Abstract:

Objective　To explore the relationships between T lymphocyte subsets and serum CD64, Toll like receptor 2 (TLR2) and recurrence after discharge in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods　A retrospective analysis was conducted on 120 cases of AECOPD admitted to Xi'an Central Hospital from January 2020 to October 2023. Among them, there were 70 males and 50 females, aged 51-84 (69.01±11.09) years, and the course of COPD was 6-12 (8.95±2.29) years. All patients were divided into a recurrence group (40 cases) and a non-recurrence group (80 cases) based on whether they had relapsed (acute deterioration worsened) within 90 days of telephone or outpatient follow-up after discharge. The general information [gender, age, COPD course, underlying diseases, smoking history, drinking history, and COPD Patient Self-Assessment Test (CAT) score], T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺), CD64, and TLR2 levels were compared between the two groups. The influencing factors of recurrence in AECOPD patients after discharge were identified by multi-factor unconditional logistic stepwise regression analysis. Finally, the values of forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC), T lymphocyte subsets, CD64, and TLR2 levels in predicting recurrence in AECOPD patients after discharge were analyzed by the receiver operating characteristic curve (ROC). Independent sample t test and χ² test were used. Results　The levels of FEV₁/FVC, CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the recurrence group were lower than those in the non-recurrence group, and the levels of CD8⁺, CD64, and TLR2 were higher than those in the non-recurrence group, with statistically significant differences (all P<0.05). Multivariate logistic regression analysis showed that the levels of FEV₁/FVC, T lymphocyte subsets, CD64, and TLR2 were the influencing factors for recurrence in AECOPD patients after discharge (all P<0.05). ROC analysis confirmed that FEV₁/FVC, CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺, CD64, and TLR2 levels could be used to predict recurrence in AECOPD patients after discharge, with the areas under the curves of 0.810, 0.639, 0.912, 0.793, 0.945, 0.632, and 0.908 (all P<0.05). Conclusion　The recurrence of AECOPD patients after discharge is influenced by FEV₁/FVC, T lymphocyte subsets, CD64, and TLR2 levels, which should be closely monitored clinically.

Key words:

Acute exacerbation of chronic obstructive pulmonary disease, T lymphocyte subsets, CD64, Toll like receptor 2, Recurrence after discharge

摘要：

目的　探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者T淋巴细胞亚群及血清CD64、Toll样受体2（TLR2）与出院后再次发作的关系。方法　回顾性分析2020年1月至2023年10月西安市中心医院收治的120例AECOPD患者，其中男70例、女50例，年龄51～84（69.01±11.09）岁，COPD病程6～12（8.95±2.29）年。根据所有患者出院后90 d内电话或门诊随访是否再次发作（急性恶化加重），分为复发组（40例）与未复发组（80例）。比较两组一般资料［性别、年龄、COPD病程、基础疾病、吸烟史、饮酒史、COPD患者自我评估测试（CAT）评分］以及T淋巴细胞亚群（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺）、CD64、TLR2水平。通过多因素非条件logistic逐步回归分析明确AECOPD患者出院后再次发作的影响因素，最后通过受试者操作特征曲线（ROC）分析第1秒用力呼气容积/用力肺活量（FEV₁/FVC）、T淋巴细胞亚群、CD64、TLR2水平预测AECOPD患者出院后再次发作的价值。采用独立样本t检验、χ²检验。结果　复发组FEV₁/FVC、CD3⁺、CD4⁺、CD4⁺/CD8⁺低于未复发组，CD8⁺、CD64、TLR2水平高于未复发组，差异均有统计学意义（均P<0.05）。多因素logistic回归分析结果显示，FEV₁/FVC、T淋巴细胞亚群、CD64、TLR2水平是AECOPD患者出院后再次发作的影响因素（均P<0.05）。ROC分析证实，FEV₁/FVC、CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺、CD64、TLR2水平均可用于AECOPD患者出院后再次发作的预测，曲线下面积分别为0.810、0.639、0.912、0.793、0.945、0.632、0.908（均P<0.05）。结论　AECOPD患者出院后再次发作受FEV₁/FVC、T淋巴细胞亚群、CD64、TLR2水平影响，临床应予以密切关注。

关键词:

慢性阻塞性肺疾病急性加重期, T淋巴细胞亚群, CD64, Toll样受体2, 出院后再次发作