血清CXCL9和SFRP1在AECOPD合并肺栓塞患者中的表达及对预后的影响

doi:10.11958/20221267

摘要/Abstract

摘要：

目的探讨血清CXC趋化因子配体9（CXCL9）和分泌型卷曲相关蛋白1（SFRP1）在慢性阻塞性肺疾病急性加重期（AECOPD）合并肺栓塞（PE）患者中的表达水平及其对预后的预测价值。方法 56例AECOPD合并PE患者为病例组，并收集同期的80例单纯AECOPD患者为对照组。采用酶联免疫吸附试验检测各组血清CXCL9、SFRP1水平。采用Logistic回归模型分析AECOPD发生PE的影响因素，绘制受试者工作特征（ROC）曲线评估血清CXCL9、SFRP1对AECOPD患者PE的预测价值，采用COX比例风险回归模型分析血清CXCL9、SFRP1对不良预后的影响。结果与对照组比较，病例组AECOPD病程较长，血清CXCL9、SFRP1水平升高（P<0.05）。较长AECOPD病程（OR=1.420，95%CI：1.246~1.620）和较高CXCL9（OR=1.835，95%CI：1.502~2.241）、SFRP1（OR=1.608，95%CI：1.351~1.914）水平是AECOPD患者发生PE的独立危险因素。血清CXCL9、SFRP1均可预测AECOPD患者PE发生风险，指标联合预测价值更大。血清CXCL9、SFRP1与PESI分级呈正相关（r_s分别为0.752和0.716，P<0.05）。较高水平的血清CXCL9（HR=1.374，95%CI：1.184~1.595）以及SFRP1（HR=1.186，95%CI：1.329~1.542）是PE患者死亡的独立危险因素。结论血清CXCL9、SFRP1异常升高是AECOPD患者发生PE的危险因素，并且与PE病情严重程度以及预后密切相关。

关键词: 肺疾病，慢性阻塞性, 急性病, 肺栓塞, CXC趋化因子配体9, 分泌型卷曲相关蛋白1

Abstract:

Objective To explore expression levels of serum C-X-C chemokine ligand 9 (CXCL9) and secretory frizzled-associated protein 1 (SFRP1) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary embolism (PE) and their prognostic value. Methods Fifty-six AECOPD patients with PE were collected as the case group, and 80 patients with AECOPD in the same period were selected as the control group. The serum CXCL9 and SFRP1 levels were detected by enzyme-linked immunosorbent assay. Logistic regression model was used to analyze the influencing factors of PE in AECOPD patients, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of serum CXCL9 and SFRP1 on PE in AECOPD patients. COX proportional risk regression model was used to analyze the influencing factors of serum CXCL9 and SFRP1 on poor prognosis. Results The course of AECOPD was longer in the case group than that in the control group, and the serum CXCL9 and SFRP1 levels were higher than those in the control group (P<0.05). Long AECOPD course (OR=1.420，95%CI：1.246-1.620), higher CXCL9 (OR=1.835，95%CI：1.502-2.241) and SFRP1 (OR=1.608，95%CI：1.351-1.914) were independent risk factors for PE in AECOPD patients. Serum levels of CXCL9 and SFRP1 can predict the risk of PE in AECOPD patients, and the predictive value of combination of two indicators was more better. Serum CXCL9 and SFRP1 levels were positively associated with PESI grade (r_s=0.752, 0.716; P<0.05). Higher serum levels of CXCL9 (HR=1.374, 95%CI:1.184-1.595) and SFRP1 (HR=1.186，95%CI：1.329-1.542) were independent risk factors for death in AECOPD patients with PE. Conclusion The abnormal increased serum levels of CXCL9 and SFRP1 are risk factors for PE in AECOPD patients, which is closely related to the severity and prognosis of PE.

Key words: pulmonary disease, chronic obstructive, acute disease, pulmonary embolism, CXC chemokine ligand 9, secretory crimp-associated protein 1

中图分类号:

R563.5

图/表 7

参考文献 19

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组别	n	性别（男/女）		年龄（岁）		BMI （kg/m²）		吸烟史		AECOPD 病程（d）
对照组	80	45/35		56.29±11.35		22.87±2.06		31（38.75）		2.34±0.67
病例组	56	34/22		58.17±10.63		23.05±2.18		19（33.93）		3.69±0.85
χ²或t		0.270		0.985		0.493		0.329		10.344^**
组别	高血压史		糖尿病史		冠心病史		CXCL9 （pmol/L）		SFRP1 （pmol/L）
对照组	27（33.75）		25（31.25）		13（16.25）		9.22±3.53		361.59±78.62
病例组	13（23.21）		10（17.86）		3（5.36）		12.09±3.82		455.57±90.35
χ²或t	1.761		3.092		3.765		4.518^**		6.455^**

组别	n	性别（男/女）		年龄（岁）		BMI （kg/m²）		吸烟史		AECOPD 病程（d）
对照组	80	45/35		56.29±11.35		22.87±2.06		31（38.75）		2.34±0.67
病例组	56	34/22		58.17±10.63		23.05±2.18		19（33.93）		3.69±0.85
χ²或t		0.270		0.985		0.493		0.329		10.344^**
组别	高血压史		糖尿病史		冠心病史		CXCL9 （pmol/L）		SFRP1 （pmol/L）
对照组	27（33.75）		25（31.25）		13（16.25）		9.22±3.53		361.59±78.62
病例组	13（23.21）		10（17.86）		3（5.36）		12.09±3.82		455.57±90.35
χ²或t	1.761		3.092		3.765		4.518^**		6.455^**

变量	β	SE	Wald χ²	P	OR	95%CI
AECOPD病程	0.351	0.067	27.445	<0.001	1.420	1.246~1.620
CXCL9	0.607	0.102	35.414	<0.001	1.835	1.502~2.241
SFRP1	0.475	0.089	28.484	<0.001	1.608	1.351~1.914
常数项	-2.029	0.395	26.386	<0.001	0.131

变量	β	SE	Wald χ²	P	OR	95%CI
AECOPD病程	0.351	0.067	27.445	<0.001	1.420	1.246~1.620
CXCL9	0.607	0.102	35.414	<0.001	1.835	1.502~2.241
SFRP1	0.475	0.089	28.484	<0.001	1.608	1.351~1.914
常数项	-2.029	0.395	26.386	<0.001	0.131

诊断指标	AUC（95%CI）	敏感度	特异度	约登指数	截断值
CXCL9	0.875（0.803~0.948）	0.88	0.69	0.57	10.98 pmol/L
SFRP1	0.907（0.842~0.972）	0.91	0.78	0.69	413.22 pmol/L
联合检测	0.946（0.891~1.000）	0.96	0.91	0.87