Abstract:

Objective　To investigate the relationships between regulatory T cells (Treg) / helper T cell 17 (Th17) immune imbalance and serum procalcitonin (PCT) level and risk of acute exacerbation in patients with chronic obstructive pulmonary disease (COPD). Methods　The clinical data of 80 COPD patients diagnosed and treated in the Second Affiliated Hospital of Xi'an Medical University from June 2020 to June 2023 were analyzed retrospectively. According to their condition, they were divided into stable COPD patients (SCOPD group, 48 cases) and acute exacerbation of COPD patients (AECOPD group, 32 cases). The differences of basic data information between the two groups were observed. Multivariate logistic regression analysis was used to analyze the risk factors of AECOPD. The receiver operating characteristic curve (ROC) was drawn to analyze the efficacy of various serum indexes in evaluating AECOPD. Spearman correlation analysis was used to analyze the relationships between Treg, Th17, Treg/Th17, and PCT levels in the peripheral blood and AECOPD. χ² test and t test were used. Results　In the AECOPD group, there were 20 males and 12 females, aged (59.66±9.17) years, and the course of disease was (9.16±2.52) years. In the SCOPD group, there were 28 males and 20 females, aged (60.13±9.05) years, with a course of disease of (8.98±2.14) years. The levels of Treg and Treg/Th17 in the AECOPD group were lower than those in the SCOPD group [(2.52±0.48)% vs. (3.61±0.73)%, (0.54±0.16) vs. (1.10±0.33)], with statistically significant differences (t=7.435 and 8.913, both P<0.001). The levels of Th17 and PCT in the AECOPD group were higher than those in the SCOPD group [(4.64±0.95)% vs. (3.28±0.69)%, (1.33±0.46) μg/L vs. (0.75±0.32) μg/L], with statistically significant differences (t=7.417 and 6.656, both P<0.001). Multivariate logistic regression analysis confirmed that Treg, Th17, Treg/Th17, and PCT were the influencing factors of AECOPD (all P<0.05). ROC analysis showed that the levels of Treg, Th17, Treg/Th17, and PCT in the peripheral blood could be used to evaluate AECOPD, and the areas under the curves were 0.895, 0.910, 0.932, and 0.803, respectively (all P<0.001). Correlation analysis showed that peripheral blood Treg and Treg/Th17 were negatively correlated with AECOPD, and Th17 and PCT levels were positively correlated with AECOPD (all P<0.05). Conclusions　Treg, Th17, Treg/Th17, and PCT were all influencing factors of AECOPD and were closely related to AECOPD. These indicators could be used as markers to evaluate AECOPD and provide references for clinical prevention and treatment of AECOPD.

Key words:

Chronic obstructive pulmonary disease, Regulatory T cells, Helper T cell 17, Immune imbalance, Procalcitonin, Acute exacerbation

摘要：

目的　探讨慢性阻塞性肺疾病（COPD）患者调节性T细胞（Treg）/辅助性T细胞17（Th17）免疫失衡及血清降钙素原（PCT）水平与急性加重发作风险的关系。方法　回顾性分析2020年6月至2023年6月在西安医学院第二附属医院进行诊治的80例COPD患者临床资料，依据病情划分为COPD稳定期（SCOPD组，48例）和COPD急性加重期（AECOPD组，32例）。观察两组患者基础资料差异，采用多因素logistic回归分析AECOPD的危险因素，绘制受试者操作特征曲线（ROC）分析各项血清指标评估AECOPD的效能，采用Spearman相关性分析外周血Treg、Th17、Treg/Th17及PCT水平与AECOPD的关系。采用χ²检验、t检验。结果　AECOPD组中男20例，女12例，年龄（59.66±9.17）岁，病程（9.16±2.52）年；SCOPD组中男28例，女20例，年龄（60.13±9.05）岁，病程（8.98±2.14）年。AECOPD组Treg、Treg/Th17均低于SCOPD组［（2.52±0.48）%比（3.61±0.73）%、（0.54±0.16）比（1.10±0.33）］，差异均有统计学意义（t=7.435、8.913，均P<0.001）；AECOPD组Th17、PCT水平均高于SCOPD组［（4.64±0.95）%比（3.28±0.69）%、（1.33±0.46）µg/L比（0.75±0.32）µg/L］，差异均有统计学意义（t=7.417、6.656，均P<0.001）。经多因素logistic回归分析证实，Treg、Th17、Treg/Th17、PCT均是AECOPD的影响因素（均P<0.05）。ROC分析结果显示，外周血Treg、Th17、Treg/Th17及PCT水平均可用于AECOPD的评估，曲线下面积分别为0.895、0.910、0.932、0.803（均P<0.001）。相关性分析显示，外周血Treg、Treg/Th17均与AECOPD呈负相关，Th17、PCT水平均与AECOPD呈正相关（均P<0.05）。结论　Treg、Th17、Treg/Th17、PCT均是AECOPD的影响因素，且与AECOPD密切相关，可将以上指标作为评估AECOPD的标志物，为临床防治AECOPD提供参考。

关键词:

慢性阻塞性肺疾病, 调节性T细胞, 辅助性T细胞17, 免疫失衡, 降钙素原, 急性加重发作