老年慢阻肺稳定期患者肺泡灌洗液细胞因子、组织蛋白酶S水平与肺功能的关系及预测急性加重的效能分析

Relationship between cytokines and cathepsin S in alveolar lavage fluid and lung function,and their predictive efficiency for a-cute exacerbation in elderly patients with stable COPD

中文关键词: 老年  慢性阻塞性肺疾病  肺泡灌洗液  细胞因子  组织蛋白酶S  肺功能  急性加重

英文关键词: elderly  chronic obstructive pulmonary disease  alveolar lavage fluid  cytokine  cathepsin S  lung function  acute exacerbation

中文摘要:

      目的 探讨老年慢性阻塞性肺疾病(慢阻肺)稳定期患者肺泡灌洗液细胞因子、组织蛋白酶S水平与肺功能的关系,并分析其预测急性加重的效能.方法 回顾性选取2020年7月—2023年10月三六三医院收治的82例老年慢阻肺稳定期患者(设为慢阻肺组),同期选取80例体检健康者为健康组,入院时收集2组的肺泡灌洗液,检测其中白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)等细胞因子和组织蛋白酶S水平,同时测定用力肺活量(FVC)与第一秒用力呼气容积(FEV1)的比值FEV1/FVC、FEV1占预计值百分比(FEV1/pred)等肺功能指标值,采用Person相关性分析IL-6、CRP、TNF-α、组织蛋白酶S水平与肺功能的相关性.随后对慢阻肺组患者进行为期12个月的随访,依据相关标准将慢阻肺组分为急性加重亚组与未急性加重亚组,分析2亚组IL-6、CRP、TNF-α、组织蛋白酶S水平,并采用受试者工作特征曲线(ROC)分析其预测慢阻肺急性加重的价值.结果 慢阻肺组肺泡灌洗液IL-6、CRP、TNF-α、组织蛋白酶S水平均高于健康组(P＜0.05),FEV1/pred、FEV1/FVC值均低于健康组(P＜0.05).IL-6、CRP、TNF-α、组织蛋白酶S水平与FEV1/pred、FEV1/FVC值呈负相关(P＜0.05);随访12个月期间,慢阻肺组患者出现急性加重者34例,未出现急性加重者48例;急性加重亚组IL-6、CRP、TNF-α、组织蛋白酶S水平均高于未急性加重亚组(P＜0.05);ROC曲线分析显示,相较于IL-6、CRP、TNF-α、组织蛋白酶S单独指标预测,联合预测慢阻肺急性加重的AUC更高(P＜0.05).结论 老年慢阻肺稳定期患者肺泡灌洗液中IL-6、CRP、TNF-α等细胞因子、组织蛋白酶S水平与肺功能可能有相关性,且对慢阻肺急性加重有预测效能,其中联合预测效能更高.

英文摘要:

      Objective To explore the relationship between the levels of cytokines and cathepsin S in alveolar lavage flu-id and lung function,and analyze their predictive efficiency for acute exacerbation in elderly patients with stable chronic ob-structive pulmonary disease(COPD).Methods 82 elderly patients with stable COPD(COPD group)admitted to 363 Hospi-tal from July 2020 to October 2023 were retrospectively selected,and 80 healthy subjects were selected as the healthy group during the same period.The alveolar lavage fluid of the two groups was collected at admission,and the levels of cytokines[in-terleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)],cathepsin S and lung function indexes[ra-tio of forced vital capacity(FVC)to forced expiratory volume in one second(FEV1)ratio(FEV1/FVC)and percentage of forced expiratory volume in one second to predicted value(FEV1/pred)]were detected.The correlation between the levels of IL-6,CRP,TNF-α and cathepsin S and lung function was analyzed by Person correlation analysis.Subsequently,patients in the COPD group were followed up for 12 months.According to relevant criteria,they were divided into acute exacerbation group(AE subgroup)and non-exacerbation group(non-AE subgroup).The levels of IL-6,CRP,TNF-α and cathepsin S in the two subgroups were analyzed,and their predictive value for acute exacerbation of COPD was analyzed by receiver operating characteristic(ROC)curves.Results The levels of IL-6,CRP,TNF-α and cathepsin S in alveolar lavage fluid in the COPD group were higher than those in the healthy group(P＜0.05),while FEV1/pred and FEV1/FVC were lower than those in the healthy group(P＜0.05).The levels of IL-6,CRP,TNF-α and cathepsin S were negatively correlated with FEV1/pred and FEV1/FVC(P＜0.05).During 12 months of follow-up,34 COPD patients experienced acute exacerbations,and 48 did not.The levels of IL-6,CRP,TNF-α and cathepsin S in the AE subgroup were higher than those in the non-AE subgroup(P＜0.05).ROC analysis revealed that compared with IL-6,CRP,TNF-α and cathepsin S alone,the combination of these indexes achieved a higher AUC for predicting acute exacerbations(P＜0.05).Conclusion The levels of cytokines(IL-6,CRP,TNF-α)and cathepsin S in alveolar lavage fluid may be closely related to lung function in elderly patients with stable COPD.Moreover,they have predictive efficacy for acute exacerbation of COPD,and the combined prediction efficacy is higher.