外周血NF-κB、IL-6、IL-10、IFN-α、T细胞亚群计数水平在预测AECOPD患者预后中的临床价值
doi: 10.16766/j.cnki.issn.1674-4152.003957
The clinical value of NF-κB, IL-6, IL-10, IFN-α and T cell subsets in peripheral blood in predicting the prognosis of AECOPD patients
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摘要:
目的 探究外周血核转录因子κB(NF-κB)、白介素-6(IL-6)、白介素10(IL-10)、干扰素α(IFN-α)、T细胞亚群计数水平在预测慢性阻塞性肺疾病急性加重期(AECOPD)患者预后中的临床价值,以期为该病临床治疗提供参考。 方法 选取2023年6月—2024年3月河北省胸科医院收治的204例AECOPD患者为研究对象,根据6个月预后情况分为预后不良组(67例)与预后良好组(137例)。比较2组外周血NF-κB、IL-6、IL-10、IFN-α、T细胞亚群计数水平,并分析上述指标对患者预后的预测价值。 结果 预后不良组外周血NF-κB、IL-6、IL-10、IFN-α水平及CD8+高于预后良好组,CD3+、CD4+、CD4+/CD8+低于预后良好组(P<0.05)。Logistic回归分析结果显示,外周血NF-κB、IL-6、IL-10、IFN-α、CD3+、CD4+、CD8+、CD4+/CD8+均为影响AECOPD患者预后的相关因素(P<0.05)。受试者工作特征曲线显示,外周血NF-κB、IL-6、IL-10、IFN-α、CD3+、CD4+、CD8+、CD4+/CD8+预测AECOPD患者预后的曲线下面积分别为0.804、0.806、0.858、0.842、0.626、0.702、0.724、0.854。 结论 外周血NF-κB、IL-6、IL-10、IFN-α、T细胞亚群计数水平与AECOPD患者预后密切相关,可作为预测AECOPD患者预后的重要指标,具有一定的临床价值。 Abstract:Objective To explore the clinical value of nuclear factor kappa-B (NF-κB), interleukin-6 (IL-6), IL-10, interferon-α (IFN-α) and T cell subset count in peripheral blood in predicting the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), in order to provide reference for the clinical treatment of the disease. Methods A total of 204 AECOPD patients admitted to Hebei Chest Hospital from June 2023 to March 2024 were studied and separated into poor prognosis group and good prognosis group by the 6-month prognosis. The levels of NF-κB, IL-6, IL-10, IFN-α and T cell subsets in peripheral blood were compared between the two groups, and the prognostic value of the above indexes was analyzed. Results The levels of NF-κB, IL-6, IL-10, IFN-α and CD8+ in peripheral blood in the poor prognosis group were higher than those in the good prognosis group (P < 0.05), while CD3+, CD4+, CD4+/CD8+ were lower (P < 0.05). Logistic regression analysis showed that NF-κB, IL-6, IL-10, IFN-α, CD3+, CD4+, CD8+ and CD4+/CD8+ in peripheral blood were all related factors affecting the prognosis of AECOPD patients (P < 0.05). Receiver operating characteristic curve analysis results showed that the areas under the curve of peripheral blood NF-κB, IL-6, IL-10, IFN-α, CD3+, CD4+, CD8+, CD4+/CD8+ in the prediction of the prognosis of AECOPD patients were 0.804, 0.806, 0.858, 0.842, 0.626, 0.702, 0.724, 0.854, respectively. Conclusion NF-κB, IL-6, IL-10, IFN-α and T cell subset count levels in peripheral blood are closely related to the prognosis of of AECOPD patients, and can be used as an important indicator to predict the prognosis of AECOPD patients. -
Key words:
- Chronic obstructive pulmonary disease /
- Nuclear factor κB /
- Interleukin /
- Interferon-α /
- T cell subsets /
- Prognosis
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表 1 2组AECOPD患者一般资料比较
Table 1. Comparison of general information between two patient groups with AECOPD
