MCP-1联合CREWS在AECOPD患者不良预后评估中的价值

doi:10.3969/j.issn.1673-8640.2022.010.005

摘要/Abstract

摘要：

目的探讨单核细胞趋化蛋白-1（MCP-1）及慢性呼吸系统早期预警评分（CREWS）对慢性阻塞性肺疾病急性加重期（AECOPD）患者不良预后的预测价值。方法选取AECOPD患者260例，检测其入院时的MCP-1水平，同时进行CREWS，根据住院期间及出院后1年内的预后情况分为预后不良组和预后良好组。采用多因素Cox回归分析评估AECOPD患者不良预后的危险因素。采用受试者工作特征（ROC）曲线评价各项指标判断AECOPD患者不良预后（再入院或死亡）的效能。采用Kaplan-Meier生存曲线评估AECOPD患者的生存情况。结果预后不良组肺功能分级Ⅲ~Ⅳ级比例、MCP-1水平及CREWS显著高于预后良好组（P<0.05），其他指标2个组之间差异均无统计学意义（P>0.05）。多因素Cox回归分析结果显示，肺功能分级、MCP-1、CREWS均为AECOPD患者预后不良的危险因素[比值比（OR）值分别为3.045、1.683、1.423，95%可信区间（CI）分别为1.467~4.638、1.132~4.248、1.138~1.865]。ROC曲线分析结果显示，MCP-1和CREWS单项检测及联合检测判断AECOPD患者预后不良（再入院或死亡）的曲线下面积（AUC）分别为0.823、0.881、0.912，最佳临界值分别为42.19 ng/L、6分、0.48。将CREWS<6分且MCP-1<42.19 ng/L的AECOPD患者归入低危组（78例），CREWS≥6分且MCP-1≥42.19 ng/L的AECOPD患者归入高危组（87例），其他AECOPD患者归入中危组（95例）。Kaplan-Meier生存曲线分析结果显示，高危组无事件生存率显著低于低危组和中危组（P<0.001）。结论 MCP-1水平和CREWS对AECOPD患者不良预后有一定的预测价值。

关键词: 单核细胞趋化蛋白-1, 慢性呼吸系统早期预警评分, 慢性阻塞性肺疾病急性加重期

Abstract:

Objective To investigate the effect of monocyte chemotactic protein-1（MCP-1） and chronic respiratory early warning score（CREWS） on predicting acute exacerbations of chronic obstructive pulmonary disease（AECOPD） poor prognosis. Methods A total of 260 patients with AECOPD were enrolled. MCP-1 level at admission was determined，and CREWS was performed simultaneously. According to the prognosis during hospitalization and within 1 year after discharge，they were classified into poor prognosis group and good prognosis group. Multivariate Cox regression analysis was used to evaluate the risk factors for poor prognosis in patients with AECOPD. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of each index in predicting poor prognosis（readmission or death） in patients with AECOPD. Kaplan-Meier survival curve was used to evaluate the survival of AECOPD patients. Results The proportion of pulmonary function grade Ⅲ-Ⅳ，MCP-1 level and CREWS in poor prognosis group were higher than those in good prognosis group（P<0.05），but there was no statistical significance in the other indicators between the 2 groups（P>0.05）. Multivariate Cox regression analysis showed that pulmonary function grade，MCP-1 and CREWS were risk factors for poor prognosis in patients with AECOPD [odds ratios（OR） were 3.045，1.683 and 1.423，respectively，95% confidence intervals（CI） were 1.467-4.638，1.132-4.248 and 1.138-1.865，respectively]. ROC curve analysis showed that the areas under curves（AUC） of MCP-1 and CREWS single determinations and combined determination for predicting poor prognosis（readmission or death） of AECOPD patients were 0.823，0.881 and 0.912，respectively，and the optimal cut-off values of MCP-1 and CREWS were 42.19 ng/L，6 and 0.48，respectively. AECOPD patients with CREWS<6 and MCP-1<42.19 ng/L were classified into low-risk group（78 cases），and AECOPD patients with CREWS≥6 and MCP-1≥42.19 ng/L were classified into high-risk group（87 cases），and the remaining AECOPD patients were classified into medium-risk group（95 cases）. The event free survival rate in high-risk group was lower than those in low-risk and medium-risk groups（P<0.001）. Conclusions MCP-1 level and CREWS have certain predictive value for poor prognosis of AECOPD patients.

Key words: Monocyte chemotactic protein-1, Chronic respiratory early warning score, Acute exacerbation of chronic obstructive pulmonary disease

王晓清, 彭雪梅, 兰美锋, 潘敏. MCP-1联合CREWS在AECOPD患者不良预后评估中的价值[J]. 检验医学, 2022, 37(10): 934-938.

WANG Xiaoqing, PENG Xuemei, LAN Meifeng, PAN Min. Evaluation of MCP-1 combined with CREWS for poor prognosis in patients with AECOPD[J]. Laboratory Medicine, 2022, 37(10): 934-938.

