摘要
目的探讨外周血淋巴细胞计数(LYM)对间质性肺疾病急性加重(AE-ILD)患者短期预后的预测价值。方法本研究为病例对照研究,采用非随机抽样的方法选取2020年6月至2023年6月徐州医科大学附属医院呼吸与危重症医学科收治的119例AE-ILD患者为研究对象。根据患者的住院结局和出院后28 d预后情况,将患者分为死亡组(54例)与存活组(65例),比较2组患者的一般资料,包括性别、年龄、吸烟史、基础疾病史、间质性肺疾病分型、有无特殊病原体感染、抗黑色素瘤分化相关基因5抗体是否阳性、入院前和住院期间用药情况和呼吸支持方式。比较2组患者入院后的首次实验室资料,包括中性粒细胞计数、LYM、CD4+T淋巴细胞计数、CD8+T淋巴细胞计数、C反应蛋白、降钙素原、乳酸脱氢酶、肌酸激酶、血肌酐、乳酸、活化部分凝血活酶时间和氧合指数(OI)。通过logistic回归分析AE-ILD患者短期预后的影响因素,绘制受试者操作特征曲线分析LYM和OI对AE-ILD患者短期预后的预测价值,并采用平行试验进行联合诊断。结果2组AE-ILD患者性别比较差异无统计学意义(P>0.05)。死亡组AE-ILD患者年龄、合并心血管疾病、肾功能不全、有特殊病原体感染、住院期间使用抗凝药物、丙种球蛋白、血管活性药物、使用无创机械通气、有创机械通气者占比均高于存活组[73.50(68.00,79.25)岁比68.00(59.00,75.00)岁,62.96%(34/54)比36.92%(24/65),16.67%(9/54)比4.62%(3/65),40.74%(22/54)比18.46%(12/65),92.59%(50/54)比75.38%(49/65),53.70%(29/54)比26.15%(17/65),68.52%(37/54)比3.08%(2/65),48.15%(26/54)比29.23%(19/65),33.33%(18/54)比3.08%(2/65),均P<0.05]。死亡组AE-ILD患者中性粒细胞计数、C反应蛋白、降钙素原、乳酸脱氢酶和乳酸高于存活组[9.65(6.87,13.61)×10^(9)/L比7.68(4.94,10.57)×10^(9)/L,101.10(45.52,158.63)mg/L比32.90(5.70,93.45)mg/L,0.20(0.08,0.56)μg/L比0.07(0.05,0.26)μg/L,432.50(311.25,680.75)U/L比290.00(231.00,430.50)U/L,1.70(1.30,2.43)mmol/L比1.30(0.90,1.85)mmol/L,均P<0.05]。LYM、CD4+T淋巴细胞计数、CD8+T淋巴细胞计数和OI低于存活组[0.60(0.40,1.00)×10^(9)/L比1.20(0.80,2.05)×10^(9)/L,207.00(90.25,350.00)×10^(6)/L比399.00(225.00,744.50)×10^(6)/L,188.50(102.25,393.75)×10^(6)/L比371.00(219.00,635.00)×10^(6)/L,142.00(100.00,211.00)mmHg(1 mmHg=0.133 kPa)比270.00(182.50,334.00)mmHg,均P<0.05]。多因素logistic回归分析显示,有心血管疾病史、接受有创机械通气是AE-ILD患者短期预后不良的危险因素(OR=4.221,95%CI:1.082~16.461;OR=13.352,95%CI:1.751~101.837),而LYM增高、OI增高是保护因素(OR=0.266,95%CI:0.086~0.825;OR=0.993,95%CI:0.987~0.999)。受试者操作特征曲线显示,LYM、OI预测AE-ILD患者短期预后的曲线下面积分别为0.781(95%CI:0.699~0.863)、0.756(95%CI:0.669~0.843),LYM的最佳截断值为0.65×10^(9)/L,敏感度为55.6%,特异度为87.7%;OI的最佳截断值为209.50 mmHg,敏感度为75.9%,特异度为66.2%。LYM和OI联合诊断的曲线下面积为0.849(95%CI:0.780~0.918),敏感度为88.9%,特异度为69.2%。结论外周血LYM对AE-ILD患者的短期预后有一定预测价值,与OI联合诊断可以提高预测价值。LYM增高是AE-ILD患者短期预后不良的保护因素。
Objective To investigate the predictive value of peripheral blood lymphocyte count(LYM)for short-term prognosis of acute exacerbation of interstitial lung disease(AE-ILD).Methods This study was a case-control study.A total of 119 AE-ILD patients admitted to the Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Xuzhou Medical University from June 2020 to June 2023 were enrolled by non-random sampling method.Patients were divided into death group(54 patients)and survival group(65 patients)based on their hospitalization outcome and 28-day prognosis after discharge.The baseline characteristics of the two groups were compared,including gender,age,smoking history,history of underlying diseases,classification of interstitial lung disease,history of special pathogens infection,testing of the anti-melanoma differentiation associated gene 5 antibody,medication before admission and during hospitalization,and mode of respiratory support.Laboratory data on the first time of admission were compared,including neutrophil count(NE),LYM,CD4+T lymphocyte count,CD8+T lymphocyte count,C-reactive protein(CRP),procalcitonin(PCT),lactate dehydrogenase(LDH),creatine kinase,serum creatinine,lactic acid(Lac),activated partial thromboplastin time and oxygenation index(OI).Logistic regression was performed to identify influencing factors for the short-term prognosis of AE-ILD.Receiver operator characteristic(ROC)curves were plotted to analyze the potentials of LYM and OI in