摘要
目的 本次探究白介素6(Interleukin 6,IL-6)、降钙素原(Procalcitonin, PCT)、D二聚体(D dimer, D-D)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、干扰素γ(interferon-γ,IFN-γ)与AECOPD疾病严重程度、预后之间的关系,希望能够为AECOPD临床治疗提供借鉴。方法 选择2021年1月—2022年6月在本院接受治疗的79例AECOPD患者作为研究对象;另选取同期与之性别、年龄相匹配的79名健康体检者、79例稳定期COPD患者作为健康对照组、稳定期对照组。根据人民卫生出版社出版第九版《内科学》中的AECOPD的临床分级方法划分,将患者分为Ⅰ级组、Ⅱ级组、Ⅲ级组;并对AECOPD患者予以半年随访,根据随访结果分为预后良好组、预后不良组。观察指标:(1)观察健康对照组、稳定对照组、AECOPD组IL-6、PCT、D-D、TNF-α、IFN-γ水平差异;(2)观察不同严重程度AECOPD亚组患者五项检查指标水平差异,并以Spearman秩相关分析五项检查指标与病情严重程度相关性,以ROC曲线分析五项指标评估严重病情的价值;(3)观察不同预后AECOPD亚组患者五项检查指标水平差异,并以Spearman秩相关分析五项指标与患者预后不良相关性,以ROC曲线分析五项指标评估预后的价值。结果 (1)AECOPD组IL-6、PCT、D-D、TNF-α、IFN-γ明显高于健康对照组和稳定期对照组,且稳定期对照组患者各项指标显著高于健康对照组,任意两组差异均有统计学意义(P<0.05)。(2)不同严重程度AECOPD亚组患者IL-6、PCT、D-D、TNF-α、IFN-γ差异均显著,任意两组对比差异均有统计学意义(P<0.05)。随着AECOPD病情加重,IL-6、PCT、D-D、TNF-α、IFN-γ阳性率均呈现上升趋势,Spearman分析证实各指标均与AECOPD病情严重程度呈正相关关系(P<0.05);其中TNF-α的相关性最强(r=0.637),IFN-γ的相关性最弱(r=0.370)。ROC曲线显示,入院时IL-6、PCT、D-D、TNF-α、IFN-γ五项指标均能够用于评估AECOPD病情严重程度,AUC分别为0.655、0.716、0.749、0.783、0.613,且当IL-6、PCT、D-D、TNF-α、IFN-γ的cut-off取11.145、0.791、1.923、2.153、2.247时评估价值最高。(3)预后不良组患者入院时IL-6、PCT、D-D、TNF-α、IFN-γ均高于预后良好组,差异有统计学意义(P<0.05)。AECOPD预后不良组患者入院时IL-6、PCT、D-D、TNF-α、IFN-γ阳性率高于预后良好组,Spearman分析证实各指标均与AECOPD预后不良呈正相关关系(P<0.05),其中TNF-α的相关性最强(r=0.653),IFN-γ的相关性最弱(r=0.371)。ROC曲线显示,入院时IL-6、PCT、D-D、TNF-α、IFN-γ五项指标均能够用于预测预后不良,预测AUC分别为0.633、0.705、0.752、0.794、0.605,且当IL-6、PCT、D-D、TNF-α、IFN-γ的cut-off取11.692、0.773、1.741、2.085、2.136时预测价值最高。结论 AECOPD患者IL-6、PCT、D-D、TNF-α、IFN-γ均明显升高,且上述五项指标水平与患者疾病严重程度、预后不良密切相关,表达水平越高,患者病情越严重、预后不良风险越高。
Objective This study explores the relationship between interleukin-6(IL-6),procalcitonin(PCT),D-dimer(D-D),tumor necrosis factor-α(TNF-α),interferonγ(IFN-γ)and the severe degree of AECOPD disease and prognosis,prospect to provide reference for the clinical treatment of AECOPD.Methods A total of 79 patients with AECOPD who were treated in our hospital from January 2021 to June 2022 were selected as the research subjects;79 healthy subjects and 79 stable subjects who were matched with their gender and age during the same period were selected as the health control group and stable stage control group.According to the classification method of disease severity described in“Chinese Expert Consensus on Diagnosis and Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD)(2017 Update)”,AECOPD patients were divided into grade I group,grade II group and grade III group.The patients were followed up for half a year and they were divided into a good prognosis group and a poor prognosis group according to the follow-up results.The following indicators were observed:(1)To observe the differences in the levels of IL-6,PCT,D-D,TNF-α,IFN-γin the healthy control group,the stable control group,and the AECOPD group;(2)To observe the five examinations of patients in different severity AECOPD subgroups,the differences in the levels of the indicators were analyzed,and the correlation between the five inspection indicators and the severity of the disease was analyzed by Spearman rank correlation,and the value of the five indicators in evaluating the severity of the disease was analyzed by the ROC curve;(3)The