血清炎症标志物预测慢性阻塞性肺疾病预后的临床意义

doi:10.3877/cma.j.issn.1674-6902.2026.01.013

目的

探讨血清炎症标志物预测慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)预后的临床意义。

方法

选取我院2022年5月至2024年12月我院收治的76例COPD患者为对象，根据病情程度及预后分为观察组30例，对照组46例。比较两组一般资料、血清炎症标志物水平，采用多因素Logistic回归筛选预后影响因素，绘制受试者特征工作曲线(receiver operating characteristic, ROC)验证相关因素的预测。

结果

观察组慢性阻塞性肺疾病全球倡议(Global Initiative for Chronic Obstructive Lung Disease, GOLD)轻度分级2例(6.67%)、改良版英国医学研究委员会呼吸困难问卷(modified british medical research council dyspnea questionnaire, mMRC)评分(2.04±0.42)分、急性生理和慢性健康状况(acute physiology and chronic health evaluation Ⅱ，APACHEⅡ)评分(16.32±2.15)分、降钙素原(procalcitonin, PCT)(1.04±0.25)、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)(5.81±1.03)、血嗜酸粒细胞(eosinophil, EOS)(1.45±0.44)高于对照组GOLD轻度13例(28.26%)、mMRC(1.79±0.35)分、APACHEⅡ(14.51±2.07)分、PCT(0.79±0.21)、NLR(4.64±1.17)、EOS(1.01±0.31)(P<0.05)。多因素Logistic回归分析显示，APACHEⅡ评分(OR＝1.991，95%CI：1.156~3.427)、PCT(OR＝4.871，95%CI: 1.260~18.826)、NLR(OR＝6.032，95%CI: 1.848~19.688)、EOS(OR＝4.498，95%CI: 1.445~13.998)为预后不良影响因素。Pearson检验显示，PCT、NLR、EOS与APACHEⅡ评分(r＝0.838、0.906、0.839、0.851)呈正相关(P<0.05)。ROC分析显示，PCT、NLR、EOS联合预测AUC为0.909，高于单独检测。

结论

PCT、NLR、EOS等血清炎症标志物联合预测对COPD预后有临床意义。

关键词: 血清炎症标志物, 肺疾病，慢性阻塞性, 临床意义, 预后

Objective

To investigate the clinical significance of serum inflammatory markers in predicting the prognosis of chronic obstructive pulmonary disease (COPD).

Methods

A total of 76 COPD patients admitted to our hospital from May 2022 to December 2024 were selected as subjects. According to the severity and prognosis of the disease, the patients were divided into an observation group 30 cases and a control group 46 cases. General data and levels of serum inflammatory markers were compared between the two groups. Multivariate logistic regression was used to screen prognostic factors, and receiver operating characteristic (ROC) curves were plotted to validate the predictive value of relevant factors.

Results

In the observation group, there were 2 cases (6.67%) of mild Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, modified British Medical Research Council dyspnea questionnaire (mMRC) score (2.04±0.42), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score (16.32±2.15), procalcitonin (PCT) (1.04±0.25), neutrophil-to-lymphocyte ratio (NLR) (5.81±1.03), and blood eosinophil (EOS) count (1.45±0.44), which were significantly higher than those in the control group: 13 cases (28.26%) of mild GOLD classification, mMRC score (1.79±0.35), APACHE Ⅱ score (14.51±2.07), PCT (0.79±0.21), NLR (4.64±1.17), and EOS (1.01±0.31) (P<0.05). Multivariate logistic regression analysis showed that APACHE Ⅱ score (OR=1.991, 95%CI: 1.156~3.427), PCT (OR=4.871, 95%CI: 1.260~18.826), NLR (OR=6.032, 95%CI: 1.848~19.688), and EOS (OR=4.498, 95%CI: 1.445~13.998) were independent risk factors for poor prognosis. Pearson correlation analysis revealed that PCT, NLR, and EOS were positively correlated with APACHE Ⅱ score (r=0.838, 0.906, 0.839, 0.851, respectively) (P<0.05). ROC curve analysis showed that the combined prediction of PCT, NLR, and EOS achieved an AUC of 0.909, which was higher than that of any single marker.

Conclusion

The combined prediction of serum inflammatory markers such as PCT, NLR, and EOS holds clinical significance for assessing the prognosis of COPD.

Key words: Serum inflammatory markers, Chronic obstructive pulmonary disease, Clinical significance, Prognosis

表1 两组COPD患者临床资料结果

临床资料	观察组(n＝30)	对照组(n＝46)	t/χ²/Z值	P值
吸烟史[n(%)]	16(53.33)	21(45.65)	0.429	0.513
高血压[n(%)]	14(46.47)	18(39.13)	0.423	0.515
糖尿病[n(%)]	7(23.33)	10(21.74)	0.027	0.871
冠心病[n(%)]	5(16.67)	6(13.04)	0.193	0.661
呼吸机使用[n(%)]	9(30.00)	12(26.09)	0.139	0.709
疾病分期[n(%)]			0.806	0.369
急性加重期	10(33.33)	11(23.91)
慢性稳定期	20(66.67)	35(76.09)
FEV₁%pred[%, (±s)]	59.12±5.74	60.58±4.29	1.193	0.239
FEV₁/FVC[%, (±s)]	66.91±4.67	54.04±4.23	1.770	0.082
PaO₂[mmHg, (±s)]	64.26±5.87	66.27±5.55	1.491	0.141
PaCO₂[mmHg, (±s)]	58.48±5.89	60.26±6.45	1.240	0.219
GOLD分级[n(%)]			6.747	0.080
轻度	2(6.67)	13(28.26)
中度	21(70.00)	27(58.70)
重度	6(20.00)	6(13.04)
极重度	1(3.33)	0(0.00)
mMRC评分(±s)	2.04±0.42	1.79±0.35	2.705	0.009
APACHEⅡ评分[分，(±s)]	16.32±2.15	14.51±2.07	3.640	0.001

