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
计量
- 文章访问数: 181
- HTML全文浏览量: 32
- PDF下载量: 1
- 被引次数: 0
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

HTML全文

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

下载: 全尺寸图片幻灯片

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。

下载: 导出CSV

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。

下载: 导出CSV

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)

下载: 导出CSV

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

下载: 导出CSV

参考文献(21)

[1]	ROTHNIE K J, MULLEROVA H, SMEETH L, et al. Natural history of chronic obstructive pulmonary disease exacerbations in a general practice-based population with chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2018, 198(4): 464-471. doi: 10.1164/rccm.201710-2029OC
[2]	RAHIMIRAD S, GHAFFARY M R, RAHIMIRAD M H, et al. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Tuberk Toraks, 2017, 65(1): 25-31. http://www.ncbi.nlm.nih.gov/pubmed/28621246
[3]	CAO C L, GU J X, ZHANG J Y. Soluble triggering receptor expressed on myeloid cell-1 (sTREM-1): a potential biomarker for the diagnosis of infectious diseases[J]. Front Med, 2017, 11(2): 169-177. doi: 10.1007/s11684-017-0505-z
[4]	SUZUKI Y Z, SHIRAI M, ASADA K, et al. Utility of macrophage-activated marker CD163 for diagnosis and prognosis in pulmonary tuberculosis[J]. Ann Am Thorac Soc, 2017, 14(1): 57-64. doi: 10.1513/AnnalsATS.201607-528OC
[5]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013年修订版)[J]. 中华结核和呼吸杂志, 2013, 36(4): 255-264. doi: 10.3760/cma.j.issn.1001-0939.2013.04.007
[6]	王胜云, 陈德昌. 降钙素原和C-反应蛋白与脓毒症患者病情严重程度评分的相关性研究及其对预后的评估价值[J]. 中华危重病急救医学, 2015, 27(2): 97-101.
[7]	林颖. mMRC评估和CAT评分评估慢性阻塞性肺疾病患者病情严重程度的临床效果[J]. 临床医学, 2016, 36(10): 19-20. https://www.cnki.com.cn/Article/CJFDTOTAL-EBED201610008.htm
[8]	卢水焕, 陆俊羽, 刘学员. AECOPD住院患者病情恶化的危险因素研究[J]. 临床肺科杂志, 2015, 20(1): 4-6. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFK201501004.htm
[9]	9] HESS M W. The 2017 global initiative for chronic obstructive lung disease report and practice implications for the respiratory therapist[J]. Respir Care, 2017, 62(11): 1492-1500. doi: 10.4187/respcare.05402
[10]	FUHRMAN C, MOUTENGOU E, ROCHE N, et al. Prognostic factors after hospitalization for COPD exacerbation[J]. Rev Mal Respir, 2017, 34(1): 1-18. doi: 10.1016/j.rmr.2016.03.012
[11]	SU L X, LIU D, CHAI W Z, et al. Role of sTREM-1 in predicting mortality of infection: a systematic review and meta-analysis[J]. BMJ Open, 2016, 6(5): e010314. doi: 10.1136/bmjopen-2015-010314
[12]	HU C P, JIANG J, LI Z, et al. Expression pattern of soluble triggering receptor expressed on myeloid cells-1 in mice with Acinetobacter baumannii colonization and infection in the lung[J]. J Thorac Dis, 2018, 10(3): 1614-1621. doi: 10.21037/jtd.2018.03.41
[13]	LI C X, ZHU L M, GONG X L, et al. Soluble triggering receptor expressed on myeloid cells-1 as a useful biomarker for diagnosing ventilator-associated pneumonia after congenital cardiac surgery in children[J]. Exp Ther Med, 2019, 17(1): 147-152.
[14]	AKSARAY S, ALAGOZ P, INAN A, et al. Diagnostic value of sTREM-1 and procalcitonin levels in the early diagnosis of sepsis[J]. North Clin Istanb, 2016, 3(3): 175-182. http://pdfs.semanticscholar.org/b378/eb182e09086be8a5025d3f6b4512bb289d49.pdf
[15]	ROHDE G, RADSAK M P, BORG I, et al. Levels of soluble triggering receptor expressed on myeloid cells 1 in infectious exacerbations of chronic obstructive pulmonary disease[J]. Respiration, 2012, 83(2): 133-139. doi: 10.1159/000328413
[16]	周毅, 沈华浩, 黄华琼, 等. 血清sTREM-1变化对AECOPD患者预后及再次急性发作的判断意义[J]. 中华急诊医学杂志, 2015, 24(6): 666-668.
[17]	李明霞, 洪智峰, 陈伟健, 等. 可溶性髓样细胞触发受体1与可溶性血红蛋白清道夫受体诊断呼吸机相关性肺炎的价值[J]. 实用临床医学, 2018, 19(2): 19-21, 25. https://www.cnki.com.cn/Article/CJFDTOTAL-LCSY201802007.htm
[18]	ZHI Y, GAO P, XIN X, et al. Clinical significance of sCD163 and its possible role in asthma (Review)[J]. Mol Med Rep, 2017, 15(5): 2931-2939. http://pdfs.semanticscholar.org/3772/f0be19472b51990e517b7fb357897409d436.pdf
[19]	陈永海, 方凤, 范美花, 等. 血清可溶性清道夫受体CD163在慢性阻塞性肺疾病急性加重期中的临床意义[J]. 临床肺科杂志, 2019, 24(8): 1429-1432. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFK201908018.htm
[20]	洪智峰, 陈伟健, 李明霞, 等. 可溶性髓样细胞触发受体1(sTREM-1)与可溶性血红蛋白清道夫受体(sCD163)在呼吸机相关性肺炎诊断中的临床意义[J]. 临床肺科杂志, 2017, 22(3): 431-433. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFK201703012.htm
[21]	GERSHON A S, GUAN J, VICTOR J C, et al. Quantifying health services use for chronic obstructive pulmonary disease[J]. Am J Respir Crit Care Med, 2013, 187(6): 596-601. http://eurheartj.oxfordjournals.org/content/34/36/2795