differences in the levels of the five inspection indicators in AECOPD subgroups with different prognosis were observed,and Spearman rank correlation was used to analyze the correlation between the five indicators and the poor prognosis of patients,and the ROC curve was used to analyze the five indicators to evaluate the prognostic value.Results Levels of IL-6,PCT,D-D,TNF-α,and IFN-γin the AECOPD group were significantly higher than those in the healthy control group and the stable control group,and the indicators in the stable control group were significantly higher than those in the healthy control group,the differences between groups were statistically significant(P<0.05).(2)There were significant differences in IL-6,PCT,D-D,TNF-α,and IFN-γin AECOPD subgroups of different severity,and there were significant differences between any two groups(P<0.05).With the aggravation of AECOPD,the positive rates of IL-6,PCT,D-D,TNF-αand IFN-γall showed an upward trend.Spearman analysis confirmed that each index was positively correlated with the severity of AECOPD(P<0.05).The correlation was strongest for TNF-α(r=0.637)and the weakest for IFN-γ(r=0.370).The ROC curve shows that the five indicators of IL-6,PCT,D-D,TNF-α,and IFN-γat admission can be used to evaluate the severity of AECOPD,and the AUCs were 0.655,0.716,0.749,0.783,and 0.613,respectively.When the cut-off of PCT,D-D,TNF-αand IFN-γwere 11.145,0.791,1.923,2.153 and 2.247,the evaluation value was the highest.(3)IL-6,PCT,D-D,TNF-α,and IFN-γin the poor prognosis group were higher than those in the good prognosis group at admission,and the differences were statistically significant(P<0.05).The positive rates of IL-6,PCT,D-D,TNF-α,and IFN-γin the AECOPD poor prognosis group were higher than those in the good prognosis group.Spearman analysis confirmed that each index was positively correlated with the poor prognosis of AECOPD(P<0.05).The correlation of TNF-αwas the strongest(r=0.653),and the correlation of IFN-γwas the weakest(r=0.371).The ROC curve showed that five indicators of IL-6,PCT,D-D,TNF-α,and IFN-γat admission could be used to predict poor prognosis,and the predicted AUCs were 0.633,0.705,0.752,0.794,and 0.605,respectively.When the cut-off of IL-6,PCT,D-D,TNF-αand IFN-γwere 11.692,0.773,1.741,2.085 and 2.136,the predictive value was the highest.Conclusions IL-6,PCT,D-D,TNF-αand IFN-γin patients with AECOPD are significantly increased,and the levels of the above five indicators are closely related to the disease severity and poor prognosis of patients.The higher the expression level,the more severe the patient's condition,the higher the risk of poor prognosis.
作者
赖育庭
黄慧
Lai Yuting;Huang Hui(School of Medicine,Shantou University,Shantou,Guangdong,515041,China;Longgang central hospital,Shenzhen,Guangdong,518100,China;Huizhou central people's hospital,Huizhou,Guangdong,516001,China)
出处
《齐齐哈尔医学院学报》
2023年第7期601-606,共6页
Journal of Qiqihar Medical University
基金
深圳市龙岗区医疗卫生科技计划项目[LGWJ2021-(13)]。
关键词
慢阻肺急性加重
白介素6
降钙素原
D二聚体
肿瘤坏死因子-Α
干扰素Γ
Acute exacerbation of chronic obstructive pulmonary disease
Interleukin-6
Procalcitonin
D-dimer
Tumor necrosis factor-α
Interferon-γ
