慢性阻塞性肺疾病急性加重期患者血清sTREM-1、sCD163水平变化及临床意义

汪伟; 吴蔚; 高峰; 王彬

doi:10.16766/j.cnki.issn.1674-4152.001776

慢性阻塞性肺疾病急性加重期患者血清sTREM-1、sCD163水平变化及临床意义

doi: 10.16766/j.cnki.issn.1674-4152.001776

中国中医科学院望京医院呼吸科，北京 100102

基金项目:

北京市科技计划课题项目 Z181100001718114

详细信息

通讯作者:
王彬，E-mail：xiaobai57@yeah.net

中图分类号: R563 R446
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出版历程
- 收稿日期: 2020-07-06
- 网络出版日期: 2022-02-19

Changes and clinical significance of serum STREM-1 and sCD163 levels in patients with acute exacerbation of chronic obstructive pulmonary disease

Department of Respiratory, Wangjing Hospital of CACMS, Beijing 100102, China

摘要

摘要: 目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者血清可溶性髓样细胞触发受体1(sTREM-1)、可溶性血红蛋白道夫受体(sCD163)变化，分析其对AECOPD患者预后的诊断价值。方法选择2017年5月—2019年8月中国中医科学院望京医院收治的124例AECOPD患者，根据住院28 d临床结局将其分为恶化组(32例)和好转组(92例)，另选择50例健康体检者为对照组。采用酶联免疫吸附试验检测血清sTREM-1、sCD163水平，收集患者临床资料，采用logistic逐步回归分析探究影响AECOPD患者预后的因素，采用受试者工作特征曲线(ROC)分析sTREM-1、sCD163诊断AECOPD患者预后的价值。结果恶化组血清sTREM-1、sCD163水平高于好转组和对照组(均P＜0.05)，好转组血清sTREM-1、sCD163水平高于对照组(均P＜0.05)。Logistic逐步回归分析结果显示急性生理与慢性健康状况(APACHE Ⅱ)评分、近1年急性发作住院次数、合并休克、sTREM-1、sCD163是AECOPD患者预后不良的危险因素(均P＜0.01)。ROC分析结果显示sTREM-1、sCD163、联合sTREM-1+sCD163诊断AECOPD患者预后的曲线下面积(AUC)分别为0.727、0.730、0.910，灵敏度分别为68.75%、62.50%、84.38%，特异度分别为78.26%、82.61%、92.39%。结论 sTREM-1、sCD163水平升高可能是AECOPD患者不良预后的危险因素，联合sTREM-1、sCD163检测可能有助于提高对预后预测的准确性。
- 慢性阻塞性肺疾病 /
- 急性加重期 /
- 可溶性髓样细胞触发受体1 /
- 可溶性血红蛋白道夫受体 /
- 急性生理与慢性健康状况评分 /
- 休克 /
- 预后
Abstract: Objective To investigate the changes of serum soluble myeloid cell trigger receptor 1 (sTREM-1) and soluble hemoglobin scavenger receptor (sCD163) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and analyze their diagnostic value for the prognosis of patients with AECOPD. Methods Total 124 AECOPD patients admitted to our hospital from May 2017 to August 2019 were selected and divided into deterioration group (32 cases) and good conversion group (92 cases) according to the clinical outcome after 28 d of hospitalization. Another 50 healthy people were selected as the control group. Serum sTREM-1 and sCD163 levels were detected by enzyme linked immunosorbent assay. Clinical data of the patients were collected, and factors affecting the prognosis of AECOPD patients were analyzed by Logistic stepwise regression. The prognostic value of STREM-1 and sCD163 in AECOPD patients was analyzed by receiver operator characteristics curve (ROC). Results Serum STREM-1 and sCD163 levels in the deterioration group were higher than that in the good conversion group and control group (all P < 0.05), and the good conversion group was higher than control group (all P < 0.05). Logistic stepwise regression analysis results showed that the acute physiology and chronic health conditions (APACHE Ⅱ) score, number of acute hospital nearly 1 years, combined shock, sTREM-1, sCD163 were risk factors for poor prognosis of AECOPD patients (all P < 0.01). ROC analysis results showed that the area under curve (AUC) of sTREM-1, sCD163 and combined sTREM-1+sCD163 in the diagnosis of AECOPD patients were 0.727, 0.730, 0.910, the sensitivity were 68.75%, 62.50%, 84.38%, the specificity were 78.26%, 82.61%, 92.39%. Conclusion Elevated sTREM-1 and sCD163 levels may be risk factors for poor prognosis in AECOPD patients, and combined detection of sTREM-1 and sCD163 may help improve the accuracy of prognosis prediction.
- Chronic obstructive pulmonary disease /
- Acute exacerbation /
- Soluble myeloid cell trigger receptor 1 /
- Soluble hemoglobin scavenger receptor /
- Acute physiological and chronic health status score /
- Shock /
- Prognosis

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图 1 sTREM-1、sCD163、联合sTREM-1+sCD163诊断AECOPD患者预后的ROC曲线