表1 两组COPD患者临床资料结果

临床资料	观察组(n＝30)	对照组(n＝46)	t/χ²/Z值	P值
吸烟史[n(%)]	16(53.33)	21(45.65)	0.429	0.513
高血压[n(%)]	14(46.47)	18(39.13)	0.423	0.515
糖尿病[n(%)]	7(23.33)	10(21.74)	0.027	0.871
冠心病[n(%)]	5(16.67)	6(13.04)	0.193	0.661
呼吸机使用[n(%)]	9(30.00)	12(26.09)	0.139	0.709
疾病分期[n(%)]			0.806	0.369
急性加重期	10(33.33)	11(23.91)
慢性稳定期	20(66.67)	35(76.09)
FEV₁%pred[%, (±s)]	59.12±5.74	60.58±4.29	1.193	0.239
FEV₁/FVC[%, (±s)]	66.91±4.67	54.04±4.23	1.770	0.082
PaO₂[mmHg, (±s)]	64.26±5.87	66.27±5.55	1.491	0.141
PaCO₂[mmHg, (±s)]	58.48±5.89	60.26±6.45	1.240	0.219
GOLD分级[n(%)]			6.747	0.080
轻度	2(6.67)	13(28.26)
中度	21(70.00)	27(58.70)
重度	6(20.00)	6(13.04)
极重度	1(3.33)	0(0.00)
mMRC评分(±s)	2.04±0.42	1.79±0.35	2.705	0.009
APACHEⅡ评分[分，(±s)]	16.32±2.15	14.51±2.07	3.640	0.001

图1 典型COPD患者胸部CT图。图A、B为观察组患者胸部CT；图C、D为对照组胸部CT

表2 两组COPD患者炎症标志物结果比较(

±s)

炎症标志物	观察组(n＝30)	对照组(n＝46)	t值	P值
TNF-α(pg/ml)	22.41±1.78	21.63±2.21	1.695	0.095
IL-6(pg/ml)	25.19±7.45	18.65±5.32	4.165	0.000
IFN-γ(pg/ml)	16.87±4.51	15.94±4.65	0.868	0.389
CRP(mg/L)	10.21±1.59	9.52±1.64	1.826	0.073
PCT(ng/ml)	1.04±0.25	0.79±0.21	4.533	0.000
SAA(mg/L)	21.34±3.57	19.97±3.68	1.615	0.111
ESR(mm/1 h)	14.15±2.23	13.87±2.15	0.543	0.589
WBC(×10⁹/L)	8.24±1.42	7.55±1.69	1.919	0.059
NLR	5.81±1.03	4.64±1.17	4.585	0.000
EOS(×10⁹/L)	1.45±0.44	1.01±0.31	4.761	0.000

表2 两组COPD患者炎症标志物结果比较(

±s)

炎症标志物	观察组(n＝30)	对照组(n＝46)	t值	P值
TNF-α(pg/ml)	22.41±1.78	21.63±2.21	1.695	0.095
IL-6(pg/ml)	25.19±7.45	18.65±5.32	4.165	0.000
IFN-γ(pg/ml)	16.87±4.51	15.94±4.65	0.868	0.389
CRP(mg/L)	10.21±1.59	9.52±1.64	1.826	0.073
PCT(ng/ml)	1.04±0.25	0.79±0.21	4.533	0.000
SAA(mg/L)	21.34±3.57	19.97±3.68	1.615	0.111
ESR(mm/1 h)	14.15±2.23	13.87±2.15	0.543	0.589
WBC(×10⁹/L)	8.24±1.42	7.55±1.69	1.919	0.059
NLR	5.81±1.03	4.64±1.17	4.585	0.000
EOS(×10⁹/L)	1.45±0.44	1.01±0.31	4.761	0.000

表3 COPD预后Logistic回归分析

自变量	β	标准误	Wald	P值	OR	95%CI
自变量	β	标准误	Wald	P值	OR	下限	上限
mMRC评分	1.583	1.452	1.189	0.276	0.205	0.012	3.535
APACHEⅡ评分	0.688	0.277	6.171	0.013	1.991	1.156	3.427
IL-6	0.088	0.063	1.925	0.165	1.092	0.964	1.237
PCT	1.583	0.690	5.270	0.022	4.871	1.260	18.826
NLR	1.797	0.604	8.865	0.003	6.032	1.848	19.688
EOS	1.504	0.579	6.740	0.009	4.498	1.445	13.998
常量	29.563	8.199	13.002	0.000	0.000

表3 COPD预后Logistic回归分析

自变量	β	标准误	Wald	P值	OR	95%CI
自变量	β	标准误	Wald	P值	OR	下限	上限
mMRC评分	1.583	1.452	1.189	0.276	0.205	0.012	3.535
APACHEⅡ评分	0.688	0.277	6.171	0.013	1.991	1.156	3.427
IL-6	0.088	0.063	1.925	0.165	1.092	0.964	1.237
PCT	1.583	0.690	5.270	0.022	4.871	1.260	18.826
NLR	1.797	0.604	8.865	0.003	6.032	1.848	19.688
EOS	1.504	0.579	6.740	0.009	4.498	1.445	13.998
常量	29.563	8.199	13.002	0.000	0.000

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Significance of serum inflammatory markers for predicting prognosis in chronic obstructive pulmonary disease

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Significance of serum inflammatory markers for predicting prognosis in chronic obstructive pulmonary disease