predicting the short-term prognosis of AE-ILD patients.Parallel tests were performed in joint diagnosis.Results There was no significant difference in gender between groups(P>0.05).AE-ILD patients in the death group were significantly older than those in the survival group(73.50[68.00,79.25]years vs 68.00[59.00,75.00]years,P<0.05).The proportions of AE-ILD patients in the death group combining with cardiovascular diseases(62.96%[34/54]vs 36.92%[24/65]),renal insufficiency(16.67%[9/54]vs 4.62%[3/65]),infections of special pathogens(40.74%[22/54]vs 18.46%[12/65]),use of anticoagulants(92.59%[50/54]vs 75.38%[49/65]),gamma globulin(53.70%[29/54]vs 26.15%[17/65]),vasoactive drugs(68.52%[37/54]vs 3.08%[2/65]),non-invasive mechanical ventilation(48.15%[26/54]vs 29.23%[19/65])and invasive mechanical ventilation(33.33%[18/54]vs 3.08%[2/65])during hospitalization were significantly higher than those of survival group(all P<0.05).NE(9.65[6.87,13.61]×10^(9)/L vs 7.68[4.94,10.57]×10^(9)/L),CRP(101.10[45.52,158.63]mg/L vs 32.90[5.70,93.45]mg/L),PCT(0.20[0.08,0.56]μg/L vs 0.07[0.05,0.26]μg/L),LDH(432.50[311.25,680.75]U/L vs 290.00[231.00,430.50]U/L)and Lac(1.70[1.30,2.43]mmol/L vs 1.30[0.90,1.85]mmol/L)were significantly higher in AE-ILD patients of the death group than those of survival group(all P<0.05).LYM(0.60[0.40,1.00]×10^(9)/L vs 1.20[0.80,2.05]×10^(9)/L),CD4+T lymphocyte count(207.00[90.25,350.00]×10^(6)/L vs 399.00[225.00,744.50]×10^(6)/L),CD8+T lymphocyte count(188.50[102.25,393.75]×10^(6)/L vs 371.00[219.00,635.00]×10^(6)/L)and OI(142.00[100.00,211.00]mmHg vs 270.00[182.50,334.00]mmHg,1 mmHg=0.133 kPa)were significantly lower in the death group than those of the survival group(all P<0.05).Multivariate logistic regression analysis showed that history of cardiovascular diseases(OR=4.221,95%CI:1.082-16.461)and use of invasive mechanical ventilation(OR=13.352,95%CI:1.751-101.837)were risk factors for the poor short-term prognosis of AE-ILD,while increased LYM(OR=0.266,95%CI:0.086-0.825)and increased OI(OR=0.993,95%CI:0.987-0.999)were protective factors.The ROC curve showed that the area under the curve(AUC)of LYM and OI in predicting the short-term prognosis of AE-ILD was 0.781(95%CI:0.699-0.863)and 0.756(95%CI:0.669-0.843),respectively.The optimal cut-off value,sensitivity and specificity of LYM in predicting the short-term prognosis of AE-ILD were 0.65×10^(9)/L,55.6%and 87.7%,respectively.The optimal cut-off value,sensitivity and specificity of OI were 209.50 mmHg,75.9%and 66.2%,respectively.The AUC of LYM combined with OI in predicting the short-term prognosis of AE-ILD was 0.849(95%CI:0.780-0.918),with the sensitivity and specificity of 88.9%and 69.2%,respectively.Conclusions Peripheral blood LYM has a predictive value in the short-term prognosis of AE-ILD,the combined diagnosis of LYM and OI can improve the predictive value,and increased LYM is a protective factor for the poor short-term prognosis of AE-ILD.
作者
孟晓
奚斌
张露
刘文文
张毛为
孙宜田
张灿堂
刘平莉
陈碧
Meng Xiao;Xi Bin;Zhang Lu;Liu Wenwen;Zhang Maowei;Sun Yitian;Zhang Cantang;Liu Pingli;Chen Bi(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)
出处
《国际呼吸杂志》
2024年第5期576-584,共9页
International Journal of Respiration
基金
徐州市医学重点人才项目(XWRCHT20220063)
江苏省高校重点实验室开放课题(XZSYSKF2022004)。
关键词
肺疾病
间质性
淋巴细胞
急性加重
氧合指数
预后
Lung diseases,interstitial
Lymphocytes
Acute exacerbation
Oxygenation index
Prognosis