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表 1 各组研究对象临床基线资料比较(x ±s)

组别	例数	年龄(岁)	性别[例(%)]			基础疾病[例(%)]							COPD病程[例(%)]
组别	例数	年龄(岁)	男性	女性		糖尿病	高血压	冠心病		高脂血症			≥5年	＜5年
恶化组	32	63.12±6.13	20(62.50)	12(37.50)		20(62.50)	21(65.63)	13(40.63)		19(59.38)			19(59.38)	13(40.62)
好转组	92	62.24±6.52	53(57.61)	39(42.39)		49(53.26)	50(54.35)	32(34.78)		46(50.00)			59(64.13)	33(35.87)
对照组	50	62.48±6.61	29(58.00)	21(42.00)
统计量		0.219^a	0.245^b			0.821^b	1.234^b	0.351^b		0.837^b			0.230^b
P值		0.804	0.885			0.365	0.267	0.554		0.360			0.631

组别	例数	近1年急性发作住院次数[例(%)]		合并肺部感染[例(%)]			APACHE Ⅱ评分(分)	合并休克[例(%)]			机械通气[例(%)]		mMRC分级[例(%)]
组别	例数	≥3次	＜3次	是	否		APACHE Ⅱ评分(分)	是	否		是	否	2级	3~4级
恶化组	32	18(56.25)	14(43.75)	20(62.50)	12(37.50)		24.95±7.16	15(46.88)	17(53.12)		22(68.75)	10(31.25)	7(21.87)	25(78.13)
好转组	92	31(33.70)	61(66.30)	35(38.04)	57(61.96)		15.10±3.22	21(22.83)	71(77.17)		69(75.00)	23(25.00)	43(46.74)	49(53.26)
对照组	50
统计量		5.053^b		5.754^b			10.534^a	6.664^b			0.475^b		6.100^b
P值		0.025		0.016			< 0.001	0.010			0.491		0.014

组别	例数	FEV₁(L)	FEV₁/FVC(%)	FEV₁%pred(%)	WBC(×10⁹/L)		PLT(×10⁹/L)	HCT(%)	ALT(U/L)	BUN(mmol/L)		Scr(μmol/L)	TP(g/L)		Alb(g/L)
恶化组	32	42.91±4.65	55.42±7.19	58.24±6.35	13.05±3.26^d		226.35±21.15	49.02±2.75^d	31.23±3.56^d	8.08±3.16^d		98.66±21.35^d	56.05±6.35		35.81±5.61
好转组	92	54.26±5.49	63.48±8.59	69.35±8.72	11.42±2.85^d		228.24±22.81	48.38±2.58^d	30.15±2.46^d	7.75±3.05^d		96.61±13.16^d	57.77±6.28		35.12±5.40
对照组	50				8.56±2.16		235.16±25.46	44.56±2.19	28.26±2.37	5.23±0.69		86.35±12.04	58.94±6.89		36.65±6.12
统计量		10.456^a	4.756^a	6.615^a	29.434^c		1.876^c	45.774^c	13.699^c	17.719^c		9.817^c	1.946^c		1.196^c
P值		< 0.001	< 0.001	< 0.001	< 0.001		0.156	< 0.001	< 0.001	< 0.001		< 0.001	0.146		0.305
注：^a为t值，^b为χ²值，^c为F值。与对照组比较，^dP＜0.05。

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表 2 各组研究对象血清sTREM-1、sCD163水平比较(x ±s, pg/mL)

组别	例数	sTREM-1	sCD163
恶化组	32	169.26±31.94^ab	142.84±23.97^ab
好转组	92	98.35±22.01^a	105.83±21.54^a
对照组	50	34.26±9.54	40.62±6.25
F值		385.275	319.762
P值		< 0.001	< 0.001
注：与对照组比较，^aP＜0.05；与好转组比较，^bP＜0.05。

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表 3 影响AECOPD患者预后的logistic回归模型

项目	B	SE	Wald χ²	P值	OR(95% CI)
APACHE Ⅱ评分	0.429	0.135	10.098	0.003	1.536(1.205~1.728)
近1年急性发作住院次数	0.659	0.211	9.755	0.005	1.933(1.365~2.342)
合并休克	0.592	0.169	12.271	< 0.001	1.808(1.205~2.064)
sTREM-1	0.495	0.124	15.936	< 0.001	1.640(1.405~1.926)
sCD163	0.597	0.136	23.180	< 0.001	1.817(1.602~2.134)

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表 4 sTREM-1、sCD163、联合sTREM-1+sCD163诊断AECOPD患者预后的效能

指标	Cut-off	AUC(95% CI)	P值	灵敏度(%)	特异度(%)	约登指数
sTREM-1	130.05 pg/mL	0.727(0.619~0.835)	< 0.001	68.75	78.26	0.47
sCD163	126.11 pg/mL	0.730(0.630~0.829)	< 0.001	62.50	82.61	0.45
联合		0.910(0.847~0.972)	< 0.001	84.38	92.39	0.77

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