疑难病杂志2023，Vol.22Issue(12)：1268-1272,1284,6.DOI:10.3969/j.issn.1671-6450.2023.12.007
老年COPD合并肺部感染患者血清免疫状态变化特点及预后价值
The characteristics and prognostic value of serum immune status changes in elderly COPD patients with pulmonary infection
摘要
Abstract
Objective To explore the changes in serum immune status and predictive value of prognosis in elderly patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary infection.Methods One hun-dred and twenty elderly COPD patients with pulmonary infection admitted to the Department of Respiratory and Critical Care Medicine at Yangguang Ronghe Hospital in Weifang City from June 2021 to June 2022 were selected.They were divided in-to a survival group of 100 patients and a death group of 20 patients based on their prognosis after one year of treatment.Compare the levels of CD3+,natural killer(NK)cells,CD4+/CD8+,and their correlation with lung function indicators and COPD grading between two groups of patients.Application of multivariate logistic regression analysis to analyze the risk factors of pulmonary infection in elderly COPD patients;Draw ROC curves to evaluate the predictive value of CD4+/CD8+,CD3+,and NK cells in elderly COPD patients with pulmonary infection.Results Compared with the survival group,the levels of CD3+,NK cells,and CD4+/CD8+in the death group decreased(t/P=12.552/＜0.001,8.132/＜0.001,5.779/＜0.001).Comparison of serum CD3+,NK cells,and CD4+/CD8+levels in patients with different grades of COPD:Grade Ⅰ＞Grade Ⅱ＞Grade Ⅲ(F/P=82.514/＜0.001,35529/＜0.001,19.657/＜0.001).The expression of CD3+,NK cells,CD4+/CD8+was posi-tively correlated with FEV1/FVC,FEV1％pred,and negatively correlated with COPD grading(r=0556,0.560,-0.550,0.545,0.539,-0.567,0.572,0.587,-0.605,P＜0.001).Older age,longer disease course,higher proportion of COPD grade Ⅲ,are risk factors for prognosis in elderly COPD patients with pulmonary infection[OR(95％CI)=1.369(1.194～1.571),5.239(2.506～10.951),1.114(1.016～1212)],higher FEV1/FVC,higher FEV1％pred,higher CD3+,higher NK cells,and higher CD4+/CD8+are protective factors[OR(95％CI)=0.697(0.593～0.821),0.622(0.493～0.786),0.478(0.331～0.689),0.633(0.523～0.766),0.023(0.004～0.124)].The AUC of CD3+,NK cells,CD4+/CD8+,and the three combined tests for predicting the prognosis of elderly COPD with pulmonary infection were 0.640,0.637,0.840,and 0.935,respectively.The AUC of the three combined tests was greater than that of the individual predictors(P=0.001).Conclusion The expression of serum CD3+,NK cells,and CD4+/CD8+in elderly COPD patients with pulmonary infection decreases,and is related to lung function indicators and COPD grading.The combined detection of these three factors can effectively improve the predictive value of elderly COPD patients with pulmonary infection.关键词
慢性阻塞性肺疾病/肺部感染/自然杀伤细胞/老年人Key words
Chronic obstructive pulmonary disease/Pulmonary infection/Natural killer cell/Elderly分类
医药卫生引用本文复制引用
郑成玲,蒋慧生,王金鹏..老年COPD合并肺部感染患者血清免疫状态变化特点及预后价值[J].疑难病杂志,2023,22(12):1268-1272,1284,6.基金项目
山东省科技发展计划项目(20210154)Shandong Province Science and Technology Development Plan Project(20210154) （20210154）