项目 预后不良组(n=67) 预后良好组(n=137) 统计量 P值 性别[例(%)] 0.885a 0.347 男性 40(59.70) 91(66.42) 女性 27(40.30) 46(33.58) 年龄(x±s,岁) 58.36±5.14 57.75±5.39 0.771b 0.442 BMI(x±s) 21.93±1.03 22.01±1.15 0.482b 0.630 吸烟史[例(%)] 1.289a 0.256 有 35(52.24) 60(43.80) 无 32(47.76) 77(56.20) 饮酒史[例(%)] 0.471a 0.493 有 16(23.88) 27(19.71) 无 51(76.12) 110(80.29) 糖尿病[例(%)] 0.535a 0.465 有 31(46.27) 56(40.88) 无 36(53.73) 81(59.12) 高血压[例(%)] 1.807a 0.179 有 30(44.78) 48(35.04) 无 37(55.22) 89(64.96) COPD病程(x±s,年) 11.25±2.01 10.81±1.69 1.639b 0.103 注:a为χ2值,b为t值。 表 2 2组AECOPD患者外周血NF-κB、IL-6、IL-10、IFN-α水平比较(x±s)
Table 2. Comparison of NF-κB, IL-6, IL-10, and IFN-α in peripheral blood between two groups of AECOPD patients (x±s)
组别 例数 NF-κB(μg/L) IL-6(pg/mL) IL-10(pg/mL) IFN-α(pg/mL) 预后不良组 67 0.79±0.20 10.25±2.06 4.28±1.01 3.07±0.75 预后良好组 137 0.61±0.14 8.04±1.12 2.80±0.55 2.11±0.42 t值 7.450 9.925 13.548 11.707 P值 <0.001 <0.001 <0.001 <0.001 表 3 2组AECOPD患者T细胞亚群计数比较(x±s)
Table 3. Comparison of T cell subsets between two groups of AECOPD patient (x±s)
组别 例数 CD3+(×107/L) CD4+(×107/L) CD8+(×107/L) CD4+/CD8+ 预后不良组 67 71.20±21.02 32.94±7.69 29.15±6.13 1.10±0.21 预后良好组 137 84.73±24.29 38.86±9.41 24.90±4.92 1.45±0.28 t值 3.900 4.470 5.333 9.057 P值 <0.001 <0.001 <0.001 <0.001 表 4 AECOPD患者预后影响因素的多因素分析
Table 4. Multivariate analysis of factors influencing prognosis in AECOPD patients
变量 B SE Waldχ2 P值 OR值 95% CI NF-κB 0.927 0.315 8.660 0.003 2.527 1.363~4.685 IL-6 1.728 0.483 12.800 <0.001 5.629 2.184~14.508 IL-10 1.386 0.391 12.565 <0.001 3.999 1.858~8.605 IFN-α 0.759 0.261 8.457 0.004 2.136 1.281~3.563 CD3+ -0.897 0.312 8.266 0.004 0.408 0.221~0.752 CD4+ -0.597 0.211 8.005 0.005 0.550 0.364~0.832 CD8+ 0.521 0.206 6.396 0.012 1.684 1.124~2.521 CD4+/CD8+ -1.051 0.443 5.629 0.018 0.350 0.147~0.833 注:所有变量均为连续变量,以实际值赋值。预后不良=1,预后良好=0。 表 5 外周血NF-κB、IL-6、IL-10、IFN-α、T细胞亚群计数对AECOPD患者预后的预测价值
Table 5. Prognostic value of NF-κB, IL-6, IL-10, IFN-α, and T cell subsets in peripheral blood of patients with AECOPD
项目 截断值 灵敏度(%) 特异度(%) 约登指数 AUC 95% CI P值 NF-κB 0.66 μg/L 77.61 70.07 0.477 0.804 0.743~0.856 <0.001 IL-6 9.33 pg/mL 67.16 89.05 0.562 0.806 0.745~0.858 <0.001 IL-10 3.64 pg/mL 67.16 94.89 0.621 0.858 0.803~0.903 <0.001 IFN-α 2.57 pg/mL 73.13 83.94 0.571 0.842 0.784~0.889 <0.001 CD3+ 78.63×107/L 55.22 67.88 0.231 0.626 0.555~0.692 0.004 CD4+ 37.64×107/L 79.10 54.74 0.339 0.702 0.634~0.764 <0.001 CD8+ 28.24×107/L 41.79 94.16 0.360 0.724 0.657~0.784 <0.001 CD4+/CD8+ 1.38 91.04 68.61 0.597 0.854 0.798~0.900 <0.001 -
