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目的 :探讨炎性生物标志物对慢性阻塞性肺疾病(COPD)患者死亡风险的影响。方法 :以2011年1月至2013年12月在我院门诊就诊的106例COPD患者为研究对象。记录患者的一般临床资料,完成肺功能检查。同时抽取空腹静脉血化验炎性生物标志物包括中性粒细胞、C反应蛋白、纤维蛋白原、肿瘤坏死因子(TNF-α)、白介素(IL)-6和IL-8。每3个月进行1次随访,随访的终点事件是死亡(全死因),随访期3年。结果 :随访期间死亡11例(10.3%)。1年、2年、3年的生存率分别为92.5%、86.7%、82.6%。死亡者炎性生物标志物水平较生存者显著升高。Cox多因素回归分析证实年龄、中性粒细胞、CRP、纤维蛋白原、TNF-α、IL-6和IL-8为COPD患者死亡的独立危险因素。C统计分析发现,在将年龄、BODE指数构建的、基准模型基础上单独加上以上标志物并未明显改善C统计值,但是当所有生物标志物作为一个整体加入模型,可以明显提高C统计值。结论 :稳定期COPD死亡患者炎性生物标志物水平显著增高,中性粒细胞、CRP、纤维蛋白原、TNF-α、IL-6和IL-8为COPD患者死亡的独立危险因素,对患者的死亡风险具有预测作用。
Objective: To investigate the impact of inflammatory biomarkers on the risk of death in patients with chronic obstructive pulmonary disease (COPD). Methods: From January 2011 to December 2013 in our hospital outpatient treatment of 106 cases of COPD patients for the study. Record the general clinical data of patients to complete the pulmonary function test. Inflammatory biomarkers of fasting venous blood samples were also taken at the same time including neutrophils, C-reactive protein, fibrinogen, tumor necrosis factor (TNF-α), interleukin (IL) -6 and IL-8. Follow-up was performed every 3 months. The end point of follow-up was death (all-cause), with a follow-up of 3 years. Results: Eleven patients died during follow-up (10.3%). The survival rates at 1 year, 2 years and 3 years were 92.5%, 86.7% and 82.6% respectively. The levels of inflammatory biomarkers in deaths were significantly higher than those in survivors. Cox multivariate regression analysis confirmed that age, neutrophil, CRP, fibrinogen, TNF-α, IL-6 and IL-8 were independent risk factors for death in COPD patients. C Statistical analysis found that adding the above markers independently of the baseline model built on age and BODE index did not significantly improve the C statistic, but when all biomarkers were added as a group to the model, the C statistic . CONCLUSIONS: The level of inflammatory biomarkers in COPD patients with COPD is significantly higher than those in COPD patients. Neutrophils, CRP, fibrinogen, TNF-α, IL-6 and IL-8 are independent risk factors for death in COPD patients. The risk of death has a predictive effect.