慢性支气管炎患者合并肺部感染后肺功能与免疫反应的变化及对预后的影响  

Study on the changes in pulmonary function and immune response and their influence on prognosis in patients with chronic bronchitis after complicated with pulmonary infection

作　　者：李园[1] 马婷[2] 杨媛[1] Li Yuan;Ma Ting;Yang Yuan(Comprehensive Health Internal Medicine Three Disease Area,Xinjiang Uygur Autonomous Region People’s Hospital,Urumqi Xinjiang 830001,China;Radiological Imaging Center,Xinjiang Uygur Autonomous Region People’s Hospital,Urumqi Xinjiang 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院综合保健内科三病区,新疆乌鲁木齐830001 [2]新疆维吾尔自治区人民医院放射影像中心,新疆乌鲁木齐830001

出　　处：《中国医刊》2025年第2期144-148,共5页Chinese Journal of Medicine

基　　金：新疆维吾尔自治区自然科学基金(2021D01C413)。

摘　　要：目的探讨慢性支气管炎患者合并肺部感染后肺功能与免疫反应变化特点及对预后的影响。方法以2022年1月至2023年12月就诊于新疆维吾尔自治区人民医院的108例合并肺部感染的慢性支气管炎患者作为研究对象。所有患者均接受抗感染及对症治疗,根据启动治疗后1个月的预后情况分为预后良好组(n=81)和预后不良组(n=27)。比较两组患者的一般临床资料[年龄、性别、体重指数(BMI)、糖尿病史、高血压史、吸烟情况]、治疗前疾病特征(慢性支气管炎病程、慢性支气管炎分型、急性发作频率、最高体温、肺部啰音、病原菌类型)、肺功能[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、呼气流量峰值(PEF)]、免疫功能(NK细胞比例、CD4^(+)T细胞比例、CD8^(+)T细胞比例、CD4^(+)/CD8^(+)T细胞比值)及炎症指标[中性粒细胞/淋巴细胞比值(NLR)、降钙素原(PCT)、白介素(IL)-1β、IL-6、IL-10]水平的差异。通过多因素logistic回归分析筛选合并肺部感染的慢性支气管炎患者预后不良的危险因素。采用受试者操作特征(ROC)曲线及决策曲线(DCA)评价各危险因素联合预测患者预后的效能和价值。结果预后不良组患者慢性支气管炎病程、喘息型患者比例、合并肺部啰音比例及PCT水平、IL-6水平、NLR均显著高于预后良好组(P<0.05);FEV1、PEF、NK细胞比例、CD4^(+)T细胞比例、CD4^(+)/CD8^(+)T细胞比值及IL-10水平均显著低于预后良好组(P<0.05)。Logistic回归分析显示患者病程较长、PEF较低、NK细胞比例较低、CD4^(+)/CD8^(+)T细胞比值较低、PCT水平较高、IL-6水平较高、IL-10水平较低均是预后不良的危险因素(P<0.05);ROC曲线分析显示,基于7种筛选出的影响因素联合预测合并肺部感染的慢性支气管炎患者预后不良的曲线下面积为0.984(95%CI0.966~1.000),DCA分析显示在0~0.95阈概率范围内,各影响因素联合预测的净收益大于0。结论慢�Objective To investigate the changes of lung function and immune inflammation level in patients with chronic bronchitis complicated with acute infection and their influence on prognosis.Method 108 patients with chronic bronchitis from Xinjiang Uygur Autonomous Region People’s Hospital complicated with pulmonary infection were enrolled from From January 2022 to December 2023.All patients received anti-infection and symptomatic treatment,and were divided into good prognosis group(n=81)and poor prognosis group(n=27)according to the prognosis within 1 month after starting treatment.General clinical data[age,sex,body mass index(BMI),diabetes history,hypertension history,smoking],disease characteristics before treatment(Chronic bronchitis course,chronic bronchitis classification,acute attack frequency,maximum body temperature,pulmonary rales,pathogen type),lung function[forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),peak expiratory flow(PEF)],immune function(NK cell ratio,CD4^(+)T cell ratio,CD8^(+)T cell ratio,CD4^(+)/CD8^(+)T ratio)and inflammatory levels[neutrophil/lymphocyte ratio(NLR),procalcitonin(PCT),interleukin-1 beta(IL-1 beta),interleukin-6(IL-6),interleukin-10(IL-10)]were compared between the two groups.Logistic regression analysis were used to screen the risk factors of poor prognosis in chronic bronchitis patients with pulmonary infection.Evaluate the efficacy and value of the combined prediction of patients’prognosis by various risk factors through the receiver operating characteristic(ROC)curve and the Decision Curve Analysis(DCA).Result The average course of chronic bronchitis,the proportion of asthmatic patients,the proportion of patients with pulmonary rales,PCT,IL-6 and NLR levels in patients with poor prognosis were significantly higher than those in patients with good prognosis(P<0.05).While the FEV1,PEF,NK cell ratio,CD4^(+)T cell ratio,CD4^(+)/CD8^(+)T ratio and IL-10 level were significantly lower(P<0.05).Logistic regression analysis showed that longer disease duratio

关 键 词：慢性支气管炎 肺部感染 肺功能 免疫反应 

分 类 号：R563.1[医药卫生—呼吸系统]