[1] 盖美华, 富燕萍, 金艾香, 等. 不同光照方式对重症AECOPD患者血清褪黑素及氧化应激水平的影响[J]. 中华全科医学, 2022, 20(10): 1662-1665. doi: 10.16766/j.cnki.issn.1674-4152.002673GAI M H, FU Y P, JIN A X, et al. Influence on levels of melatonin and oxidative stress in critically ill patients with AECOPD treated by different ways of light[J]. Chin J Gen Pract, 2022, 20(10): 1662-1665. doi: 10.16766/j.cnki.issn.1674-4152.002673 [2] PRATT A J, PURSSELL A, ZHANG T, et al. Complexity in clinical diagnoses of acute exacerbation of chronic obstructive pulmonary disease[J]. BMC Pulm Med, 2023, 23(1): 298. DOI: 10.1186/s12890-023-02587-1. [3] 王静, 李英, 王贵佐. 慢性阻塞性肺疾病患者外周血单核细胞沉默信息调节因子2相关酶1 mRNA、核因子κB mRNA表达变化与病情及肺功能的相关性分析[J]. 中国医师进修杂志, 2024, 47(8): 765-768.WANG J, LI Y, WANG G Z. Correlation analysis of mRNA expression of silence-message regulator 2 related enzyme 1 and nuclear factor κB in peripheral blood mononuclear cells of patients with chronic obstructive pulmonary disease and lung function[J]. Chin J Postgrad Med, 2024, 47(8): 765-768. [4] 欧阳张宁, 高凌云. 白细胞介素与慢性阻塞性肺疾病急性加重期患者预后关系的研究进展[J]. 医学综述, 2023, 29(17): 3418-3423.OUYANG Z N, GAO L Y. Research progress on the relationship between interleukin and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Med Review, 2023, 29(17): 3418-3423. [5] PONS M J, MAYANGA-HERRERA A, PALOMINO-KOBAYASHI L A, et al. High anti-interferon-alpha autoantibody levels in severe/critical COVID-19 patients from Peru[J]. J Interferon Cytokine Res, 2023, 43(12): 565-570. doi: 10.1089/jir.2023.0087 [6] 赵萌. T淋巴细胞亚群在慢性阻塞性肺疾病发生、发展中的作用研究进展[J]. 检验医学与临床, 2023, 20(5): 705-709.ZHAO M. Research progress on the role of T lymphocyte subsets in the occurrence and development of chronic obstructive pulmonary disease[J]. Lab Med Clin, 2023, 20(5): 705-709. [7] 高建荣, 叶亚兰, 高硕, 等. IL-6、PNI与老年慢性阻塞性肺疾病急性加重期患者预后的关系[J]. 皖南医学院学报, 2022, 41(2): 142-145.GAO J R, YE Y L, GAO S, et al. IL-6 and prognostic nutritional index and the prognosis in elderly patients with chronic obstructive pulmonary disease in acute exacerbation stage[J]. Acta Acad Med Wannan, 2022, 41(2): 142-145. [8] 慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组. 慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2017年更新版)[J]. 国际呼吸杂志, 2017, 37(14): 1041-1057.Expert Group on Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Expert consensus on the diagnosis and treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in China (2017 update)[J]. Int J Resp, 2017, 37(14): 1041-1057. [9] 刘艳群, 王勤, 熊伟, 等. 住院慢性阻塞性肺疾病急性加重期患者合并低钠血症的相关危险因素分析[J]. 西部医学, 2024, 36(9): 1350-1354.LIU Y Q, WANG Q, XIONG W, et al. A study on the risk factors for hyponatremia in hospitalized acute exacerbation of chronic obstructive pulmonary disease patients[J]. Med J West Chin, 2024, 36(9): 1350-1354. [10] 黄茂晟, 张红梅, 陆海燕, 等. CC-16及炎症因子水平用于AECOPD预后评估的价值研究[J]. 国际呼吸杂志, 2022, 42(2): 126-131.HUANG M S, ZHANG H M, LU H Y, et al. Study on the prognostic value of CC-16 and inflammatory factors in acute exacerbation of chronic obstructive pulmonary disease[J]. Int J Resp, 2022, 42(2): 126-131. [11] PANEK I, LICZEK M, GABRYELSKA A, et al. Inflammasome signalling pathway in the regulation of inflammation-its involvement in the development and exacerbation of asthma and chronic obstructive pulmonary disease[J]. Postepy Dermatol Alergol, 2023, 40(4): 487-495. http://openurl.ebsco.com/contentitem/doi:10.5114%2Fada.2022.118077?sid=ebsco:plink:crawler&id=ebsco:doi:10.5114%2Fada.2022.118077 [12] 王晓林, 李静, 范志强, 等. 