慢性阻塞性肺病合并肺曲霉菌感染患者血清HIF-1α、TLR4水平变化及其诊断价值  

Changes and diagnostic value of serum HIF-1αand TLR4 levels in patients with chronic obstructive pulmonary disease complicated with pulmonary Aspergillosis infection

作　　者：耶小伟 樊爱琳 赵海卫 成蒙蒙 孙珉 甘毓舒 刘源 YE Xiaowei;FAN Ailin;ZHAO Haiwei;CHENG Mengmeng;SUN Min;GAN Yushu;LIU Yuan(Center of Laboratory Medicine,Xi′an Qinhuang Hospital,Xi′an,Shaanxi 710600,China;Department of Obstetrics Laboratory,Hanzhong Central Hospital,Hanzhong,Shaanxi 723000,China;Department of Respiratory,Xi′an Qinhuang Hospital,Xi′an,Shaanxi 710600,China)

机构地区：[1]西安秦皇医院医学检验中心,陕西西安710600 [2]汉中市中心医院产科实验室,陕西汉中723000 [3]西安秦皇医院呼吸内科,陕西西安710600

出　　处：《国际检验医学杂志》2025年第9期1108-1113,共6页International Journal of Laboratory Medicine

摘　　要：目的探究慢性阻塞性肺疾病(COPD)合并肺曲霉菌感染患者血清缺氧诱导因子1亚基α(HIF-1α)、Toll样受体4(TLR4)水平变化及其诊断价值。方法该研究选择2020年12月至2023年12月在西安秦皇医院(下称该院)就诊的240例COPD患者为研究对象,另选218例同期在该院体检的健康者为对照组,根据COPD患者是否合并肺曲霉菌感染将患者分为感染组(124例)和未感染组(116例)。酶联免疫吸附试验检测患者HIF-1α、TLR4水平,全自动生化分析仪检测乳酸脱氢酶(LDH)与白蛋白(ALB)水平。多因素Logistic回归分析COPD患者发生感染的影响因素;Pearson相关性分析感染组HIF-1α、TLR4水平的相关性;受试者工作特征(ROC)曲线分析HIF-1α、TLR4水平对COPD患者发生感染的诊断价值。结果与对照组相比,COPD组HIF-1α、TLR4水平升高(P<0.05);与未感染组相比,感染组呼吸困难、抗菌种类药物种类>3种、抗菌药物使用时间≥14d、机械通气操作所占比例、糖皮质激素(GC)使用时间及LDH、HIF-1α、TLR4水平较高(P<0.05),ALB水平较低(P<0.05);抗菌药物种类>3种、抗菌药物使用时间≥14d、GC使用时间及LDH、HIF-1α、TLR4水平升高为COPD患者发生感染的独立危险因素(P<0.05),而ALB水平升高是COPD患者发生感染的独立保护因素(P<0.05);感染组HIF-1α、TLR4水平呈正相关(r=0.453,P<0.001);HIF-1α、TLR4单独诊断COPD患者发生感染的曲线下面积(AUC)为0.816、0.813,两者联合诊断的AUC为0.930,优于各自单独诊断(Z两者联合-HIF-1α=4.923、Z两者联合-TLR4=5.192,P<0.001、P<0.001)。结论COPD患者HIF-1α、TLR4水平升高,感染肺曲霉菌后进一步升高,是患者发生感染的独立危险因素,两者呈正相关,联合诊断发生肺曲霉菌感染具有一定价值,为临床诊断提供了理论基础。Objective To investigate the changes and diagnostic value of serum hypoxia inducible factor 1 subunit alpha(HIF-1α)and Toll-like receptor 4(TLR4)levels in patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary Aspergillosis infection.Methods A total of 240 COPD patients who visited Xi′an Qinhuang Hospital(hereinafter referred to as the hospital)from December 2020 to December 2023 were selected as the study subjects in the study,and another 218 volunteers who underwent physical examinations at the hospital were selected as the control group.The COPD patients were separated into an infected group(124 cases)and an uninfected group(116 cases)based on whether they had pulmonary Aspergillosis infection.Enzyme-linked immunosorbent assay was applied to detect the levels of HIF-1αand TLR4 in patients.Fully automated biochemical analyzer was applied to detect lactate dehydrogenase(LDH)and albumin(ALB)levels.Multivariate Logistic regression was applied to analyze the influencing factors of infection in COPD patients.Pearson correlation was applied to analyze the correlation between HIF-1αand TLR4 levels in the infected group.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of HIF-1αand TLR4 levels for the occurrence of infection in COPD patients.Results Compared with the control group,the COPD group showed an increase in HIF-1αand TLR4 levels(P<0.05).Compared with the uninfected group,the proportion of dyspnea,antibiotics>3 types,the duration of antibiotic use≥14 days,mechanical ventilation procedures,the longer glucocorticosteroid(GC)use time,and levels of LDH,HIF-1α,TLR4 in the infected group were higher(P<0.05),while the level of ALB was lower(P<0.05).The types of antibiotics>3 types,the duration of antibiotic use≥14 days,the duration of GC use,and elevated levels of LDH,HIF-1α,and TLR4 were independent risk factors for infection in COPD patients(P<0.05),while elevated level of ALB was an independent protective factor for infection in COPD p

关 键 词：慢性阻塞性肺病 肺曲霉菌感染 缺氧诱导因子1亚基α TOLL样受体4 诊断价值 

分 类 号：R563.9[医药卫生—呼吸系统]