【摘要】 目的·探讨T细胞线粒体损伤指数（mitochondrial damage index,MDI）在慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）风险预测中的价值。方法·纳入2023年5月至2024年12月在金华市中心医院呼吸与危重症医学科就诊的慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者100例，根据支气管舒张后第一秒用力呼气容积（forced expiratory volume in 1 second,FEV₁）占预计值百分比（FEV₁%pred），将其分为中度COPD组（50%≤FEV₁%pred<80%,n=50）和重度COPD组（30%≤FEV₁%pred<50%,n=50）；另外纳入50例同期健康体检者作为健康对照组。收集所有受试者的基线特征（包括一般临床资料及实验室指标），采用流式细胞术检测3组受试者的外周血T细胞及其亚群（CD3⁺、CD3⁺CD4⁺、CD3⁺CD8⁺） MDI并进行比较分析。对COPD患者随访6个月，以随访期间是否发生急性加重（acute exacerbation,AE）为结局将其分为AE组和非AE组，比较2组患者基线特征的差异。采用LASSO回归对AECOPD的基线预测变量进行筛选，利用单因素及多因素Logistic回归模型建立AECOPD风险的预测模型，并使用ROC曲线、校准曲线和5折交叉验证法验证该模型的性能。结果·COPD患者的T细胞及其亚群MDI异常率均高于健康对照组；其中，重度COPD组患者的CD3+CD8+T细胞MDI异常率显著高于中度COPD组和健康对照组（均P<0.05）。随访6个月后，46例COPD患者发生AE。与非AE组相比，AE组患者的FEV1更低（P<0.001）、COPD评估测试（COPD assessment test,CAT）评分更高（P<0.001）;T细胞及其亚群MDI的各损伤分级分布的组间差异具有统计学意义（均P<0.001），且AE组患者的轻型至重型损伤比例更高。LASSO回归筛选出4个基线预测变量：CD3⁺T MDI、CD3⁺CD8⁺T MDI、 FEV₁和CAT评分。基于该4个变量构建的AECOPD风险预测模型的AUC为0.848（95%CI 0.772～0.923,P<0.001）、灵敏度为70.0%、特异度为81.0%，校准曲线显示模型拟合良好（P=0.136）,5折交叉验证中训练集和验证集准确度分别为0.80±0.03和0.82±0.06。结论·基于CD3+T MDI、CD3+CD8+T MDI、FEV1和CAT评分构建的AECOPD风险预测模型具有较高的预测价值，可为临床早期干预提供参考。更多还原

【Abstract】 Objective·To investigate the value of the T-cell mitochondrial damage index（MDI） in risk prediction for acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods·A total of 100 patients with chronic obstructive pulmonary disease（COPD） who attended the Department of Respiratory Medicine, Jinhua Municipal Central Hospital, from May 2023 to December 2024 were enrolled. According to the post-bronchodilator percentage of predicted forced expiratory volume in 1 second（FEV₁%pred）, they were divided into the moderate COPD group（50%≤FEV₁%pred<80%, n=50） and the severe COPD group（30%≤FEV₁%pred<50%, n=50）. Additionally, 50 healthy individuals who underwent physical examinations during the same period were included as the healthy control group. Baseline characteristics of all subjects（including general clinical data and laboratory indicators） were collected. Flow cytometry was used to detect and compare the MDI of peripheral blood T cells and their subsets（CD3⁺, CD3⁺CD4⁺, and CD3⁺CD8⁺） in the three groups. The patients with COPD were followed up for 6 months, and were classified into the acute exacerbation（AE） group and the non-AE group according to whether AE occurred during follow-up. Differences in baseline characteristics between the two groups were compared. LASSO regression was used to screen baseline predictors of AECOPD. Univariable and multivariable Logistic regression models were used to establish a predictive model for AECOPD risk, and the performance of the model was validated using the receiver operating characteristic（ROC） curve, calibration curve, and five-fold cross-validation. Results·The abnormal rates of MDI in T cells and their subsets were higher in patients with COPD than in the healthy control group. Among them, the abnormal rate of CD3⁺CD8⁺ T-cell MDI in the severe COPD group was significantly higher than that in the moderate COPD group and the healthy control group（both P<0.05）. After 6 months of followup, 46 patients with COPD developed AE. Compared with the non-AE group, the patients in the AE group had lower FEV₁ levels（P<0.001）, and higher COPD assessment tests（CAT） scores（P<0.001）. Moreover, there were statistically significant differences in the categorical distribution of MDI injury grades in T cells and their subsets between the two groups（all P<0.001）, with a higher proportion of mild-to-severe injury observed in the AE group. LASSO regression identified four baseline predictors: CD3⁺ T-cell MDI, CD3⁺ CD8⁺ T-cell MDI, FEV₁, and CAT score. The area under the curve（AUC） of the AECOPD risk prediction model constructed based on these four variables was 0.848（95%CI 0.772—0.923, P<0.001）, with a sensitivity of 70.0% and a specificity of 81.0%. The calibration curve showed good model fit（P=0.136）, and in the five-fold cross-validation, the accuracies of the training set and validation set was 0.80±0.03 and 0.82±0.06, respectively. Conclusion·The AECOPD risk prediction model constructed based on CD3+ T-cell MDI, CD3+CD8+ T-cell MDI, FEV₁, and CAT score has good predictive value and may provide a reference for early clinical intervention.更多还原