CD_(40)L、NF-κB/NLRP3通路与AECOPD患者病情程度的相关性及对呼吸衰竭的预测价值  

Correlation of CD_(40)L,NF-κB/NLRP3 pathway with disease severity in AECOPD patients and predictive value for respiratory failure

作　　者：梅静静[1] 刘媛华[1] 李茹一 靳建军[1] MEI Jing-jing;LIU Yuan-hua;LI Ru-yi;JIN Jian-jun(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,CHINA)

机构地区：[1]郑州大学第一附属医院呼吸与危重症医学科,河南郑州450000

出　　处：《海南医学》2025年第7期924-929,共6页Hainan Medical Journal

基　　金：河南省科技攻关项目(编号:242102310185)。

摘　　要：目的探讨分化簇40配体(CD_(40)L)、核因子-κB(NF-κB)/核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)通路与慢性阻塞性肺疾病急性加重期(AECOPD)患者病情程度的相关性及其对呼吸衰竭(RF)的预测价值。方法前瞻性选取2022年3月至2024年3月郑州大学第一附属医院收治148例AECOPD患者作为研究对象,根据COPD全球倡议(GOLD)分级标准将AECOPD患者分为1~4级,分别纳入A组(19例)、B组(31例)、C组(52例)、D组(46例),并根据6个月内是否并发RF,将患者分为RF组(49例)与无RF组(99例)。比较各组患者的血清CD_(40)L及NF-κB、NLRP3蛋白表达水平,采用Spearman法分析CD_(40)L及NF-κB、NLRP3蛋白表达水平与GOLD分级及RF的相关性,采用受试者工作特征(ROC)曲线分析CD_(40)L及NF-κB、NLRP3蛋白表达预测RF的价值,并采用危险度分析不同CD_(40)L及NF-κB、NLRP3蛋白表达水平AECOPD患者发生RF的情况。结果D组患者的血清CD_(40)L及NF-κB、NLRP3 m RNA表达水平分别为(12.14±2.09)ng/m L、128.31±20.59、11.37±2.28,明显高于C组患者的(10.89±1.98)ng/m L、114.92±19.10、10.05±2.06,B组患者的(9.65±1.71)ng/m L、102.85±18.63、8.84±1.81及A组患者的(8.73±1.46)ng/m L、93.54±17.41、7.98±1.62,且C组明显高于B组、A组,B组明显高于A组,差异均有统计学意义(P<0.05);RF组患者的血清CD_(40)L及NF-κB、NLRP3 m RNA表达水平分别为(10.38±1.62)ng/m L、111.57±16.04、9.68±1.55,明显高于无RF组的(9.72±1.75)ng/m L、102.87±17.73、8.89±1.84,差异均有统计学意义(P<0.05);Spearman法分析结果显示,血清CD_(40)L及NF-κB、NLRP3 m RNA表达水平与AECOPD患者GOLD分级(r=0.658、0.724、0.701)及RF(r=0.642、0.716、0.683)均呈正相关(P<0.05);ROC分析结果显示,血清CD_(40)L及NF-κB、NLRP3 m RNA均对AECOPD患者并发RF具有一定预测价值,三者联合预测的曲线下面积(AUC)为0.949,优于各指标单独及两两组合预测效能(均P<0.05);以最佳截断值为界,经危险度分析结�Objective To investigate the correlation between CD40 ligand(CD_(40)L),nuclear factor-κB(NF-κB)/NOD-like receptor protein 3(NLRP3)pathway and disease severity in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),as well as their predictive value for respiratory failure(RF).Methods A prospective study was conducted on 148 AECOPD patients admitted to the First Affiliated Hospital of Zhengzhou University from March 2022 to March 2024.Patients were divided into groups 1 to 4 according to the Global Initiative for Chronic Obstructive Lung Disease(GOLD)classification,and were assigned to group A(19 cases),group B(31 cases),group C(52 cases),and group D(46 cases).Based on the occurrence of RF within 6 months,patients were further divided into RF group(49 cases)and non-RF group(99 cases).Serum levels of CD_(40)L,NF-κB,and NLRP3 protein expression were compared among the groups.Spearman's method was used to analyze the correlation between CD_(40)L,NF-κB,and NLRP3 protein expression levels with GOLD classification and RF.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of CD_(40)L,NF-κB,and NLRP3 protein expression for RF.Risk analysis was conducted to assess the risk of RF in AECOPD patients with different levels of CD_(40)L,NF-κB,and NLRP3 protein expression.Results The serum levels of CD_(40)L,NF-κB,and NLRP3 mRNA in group D were(12.14±2.09)ng/mL,128.31±20.59,and 11.37±2.28,respectively,significantly higher than(10.89±1.98)ng/mL,114.92±19.10,and 10.05±2.06 in group C,(9.65±1.71)ng/mL,102.85±18.63,8.84±1.81 in group B,and(8.73±1.46)ng/mL,93.54±17.41,7.98±1.62 in group A(P<0.05).The levels in group C were significantly higher than those in group B and group A,and group B levels were significantly higher than those in group A(all P<0.05).The serum levels of CD_(40)L,NF-κB,and NLRP3 mRNA in the RF group were(10.38±1.62)ng/mL,111.57±16.04,and 9.68±1.55,respectively,significantly higher than(9.72±1.75)ng/mL,102.87±17.73

关 键 词：慢性阻塞性肺疾病 急性加重期 分化簇40配体 核因子-ΚB 核苷酸结合寡聚化结构域样受体蛋白3 病情 呼吸衰竭 预测 

分 类 号：R563[医药卫生—呼吸系统]