌酐水平显著高于预后良好组,IgA、IgG、IgM水平显著低于预后良好组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,血清IgA、IgG、IgM水平降低均为患者预后不良的危险因素(P<0.05),据此构建的列线图预测模型的预测结果具有一定的真实性,但与实际结果的一致性低(Kappa<0.40)。结论 血清IgA、IgG、IgM与老年肺结核合并COPD患者预后有关系,临床应加强对老年肺结核合并COPD患者血清IgA、IgG、IgM水平的监测。Objective To explore the changes of serum immune status in elderly patients with pulmonary tuberculosis(PTB) complicated with chronic obstructive pulmonary disease(COPD) and its predictive value for prognosis.Method 314 elderly patients with PTB complicated with COPD diagnosed in Guangzhou Chest Hospital from January 2019 to January 2023 were divided into good prognosis group(n=155) and poor prognosis group(n=159) according to the prognosis of the patients.The general data and serum immune status indexes of the two groups were compared,including immunoglobulin A(IgA),IgG and IgM.Multivariate logistic regression analysis was used to determine the independent risk factors of poor prognosis in elderly PTB patients with COPD,and nomogram prediction model was constructed and evaluated.Result In the poor prognosis group,the proportion of patients with pulmonary heart disease,the levels of interferon-γ,soluble interleukin-2 receptor,D-dimer,fibrinogen,fibrinogen and blood creatinine were higher than the good prognosis group,and the levels of IgA,IgG and IgM were lower than the good prognosis group,which were statistically significant(P<0.05).The results of multivariate logistic regression analysis showed that decreased serum levels of IgA,IgG and IgM were all risk factors for poor prognosis of patients(P<0.05).The prediction results of the nomogram prediction model constructed accordingly have some authenticity,but the consistency with the actual results is low(Kappa<0.40).Conclusion The combined prediction of serum IgA,IgG and IgM is of great value for the prediction of pre-elderly PTB patients with COPD,and the changes of serum IgA,IgG and IgM levels in elderly PTB patients with COPD should be monitored in clinical practice.

关 键 词：老年肺结核 慢性阻塞性肺疾病 免疫状态 预后 预测价值 

分 类 号：R563[医药卫生—呼吸系统] R521[医药卫生—内科学]