血清CCR5 CCR7联合预测支气管哮喘急性发作患者预后的价值

doi:10.3969/j.issn.1006-6233.2025.02.023

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摘要 目的: 分析血清细胞趋化因子受体5(CCR5)、细胞趋化因子受体7(CCR7)联合预测支气管哮喘(BA)急性发作患者预后的价值。方法: 选取2022年5月至2023年5月东南大学医学院附属南京同仁医院128例BA急性发作患者作为研究组,64例BA非急性发作患者作为BA对照组,64例健康体检者作为健康对照组。比较三组入院时一般资料、肺功能指标[第1秒用力呼气肺活量(FEV1)、用力肺活量(FVC)]、血清CCR5、CCR7水平,分析研究组入院时血清CCR5、CCR7水平与肺功能指标的相关性,研究组治疗后随访1年,根据预后情况分为预后不良亚组、预后良好亚组,比较两亚组入院时血清CCR5、CCR7水平,分析血清CCR5、CCR7水平对预后的影响及预测预后不良的价值。结果: 研究组入院时血清CCR5、CCR7水平高于BA对照组、健康对照组,BA对照组高于健康对照组,FEV1、FVC低于BA对照组、健康对照组,BA对照组低于健康对照组,差异有统计学意义(P<0.05);研究组入院时血清CCR5、CCR7水平与FEV1、FVC呈负相关(r=-0.681、-0.635、-0.549、-0.503,P<0.05);研究组随访期间失访3例,完成随访的患者中,预后不良亚组入院时血清CCR5、CCR7水平高于预后良好亚组,差异有统计学意义(P<0.05);经独立危险因素非条件Logistic二元回归分析显示,入院时高血清CCR5、CCR7水平均为BA急性发作患者预后不良的独立危险因素[Exp(B)=1.452、1.332,P<0.05];入院时血清CCR5、CCR7、FEV1、FVC单独预测BA急性发作患者预后不良的曲线下面积(AUC)分别为0.760、0.766、0.739、0.723,血清CCR5、CCR7单独预测的AUC与FEV1、FVC比较,差异无统计学意义(P>0.05);CCR5联合CCR7预测的AUC为0.858,大于二者单独预测的AUC,差异有统计学意义(Z=2.013、1.975,P<0.05)。结论: 入院时高血清CCR5、CCR7水平均为BA急性发作患者预后不良的独立危险因素,联合检测可为临床预测预后提供可靠临床依据。

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关键词 ：支气管哮喘, 急性发作, 细胞趋化因子受体5, 细胞趋化因子受体7, 预后

Abstract：Objective: To analyze the value of serum chemokine receptor 5 (CCR5) and chemokine receptor 7 (CCR7) combined in predicting the prognosis of patients with acute exacerbation of bronchial asthma (BA). Methods: A total of 128 patients with acute exacerbation of BA were enrolled as the study group, 64 BA patients without acute exacerbation as the BA control group, and 64 healthy subjects as the healthy control group from May 2022 to May 2023 at Nanjing Tongren Hospital, Affiliated to Southeast University Medical College. General data, lung function indicators (FEV1, FVC), and serum levels of CCR5 and CCR7 were compared among the three groups. The correlation between serum CCR5 and CCR7 levels and lung function indicators was analyzed in the study group. The study group was followed for one year after treatment, and based on prognosis, patients were divided into poor prognosis and good prognosis subgroups. Serum CCR5 and CCR7 levels at admission were compared between the two subgroups, and the effect of serum CCR5 and CCR7 on prognosis and their predictive value for poor prognosis were analyzed. Results: The serum levels of CCR5 and CCR7 in the study group at admission were higher than those in the BA control and healthy control groups, and the BA control group had higher levels than the healthy control group. FEV1 and FVC in the study group were lower than in the BA control and healthy control groups, and the BA control group had lower values than the healthy control group (P<0.05). Serum CCR5 and CCR7 levels at admission were negatively correlated with FEV1 and FVC (r = -0.681, -0.635, -0.549, -0.503, P<0.05). During follow-up, 3 patients were lost to follow-up. Among the remaining patients, the serum CCR5 and CCR7 levels in the poor prognosis subgroup at admission were higher than those in the good prognosis subgroup (P<0.05). Independent risk factor analysis by logistic regression showed that high serum CCR5 and CCR7 levels at admission were independent risk factors for poor prognosis in BA acute exacerbation patients (Exp(B) = 1.452, 1.332, P<0.05). The areas under the curve (AUC) for predicting poor prognosis in BA acute exacerbation patients at admission for serum CCR5, CCR7, FEV1 and FVC were 0.760, 0.766, 0.739 and 0.723, respectively. There was no significant difference between the AUC for serum CCR5, CCR7, and FEV1, FVC (P>0.05). The AUC for the combined prediction of CCR5 and CCR7 was 0.858, which was higher than the AUC for either alone, and the difference was statistically significant (Z = 2.013, 1.975, P<0.05). Conclusion: High serum levels of CCR5 and CCR7 at admission are independent risk factors for poor prognosis in patients with acute exacerbation of BA. Combined detection of CCR5 and CCR7 provides a reliable clinical basis for predicting prognosis.

Key words： Bronchial asthma Acute exacerbation Chemokine receptor 5 Chemokine receptor 7 Prognosis

基金资助:江苏省优势学科建设工程项目,(编号:YSHL2201-1121)

通讯作者: 杨馨宁

引用本文:

张小庆, 赵慧霞, 张连霞, 宫秀娟, 杨馨宁. 血清CCR5 CCR7联合预测支气管哮喘急性发作患者预后的价值[J]. 河北医学, 2025, 31(2): 306-310.
ZHANG Xiaoqing, ZHAO Huixia, ZHANG Lianxia, et al. The Value of Serum CCR5 and CCR7 Combined in Predicting the Prognosis of Patients with Acute Exacerbation of Bronchial Asthma. HeBei Med, 2025, 31(2): 306-310.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.02.023 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I2/306

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