Abstract:

Objective　To investigate the expression levels of serum myeloid differentiation factor 88 (MyD88), interleukin 33 (IL-33), and lactate clearance rate (LCR) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with respiratory failure and their correlations with prognosis. Methods　This study was a retrospective cohort study. A total of 120 patients with AECOPD combined with respiratory failure admitted to the Department of Respiratory and Critical Care Medicine, Affiliated Shenmu Hospital of Northwest University from January 2022 to December 2023 were included. According to the 28-day prognosis, they were divided into a good prognosis group (survival) (84 cases) and a poor prognosis group (death) (36 cases). The basic data of the patients were collected at admission, including age, gender, smoking history, and duration of COPD. The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score was measured before treatment to determine whether it was an acute exacerbation period. The levels of platelet count (PLT), neutrophil count, serum creatinine (Scr), glutamic oxalacetic transaminase (GOT), glutamic pyruvic transaminase (GCT), MyD88, and IL-33 were measured before treatment, and the lactate level was measured before treatment and after treatment with an interval of 24 h. Logistic regression analysis was used to explore the independent factors affecting prognosis, and Spearman correlation analysis was used to evaluate the correlations between serum biomarkers and patients' prognosis.χ² test and t test were used. Results　In the good prognosis group, there were 50 males and 34 females, aged (70.68±3.36) years, and the duration of COPD was (18.74±3.65) years. In the poor prognosis group, there were 21 males and 15 females, aged (70.41±3.27) years, and the duration of COPD was (18.59±3.78) years. Multivariate logistic regression analysis showed that APACHEⅡ score, neutrophil count, MyD88, IL-33, and LCR were the influencing factors of poor prognosis in patients with AECOPD combined with respiratory failure (all P<0.05). Spearman correlation analysis showed that serum MyD88 and IL-33 were positively correlated with poor prognosis (r=0.641 and 0.640, both P<0.05), and LCR was negatively correlated with poor prognosis (r=-0.695, P<0.05). The receiver operating characteristic curve (ROC) showed that the area under the curve of combined serum MyD88, IL-33, and LCR in predicting poor prognosis in patients with AECOPD combined with respiratory failure was 0.987 (95%CI 0.972-1.000), the sensitivity was 94.4%, the specificity was 97.6%, and the Youden index was 0.920, with the highest diagnostic efficiency. Conclusions　Serum MyD88 and IL-33 levels are upregulated, and LCR level is decreased in poor prognosis patients with AECOPD combined with respiratory failure. The combined application of the three indicators has good diagnostic efficacy.

Key words:

Chronic obstructive pulmonary disease；Acute exacerbation；Respiratory failure；Myeloid differentiation factor 88；Interleukin 33； , Lactate clearance rate；Prognosis

摘要：

目的　探讨血清髓样分化因子88（MyD88）、白细胞介素-33（IL-33）、乳酸清除率（LCR）水平在慢性阻塞性肺疾病急性加重期（AECOPD）合并呼吸衰竭患者中的表达及与预后的相关性。方法　本研究为回顾性队列研究。纳入2022年1月至2023年12月神木市医院呼吸与危重症医学科收治的AECOPD合并呼吸衰竭患者120例，根据入院治疗28 d后的预后情况分为预后良好组（生存）84例和预后不良组（死亡）36例。入院时收集患者的基本资料，包括年龄、性别、吸烟史、COPD病程等。患者入院后未治疗前测量急性生理学及慢性健康状况评分系统（APACHEⅡ）评分确定是否为急性加重期，同时测量入院后未治疗前的血小板计数（PLT）、中性粒细胞计数、血肌酐（Scr）、谷草转氨酶（GOT）、谷丙转氨酶（GCT）、MyD88、IL-33水平，测量入院后未治疗前及经过治疗、间隔24 h的乳酸水平。采用logistic回归分析探讨影响预后的独立因素，Spearman相关性分析用于评估血清生物标志物与患者预后之间的相关性。采用χ²检验、t检验。结果　预后良好组中男50例，女34例，年龄（70.68±3.36）岁，COPD病程（18.74±3.65）年；预后不良组中男21例，女15例，年龄（70.41±3.27）岁，COPD病程（18.59±3.78）年。多因素logistic回归分析表明，APACHEⅡ评分、中性粒细胞计数、MyD88、IL-33、LCR均是AECOPD合并呼吸衰竭患者预后不良的影响因素（均P<0.05）。Spearman相关性分析表明，血清MyD88、IL-33与不良预后呈正相关（r=0.641、0.640，均P<0.05），LCR与不良预后呈负相关（r=-0.695，P<0.05）。受试者操作特征曲线（ROC）表明，联合血清MyD88、IL-33、LCR预测AECOPD合并呼吸衰竭患者预后不良的曲线下面积为0.987（95%CI 0.972～1.000）、灵敏度为94.4%、特异度为97.6%、约登指数为0.920，诊断效能最高。结论　在AECOPD合并呼吸衰竭预后不良患者中，血清MyD88、IL-33表达上调，LCR水平降低，三者联合应用具有良好的诊断效能。

关键词:

慢性阻塞性肺疾病, 急性加重, 呼吸衰竭, 髓样分化因子88, 白细胞介素-33, 乳酸清除率, 预后