作者：刘淼，刘红，胡莹月，张国瑞，陈红杰，余亚丽

单位：

450052河南省郑州市，郑州大学第一附属医院呼吸与危重症医学科

Units：

Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

关键词：

多发性肺结节；肺结节病；血管紧张素转换酶；CD4 + T淋巴细胞计数；激素治疗反应；预后；预测

Keywords：

Multiple pulmonary nodules; Pulmonary sarcoidosis; Angiotensin converting enzyme; CD4 + T lymphocyte count; Response to hormone therapy; Prognosis; Forecasting

CLC：

R 734.2

DOI：

10.12114/j.issn.1008-5971.2023.00.258

Funds：

国家重点研发计划精准医学研究专项（2016YFC0901100）

摘要：

目的　分析血清血管紧张素转换酶（sACE）水平、外周血CD 4 + T淋巴细胞计数对肺结节病患者激素治 疗反应及预后的预测价值。方法　回顾性选取2017年1月至2022年3月郑州大学第一附属医院呼吸与危重症医学科收治 的肺结节病患者91例为研究对象。收集患者的临床资料，采用多因素 Logistic回归分析探讨肺结节病患者激素治疗反应 及预后的影响因素，采用ROC曲线分析sACE水平、外周血CD4 + T淋巴细胞计数及其联合对肺结节病患者激素治疗反应 及预后的预测价值。结果　91例患者中，接受糖皮质激素治疗71例（激素治疗反应情况：敏感40例，不敏感31例）， 预后良好38例、预后不良 53例。激素治疗反应敏感患者与激素治疗反应不敏感患者就诊时临床症状明显者占比、 sACE 水平、外周血CD4 + T淋巴细胞计数、外周血淋巴细胞绝对值、病变累及肺外实质器官者占比比较，差异有统计学意义 （P＜0.05）。预后良好患者与预后不良患者就诊时临床症状明显者占比、sACE水平、外周血CD4 + T淋巴细胞计数、 外周血淋巴细胞绝对值、病变累及肺外实质器官者占比比较，差异有统计学意义（P＜0.05）。多因素Logistic回归分 析结果显示，sACE水平、外周血CD4 + T淋巴细胞计数是肺结节病患者激素治疗反应不敏感、预后不良的独立影响因素 （P＜0.05）。ROC曲线分析结果显示，sACE水平、外周血CD4 + T淋巴细胞计数及其联合预测肺结节病患者激素治疗反 应不敏感的AUC分别为0.927〔95%CI（0.871，0.983）〕、0.882〔95%CI（0.783，0.981）〕、0.951〔95%CI（0.894， 1.000）〕，最佳截断值分别为122.4 U/L、556个 /μ l、0.295，灵敏度分别为93.5%、96.2%、99.9%，特异度分别为 80.0%、76.7%、83.3%；sACE水平、外周血CD4 + T淋巴细胞计数及其联合预测肺结节病患者预后不良的 AUC分别为 0.904〔95%CI（0.825，0.968）〕、0.898〔95%CI（0.820，0.976）〕、0.949〔95%CI（0.895，1.000）〕，最佳截断 值分别为122.7 U/L、562个/μ l、 0.540，灵敏度分别为91.4%、85.7%、91.4%，特异度分别为83.3%、85.7%、91.4% 。 结论　sACE水平、外周血 CD4 + T淋巴细胞计数是肺结节病患者激素治疗反应不敏感、预后不良的独立影响因素； sACE 水平、外周血CD4 + T淋巴细胞计数均对肺结节病患者激素治疗反应不敏感、预后不良有一定预测价值，且二者联合的 预测价值更高。

Abstract：

Objective To analyze the predictive value of serum angiotensin converting enzyme (sACE) levels and peripheral blood CD 4 + T lymphocyte count for hormone therapy response and prognosis in patients with pulmonary sarcoidosis. Methods A total of 91 patients with pulmonary sarcoidosis admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University from January 2017 to March 2022 were retrospectively selected as the study objects. The clinical data of patients were collected, and the influencing factors of hormone therapy response and prognosis of patients with pulmonary sarcoidosis were investigated by multivariate Logistic regression analysis. The predictive value of sACE level, peripheral blood CD4 + T lymphocyte count and their combination on hormone therapy response and prognosis of patients with pulmonary sarcoidosis was analyzed by ROC curve. Results Among the 91 patients, 71 received glucocorticoids (response to hormone therapy: 40 were sensitive, 31 were insensitive) , 38 had a good prognosis, and 53 had a poor prognosis. There were statistically significant differences in the proportion of patients with obvious clinical symptoms during medical treatment, sACE level, CD 4 + T lymphocyte count in peripheral blood, absolute value of peripheral blood lymphocytes, and the proportion of patients with lesions involving parenchymal organs outside the lung between patients with sensitive response to hormone therapy and patients with insensitive response to hormone therapy (P < 0.05) . There were statistically significant differences in the proportion of patients with obvious clinical symptoms during medical treatment, sACE level, CD 4 + T lymphocyte count in peripheral blood, absolute value of peripheral blood lymphocytes, and the proportion of patients with lesions involving parenchymal organs outside the lung between patients with good prognosis and patients with poor prognosis ( P < 0.05) . Multivariate Logistic regression analysis showed that sACE level and CD4 + T lymphocyte count in peripheral blood were independent influencing factors of insensitive response to hormone therapy and poor prognosis in patients with pulmonary sarcoidosis ( P < 0.05) . ROC curve analysis results showed that the AUC of sACE level, CD4 + T lymphocyte count in peripheral blood and their combination in predicting insensitivity to hormone therapy in patients with pulmonary sarcoidosis was 0.927 [95%CI (0.871, 0.983) ] , 0.882 [95%CI (0.783, 0.981) ] , 0.951 [95%CI (0.894, 1.000) ] , respectively. The optimal cut-off values were 122.4 U/L, 556 cells/μl and 0.295, the sensitivity was 93.5 %, 96.2% and 99.9%, and the specificity was 80.0%, 76.7% and 83.3%, respectively. The AUC of sACE level, CD4 + T lymphocyte count in peripheral blood and their combination in predicting poor prognosis in patients with pulmonary sarcoidosis was 0.904 [95%CI (0.825, 0.968) ] , 0.898 [95%CI (0.820, 0.976) ] , 0.949 [95%CI (0.895, 0.995) ] , respectively. The optimal cut-off values were 122.7 U/L, 562 cells/ μl and 0.540, the sensitivity was 91.4 %, 85.7% and 91.4%, and the specificity was 83.3%, 85.7% and 91.4%, respectively. Conclusion sACE level and CD4 + T lymphocyte count in peripheral blood are independent influencing factors of insensitive response to hormone therapy and poor prognosis in patients with pulmonary sarcoidosis. sACE level and CD 4 + T lymphocyte count in peripheral blood have certain predictive value for insensitive response to hormone therapy and poor prognosis in patients with pulmonary sarcoidosis, and the predictive value of their combination is higher.

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