【摘要】 目的 探讨血清单核细胞趋化蛋白-1(MCP-1)水平及外周血辅助性T细胞17(Th17)/调节性T细胞(Treg)平衡与老年慢性阻塞性肺疾病(COPD)并发全身炎症反应综合征(SIRS)的关系。方法 选取82例老年COPD合并SIRS患者(SIRS组)，以1∶1比例对照选取单纯老年COPD患者(非SIRS组)。采用酶联免疫吸附法与流式细胞术检测血清MCP-1与外周血Th17、Treg比例。通过多因素Logistic回归分析老年COPD并发SIRS的影响因素，受试者工作特征(ROC)曲线分析血清MCP-1水平和外周血Th17/Treg对老年COPD并发SIRS的预测价值。结果 与非SIRS组比较，SIRS组血清MCP-1和外周血Th17、Th17/Treg高，外周血Treg比例低(P<0.05)。Th17高(OR=3.640,95%CI:1.929～6.867)、MCP-1高(OR=1.035,95%CI:1.016～1.054)、Th17/Treg高(OR=3.612,95%CI:1.835～7.107)为老年COPD并发SIRS的独立危险因素，Treg高(OR=0.651,95%CI:0.467～0.907)为独立保护因素(P<0.05)。血清MCP-1水平联合外周血Th17/Treg预测老年COPD并发SIRS的曲线下面积为0.890(95%CI:0.832～0.934)，大于血清MCP-1水平、外周血Th17/Treg单独预测(P均<0.05)。结论 血清MCP-1水平升高和Th17/Treg失衡与老年COPD并发SIRS独立相关，血清MCP-1水平联合外周血Th17/Treg检测对老年COPD并发SIRS有较高的预测价值。更多还原

【Abstract】 Objective To investigate the relationships of serum monocyte chemotactic protein-1(MCP-1) level and T helper cells 17(Th17)/T regulatory cells(Treg) cellular balance with chronic obstructive pulmonary disease(COPD) complicated with systemic inflammatory response syndrome(SIRS) in the elderly. Methods Eighty-two elderly patients with COPD combined with SIRS(SIRS group) were selected, and elderly patients with COPD alone(non-SIRS group) were selected at the case-control ratio of 1∶1. Serum MCP-1 levels and the ratio of Th17 and Treg were measured by enzyme-linked immunosorbent assay and flow cytometry. Logistic regression was used to analyze the factors for COPD com-plicated with SIRS in the elderly, and ROC curves were used to analyze the predictive value of serum MCP-1 and peripheral blood Th17/Treg for COPD complicated with SIRS in the elderly. Results Compared with the non-SIRS group, serum MCP-1 and peripheral blood Th17 and Th17/Treg increased, and the peripheral blood Treg ratio decreased in the SIRS group(all P<0. 05). Th17(OR=3. 640, 95% CI: 1. 929 to 6. 867), MCP-1(OR=1. 035, 95% CI: 1. 016 to 1. 054), elevated Th17/Treg(OR=3. 612, 95% CI: 1. 835 to 7. 107) were independent risk factors for COPD complicated with SIRS in the elderly, and elevated Treg(OR=0. 651, 95% CI: 0. 467 to 0. 907) was an independent protective factor(P<0. 05). The area under the curve of serum MCP-1 combined with peripheral blood Th17/Treg in predicting COPD complicated with SIRS in the elderly was 0. 890(95% CI: 0. 832 to 0. 934), which was greater than that of serum MCP-1 [0. 786(95% CI: 0. 715 to 0. 846)] and peripheral blood Th17/Treg [0. 815(95% CI: 0. 747 to 0. 871)] alone, respectively(both P<0. 05). Conclusion The elevated serum MCP-1 level and Th17/Treg cellular imbalance were independently associated with COPD complicated with SIRS in the elderly, and serum MCP-1 combined with peripheral blood Th17/Treg had a high predictive value for COPD complicated with SIRS in the elderly.更多还原