血清sTLT-1、SP-D、NF-κB水平在脓毒症急性肺损伤预后评估中的价值[J]. 西部医学, 2024, 36(12): 1781-1785.WANG X L, LI J, FAN Z Q, et al. Evaluation value of serum sTLT-1, SP-D and NF-κB for prognosis of sepsis combined with acute lung injury[J]. Med J West Chin, 2024, 36(12): 1781-1785. [13] 郭立娟, 商焕霞, 张罗元, 等. AECOPD患者外周血NF-κB、IL-34、CCL18水平与预后的关系探讨[J]. 河北医科大学学报, 2023, 44(10): 1141-1145.GUO L J, SHANG H X, ZHANG L Y, et al. Relationship between peripheral blood NF-κB, IL-34, CCL18 levels and prognosis in patients with AECOPD[J]. J Hebei Med Univ, 2023, 44(10): 1141-1145. [14] 袁怀军, 罗利. 血清IL-6、TNF-α、MMP-9对慢性阻塞性肺疾病急性加重期患者预后的诊断价值[J]. 贵州医药, 2024, 48(4): 614-616.YUAN H J, LUO L. The diagnostic value of serum IL-6, TNF-α and MMP-9 in the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Guizhou Med J, 2024, 48(4): 614-616. [15] 许腾, 郝立君, 刘红春, 等. GRED对慢性阻塞性肺疾病患者血清IL-10、TGF-β1、sPD-1和sPD-L1表达水平及临床表现的影响[J]. 河北医学, 2024, 30(4): 575-579.XU T, HAO L J, LIU H C, et al. Effect of reflux disease on the expression levels and clinical manifestations of serum IL-10, TGF-β1, sPD-1, and sPD-L1 in patients with chronic obstructive pulmonary disease[J]. Hebei Med, 2024, 30(4): 575-579. [16] 于易琼, 丁震, 徐康, 等. 血清白介素-10与慢阻肺患者肺功能之间的关系[J]. 临床肺科杂志, 2023, 28(11): 1692-1696.YU Y Q, DING Z, XU K, et al. Relationship between serum interleukin-10 and lung function in patients with chronic obstructive pulmonary disease[J]. J Clin Pulm Med, 2023, 28(11): 1692-1696. [17] 孔德昭, 王科雯, 罗文晔, 等. 慢性阻塞性肺疾病急性加重期诊疗指南评价与综合分析[J]. 中国中医基础医学杂志, 2023, 29(8): 1307-1317.KONG D Z, WANG K W, LUO W Y, et al. Evaluation and comprehensive analysis of diagnostic and treatment guidelines for acute exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Basic Medicine in Traditional Chinese Medicine, 2023, 29(8): 1307-1317. [18] XIONG X F, ZHU M, WU H X, et al. Immunophenotype in acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study[J]. Respir Res, 2022, 23(1): 137. http://pubmed.ncbi.nlm.nih.gov/35643501/ [19] QUEIROZ M A F, BRITO W R D S, PEREIRA K A S, et al. Severe COVID-19 and long COVID are associated with high expression of STING, cGAS and IFN-α[J]. Sci Rep, 2024, 14(1): 4974. DOI: 10.1038/s41598-024-55696-0. [20] 唐文君, 曾珠, 孙增涛, 等. 外周血T淋巴细胞亚群变化对于慢阻肺患者急性加重期相对危险性的评价[J]. 临床肺科杂志, 2023, 28(10): 1511-1518.TANG W J, ZENG Z, SUN Z T, et al. Evaluation of the relative risk of patients with AECOPD by T lymphocyte subsets changes in peripheral blood[J]. Journal of Clinical Pulmonary Medicine, 2023, 28(10): 1511-1518. [21] 陈建, 汪久龙, 徐裕丰. 慢性阻塞性肺疾病患者T淋巴细胞亚群变化及与病情程度的关系[J]. 河北医药, 2023, 45(7): 1057-1060.CHEN J, WANG J L, XU Y F. Changes of T lymphocyte subsets in patients with chronic obstructive pulmonary disease and its correlations with the degree of disease[J]. Hebei Med J, 2023, 45(7): 1057-1060. -