作者：黄清平，林芳崇，王日兴，符超

单位：

海南医学院第二附属医院急诊科

单位（英文）：

Department of Emergency, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China

关键词：

肺疾病,慢性阻塞性; 慢性阻塞性肺疾病急性加重; 白介素37; 免疫功能; 预后;

关键词（英文）：

Pulmonary disease, chronic obstructive; Acute exacerbation of chronic obstructive pulmonary disease; IL-37; Immune function; Prognosis

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2023.00.164

基金项目：

海南省卫生计生行业科研项目（20A2000375）

摘要：

目的 探讨IL-37与慢性阻塞性肺疾病急性加重(AECOPD)患者免疫功能及预后的关系。方法 选取2020年10月至2022年6月于海南医学院第二附属医院住院的AECOPD患者204例，按出院时预后情况将患者分为好转组(n=163)和恶化组(n=41)。比较两组临床资料[年龄、性别、BMI、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)]、IL-37与免疫功能指标。采用Pearson相关分析探讨AECOPD患者入院第1天IL-37与免疫功能指标的相关性。采用多因素Logistic回归分析探讨AECOPD患者预后的影响因素。绘制ROC曲线以评估入院第1天IL-37对AECOPD患者预后恶化的预测价值。结果 好转组FEV1、FEV1/FVC高于恶化组(P<0.05)。恶化组入院第7天IL-37、CD8+T淋巴细胞百分比分别高于本组入院第1天，CD4+/CD8+T淋巴细胞比值低于本组入院第1天(P<0.05)；好转组入院第7天IL-37、CD8+T淋巴细胞百分比分别低于本组入院第1天，CD4+/CD8+T淋巴细胞比值高于本组入院第1天(P<0.05)；恶化组入院第1天和入院第7天IL-37、CD8+T淋巴细胞比值高于好转组，CD4+/CD8+T淋巴细胞比值低于好转组(P<0.05)。Pearson相关分析结果显示，AECOPD患者入院第1天IL-37与CD8+T淋巴细胞百分比呈正相关(r=0.782,P<0.001)，与CD4+/CD8+T淋巴细胞比值呈负相关(r=-0.693,P=0.012)。多因素Logistic回归分析结果显示，IL-37、CD8+T淋巴细胞百分比、CD4+/CD8+T淋巴细胞比值是AECOPD患者预后恶化的独立影响因素(P<0.05)。ROC曲线分析结果显示，入院第1天IL-37预测AECOPD患者预后恶化的AUC为0.813[95%CI(0.745,0.881)]，最佳截断值为121.5 ng/L，灵敏度为84.3%，特异度为78.6%。结论 AECOPD患者入院第1天IL-37与免疫功能相关，其是AECOPD患者预后恶化的影响因素，且对AECOPD患者预后恶化有一定预测价值。

英文摘要：

Objective To explore the relationship between IL-37 and immune function and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) . Methods A total of 204 patients with AECOPD admitted to the Second Affiliated Hospital of Hainan Medical University from October 2020 to June 2022 were selected. According to the prognosis at discharge, the patients were divided into the improvement group (n=163) and the deterioration group (n=41) . Clinical data [age, sex, BMI, arterial partial oxygen pressure (PaO2) , arterial partial carbon dioxide pressure (PaCO2) , forced expiratory volume in one second (FEV1) , FEV1/forced vital capacity (FVC) ] , IL-37 and immune function indexes were compared between the two groups. Pearson correlation analysis was used to investigate the correlation between IL-37 and immune function indexes in AECOPD patients on the 1st day of admission. Multivariate Logistic regression analysis was used to investigate the influencing factors of prognosis of patients with AECOPD. ROC curve was drawn to investigate the predictive value of IL-37 on the 1st day of admission for prognosis deterioration in patients with AECOPD. Results FEV1 and FEV1/FVC in improvement group were higher than those in deterioration group (P < 0.05) . IL-37 and percentage of CD8 + T lymphocytes in the worsening group on the 7th day of admission were higher than those on the 1st day of admission, while CD4 + /CD8 + T lymphocyte ratio was lower than that on the 1st day of admission (P < 0.05) . IL-37 and percentage of CD8 + T lymphocytes in the improvement group on the 7th day of admission were lower than those on the 1st day of admission, while CD4 + /CD8 + T lymphocyte ratio was higher than that on the 1st day of admission (P < 0.05) . And the IL-37 and percentage of CD8 + T lymphocytes in the worsening group on the first and seventh days of admission were higher than those in the improvement group, CD4 + /CD8 + T lymphocyte ratio was lower than that in the improvement group (P < 0.05) . Pearson correlation analysis results showed that IL-37 in AECOPD patients was positively correlated with percentage of CD8 + T lymphocytes on the 1st day of admission (r=0.782, P < 0.001) , and negatively correlated with CD4 + /CD8 + T lymphocyte ratio (r=-0.693, P=0.012) . Multivariate Logistic regression analysis showed that IL-37, percentage of CD8 + T lymphocytes, CD4 + /CD8 + T lymphocyte ratio were independent influencing factors of prognosis deterioration in patients with AECOPD (P < 0.05) . ROC curve analysis results showed that the AUC of IL-37 on the first day of admission in predicting prognosis deterioration of AECOPD patients was 0.813 [95%CI (0.745, 0.881) ] , the optimal cut-off value was 121.5 ng/L, the sensitivity was 84.3%, and the specificity was 78.6%. Conclusion IL-37 on the first day of admission is associated with immune function in AECOPD patients, and it is a influencing factor for prognosis deterioration in AECOPD patients, and it has certain predictive value for prognosis deterioration in AECOPD patients.

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