摘要
Abstract
Objective:Chronic obstructive pulmonary disease(COPD)is a common chronic inflammatory disease in the elderly population and is associated with a poor prognosis.Disease progression is often accompanied by immune dysfunction and airway remodeling.Identifying simple and effective biomarkers for the early identification of elderly COPD patients at high risk of poor prognosis is therefore of clinical importance.This study aims to investigate the value of serum surfactant protein D(SP-D),monocyte chemoattractant protein-1(MCP-1),and cluster of differentiation(CD)4 receptor(CD4+)/CD8+levels in predicting poor prognosis in elderly patients with COPD,in order to provide a reference for early intervention and individualized management.
Methods:A retrospective analysis was conducted on the clinical data of 150 elderly patients with COPD treated at Changsha Third Hospital between January 2021 and October 2024.According to the guidelines for the management of chronic obstructive pulmonary disease in the elderly,prognosis stratification was performed using the COPD assessment test(CAT)combined with clinical endpoint events.Patients were divided into a good-prognosis group(n=36)and a poor-prognosis group(n=114).General characteristics,including gender,age,body mass index(BMI),smoking history,alcohol consumption history,and comorbidities,were compared between the 2 groups.Pulmonary function tests were performed to obtain the percentage of predicted forced expiratory volume in 1 second(FEV1%pred)and the ratio of forced expiratory volume in 1 second to forced vital capacity(FEV1/FVC).Levels of CD4+and CD8+were measured by flow cytometry,and the CD4+/CD8+ratio was calculated.Serum MCP-1 and SP-D levels were determined using enzyme-linked immunosorbent assay.Multivariate logistic regression analysis was performed to identify risk factors for poor prognosis in elderly patients with COPD.
Results:There were no significant differences between the 2 groups in sex,smoking history,BMI,alcohol consumption history,age,or complications(all P>0.05).Serum levels of SP-D,CD8+,and MCP-1 were significantly higher in the poor-prognosis group than those in the good-prognosis group(all P<0.05).In contrast,serum CD4+levels,the CD4+/CD8+ratio,FEV1%pred,and FEV1/FVC were significantly lower in the poor-prognosis group(all P<0.05).Multivariate logistic regression analysis revealed that decreased FEV1%pred,decreased FEV1/FVC ratio,elevated SP-D,decreased CD4+,and elevated CD8+were independent risk factors for poor prognosis in elderly patients with COPD(all P<0.05),whereas increased CD4+/CD8+ratio and decreased MCP-1 were protective factors(both P<0.05).
Conclusion:Decreased FEV1%pred,decreased FEV1/FVC ratio,elevated SP-D,decreased CD4+,and elevated CD8+are risk factors for poor prognosis in elderly patients with COPD,whereas increased CD4+/CD8+ratio and decreased MCP-1 are protective factors.These indicators warrant close attention in clinical practice.关键词
慢性阻塞性肺疾病/肺泡表面活性蛋白-D/单核细胞趋化蛋白-1/抗原分化簇4受体/抗原分化簇8受体Key words
chronic obstructive pulmonary disease/surfactant protein D/monocyte chemoattractant protein-1/cluster of differentiation 4 receptor/cluster of differentiation 8 receptor