图/表 5

参考文献 17

[1]	PRAGMAN A A, LYU T, BALLER J A, et al. The lung tissue microbiota of mild and moderate chronic obstructive pulmonary disease[J]. Microbiome, 2018, 6(1):7. DOI PMID
[2]	MACDONALD M I, OSADNIK C R, BULFIN L, et al. Low and high blood eosinophil counts as biomarkers in hospitalized acute exacerbations of COPD[J]. Chest, 2019, 156(1):92-100. DOI PMID
[3]	PARK S K. Trajectories of change in cognitive function in people with chronic obstructive pulmonary disease[J]. J Clin Nurs, 2018, 27(7-8):1529-1542. DOI PMID
[4]	EVANS W J, HURST B L, PETERSON C J, et al. Development of a respiratory disease model for enterovirus D68 in 4-week-old mice for evaluation of antiviral therapies[J]. Antiviral Res, 2019, 162:61-70. DOI URL
[5]	戈艳蕾, 刘聪辉, 张嘉宾, 等. 慢性阻塞性肺疾病伴或不伴低氧血症患者外周血MCP-1、SAA蛋白及mRNA水平与认知功能损伤关系探讨[J]. 中国呼吸与危重监护杂志, 2018, 17(4):327-330.
[6]	LEE H, UM S J, KIM Y S, et al. Association of the neutrophil-to-lymphocyte ratio with lung function and exacerbations in patients with chronic obstructive pulmonary disease[J]. PLoS One, 2016, 11(6):e0156511.
[7]	慢性阻塞性肺疾病诊治指南2013年修订版(一)[J]. 全科医学临床与教育, 2013, 11(5):484-491.
[8]	ANTHONISEN N R, MANFREDA J, WARREN C P, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease[J]. Ann Intern Med, 1987, 106(2):196-204. PMID
[9]	RABE K F, HURD S, ANZUETO A, et al. Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary[J]. Am J Respir Crit Care Med, 2007, 176(6):532-555. DOI URL
[10]	DIETRICH E, KLINKER K P, LI J, et al. Antibiotic stewardship for acute exacerbation of chronic obstructive pulmonary disease[J]. Am J Ther, 2019, 26(4):e499-e501.
[11]	ÇOBAN AĞ CA M, AKSOY E, DUMAN D, et al. Does eosinophilia and neutrophil to lymphocyte ratio affect hospital re-admission in cases of COPD exacerbation?[J]. Tuberk Toraks, 2017, 65(4):282-290. DOI URL
[12]	戈艳蕾, 刘聪辉, 付爱双, 等. COPD-OSAHS重叠综合征患者认知功能障碍与血清MCP-1及SAA水平变化的临床意义[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(7):485-488.
[13]	叶伟麟, 李少霞, 吴才胜. 噻托溴铵联合香菇多糖注射液对COPD稳定期患者免疫功能及血清HMGB1、MCP-1水平变化的影响[J]. 国际呼吸杂志, 2018, 38(21):1624-1628.
[14]	SONG C H, JOO H M, HAN S H, et al. Low-dose ionizing radiation attenuates mast cell migration through suppression of monocyte chemoattractant protein-1(MCP-1) expression by Nr4a2[J]. Int J Radiat Biol, 2019, 95(11):1498-1506. DOI URL
[15]	BIAN Z M, FIELD M G, ELNER S G, et al. Distinct CD40L receptors mediate inflammasome activation and secretion of IL-1β and MCP-1 in cultured human retinal pigment epithelial cells[J]. Exp Eye Res, 2018, 170:29-39. DOI URL
[16]	MOHAMED H T, EL-GHONAIMY E A, EL-SHINAWI M, et al. IL-8 and MCP-1/CCL2 regulate proteolytic activity in triple negative inflammatory breast cancer a mechanism that might be modulated by Src and Erk1/2[J]. Toxicol Appl Pharmacol, 2020, 401:115092. DOI URL
[17]	黄文婷, 崔妙玲, 蒋云, 等. CREWS、BAP-65评分对急性加重期COPD患者是否需要机械通气治疗的预测效能[J]. 山东医药, 2017, 57(7):20-22.

组别	例数	年龄/岁	性别		病程/年	BMI/ （kg/m²）
组别	例数	年龄/岁	男/[例（%）]	女/[例（%）]	病程/年	BMI/ （kg/m²）
预后不良组	128	64.21 ±9.01	58（45.31）	70（54.69）	14.82±9.46	21.29±4.01
预后良好组	132	63.45±8.39	66（50.00）	66（50.00）	13.28±8.34	21.74±3.82
统计值		0.704	1.558		1.393	0.927
P值		0.482	0.212		0.165	0.355

组别	例数	年龄/岁	性别		病程/年	BMI/ （kg/m²）
组别	例数	年龄/岁	男/[例（%）]	女/[例（%）]	病程/年	BMI/ （kg/m²）
预后不良组	128	64.21 ±9.01	58（45.31）	70（54.69）	14.82±9.46	21.29±4.01
预后良好组	132	63.45±8.39	66（50.00）	66（50.00）	13.28±8.34	21.74±3.82
统计值		0.704	1.558		1.393	0.927
P值		0.482	0.212		0.165	0.355

项目	β值	标准误	Wald值	P值	OR值（95%CI）
肺功能分级	1.793	0.632	7.724	0.003	3.045（1.467~4.638）
MCP-1	0.521	0.684	0.580	0.521	1.683（1.132~4.248）
CREWS	2.637	0.816	5.648	0.021	1.423（1.138~1.865）

项目	β值	标准误	Wald值	P值	OR值（95%CI）
肺功能分级	1.793	0.632	7.724	0.003	3.045（1.467~4.638）
MCP-1	0.521	0.684	0.580	0.521	1.683（1.132~4.248）
CREWS	2.637	0.816	5.648	0.021	1.423（1.138~1.865）

项目	AUC（95%CI）	最佳临界值	敏感性/%	特异性/%	P值
CREWS	0.881（0.834~0.929）	6分	77.00	88.90	<0.001
MCP-1	0.823（0.883~0.976）	42.19 ng/L	83.32	84.53	<0.001
联合检测	0.912（0.654~0.874）	0.48	93.45	90.54	<0.001