外周血CXCL9、CX3CR1在老年慢性阻塞性肺疾病相关肺动脉高压病人中的表达水平及临床价值

doi:10.3969/j.issn.1003-9198.2025.04.015

摘要/Abstract

摘要： 目的探讨外周血C-X-C基序趋化因子配体9(CXCL9)、C-X3-C基序趋化因子受体1(CX3CR1)在老年COPD相关肺动脉高压(PH)病人中的表达水平及临床价值。方法本研究为前瞻性研究,选取2021年1月至2023年2月邢台市中心医院收治的老年COPD相关PH病人177例,根据肺功能分级分为轻度组(21例)、中度组(51例)、重度组(84例)、极重度组(21例),根据1年预后情况分为不良预后组(81例)和良好预后组(96例)。采用酶联免疫吸附法检测外周血CXCL9、CX3CR1水平。建立多因素非条件logistic回归模型确定不良预后的影响因素,并绘制ROC曲线评价外周血CXCL9、CX3CR1预测老年COPD相关PH病人不良预后的价值。结果轻度组、中度组、重度组、极重度组外周血CXCL9、CX3CR1水平依次升高(P＜0.05)。随访1年,老年COPD相关PH病人不良预后发生率为45.76%(81/177)。高水平的N末端B型利钠肽前体、CXCL9、CX3CR1是老年COPD相关PH病人不良预后的独立危险因素,6 min步行距离延长和心脏指数升高为独立保护因素(P＜0.05)。外周血CXCL9联合CX3CR1预测老年COPD相关PH病人不良预后的AUC(95%CI)为0.897(0.843～0.938),大于外周血CXCL9、CX3CR1单独预测的0.796(0.729～0.853)、0.785(0.717～0.843)。结论老年COPD相关PH病人外周血CXCL9、CX3CR1水平升高与肺功能降低和不良预后密切相关,外周血CXCL9联合CX3CR1预测老年COPD相关PH病人不良预后的价值较高。

关键词: 老年人, 慢性阻塞性肺疾病, 肺动脉高压, C-X-C基序趋化因子配体9, C-X3-C基序趋化因子受体1

Abstract: Objective To investigate the expression and clinical significance of peripheral blood C-X-C motif chemokine ligand 9 (CXCL9) and C-X3-C motif chemokine receptor 1 (CX3CR1) in the elderly patients with chronic obstructive pulmonary disease (COPD)-related pulmonary hypertension (PH). Methods A total of 177 elderly patients with COPD-related PH treated at Xingtai Central Hospital from January 2021 to February 2023 were enrolled in this prospective study. The patients were divided into mild group(21 cases), moderate group(51 cases), severe group(84 cases) and very severe group(21 cases) according to pulmonary function classification, and were divided into poor prognosis group (81 cases) and good prognosis group(96 cases) based on one-year outcomes. The levels of peripheral blood CXCL9 and CX3CR1 were measured using enzyme-linked immunosorbent assay. A multivariate unconditional logistic regression model was applied to identify risk factors for poor prognosis in the elderly COPD-related PH patients, and receiver operating characteristic (ROC) curve was used to assess the predictive value of peripheral blood CXCL9 and CX3CR1 for poor prognosis. Results The levels of peripheral blood CXCL9 and CX3CR1 increased progressively from mild group to very severe group (P＜0.05). After a one year of follow-up, the incidence rate of poor prognosis was 45.76% (81/177). Elevated levels of N-terminal pro-B-type natriuretic peptide, CXCL9 and CX3CR1 were independent risk factors for poor prognosis in the elderly patients with COPD-related PH, while longer 6-minute walk distance (6MWD) and higher cardiac index were independent protective factors (P＜0.05). The area under the curve (AUC) of combined CXCL9 and CX3CR1 for predicting poor prognosis in the elderly patients with COPD-related PH was 0.897 (95%CI: 0.843-0.938), which was higher than that of CXCL9 (0.796, 95%CI: 0.729-0.853) or CX3CR1 (0.785, 95%CI: 0.717-0.843) alone. Conclusions Elevated peripheral blood CXCL9 and CX3CR1 levels in the elderly patients with COPD-related PH are closely associated with reduced lung function and poor prognosis. Combined measurement of peripheral blood CXCL9 and CX3CR1 has a high predictive value for poor prognosis in the elderly patients with COPD-related PH.

Key words: aged, chronic obstructive pulmonary disease, pulmonary hypertension, C-X-C motif chemokine ligand 9, C-X3-C motif chemokine receptor 1

中图分类号:

R 563.5

李俊仙, 王金国, 李卉, 贾丽倩. 外周血CXCL9、CX3CR1在老年慢性阻塞性肺疾病相关肺动脉高压病人中的表达水平及临床价值[J]. 实用老年医学, 2025, 39(4): 395-400.

LI Junxian, WANG Jinguo, LI hui, JIA Liqian. Expression and clinical value of peripheral blood CXCL9 and CX3CR1 in elderly patients with pulmonary hypertension related to chronic obstructive pulmonary disease[J]. Practical Geriatrics, 2025, 39(4): 395-400.

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