1、140现代检验医学杂志第 38 卷第 1 期2023 年 1 月J Mod Lab Med,Vol.38,No.1,Jan.2023慢性阻塞性肺疾病并发肺动脉高压患者血清 CCL28 和 SDF-1 表达水平及临床意义孙澜，马吉芳，崔乃凡（辽阳中心医院检验科，辽宁辽阳 111000）摘要：目的探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）并发肺动脉高压（pulmonary hypertension，PAH）患者血清 CC 趋化因子配体 28（CC chemokine ligand 28，CCL28）、基质细胞衍生因子-1（strom
2、al cell-derived factor-1，SDF-1）表达水平及临床意义。方法选取 2019 年 2 月 2021 年 6 月辽阳中心医院收治的 209例 COPD 患者，分为 PAH 组（n=39 例）和非 PAH 组（n=170），根据平均肺动脉压（mean pulmonary artery pressure，mPAP）将 PAH 组分为轻中度组（n=23）和重度组（n=16），选择同期 53 例健康体检者为对照组。检测各组血清CCL28 和 SDF-1 水平，采用 Logistic 回归分析 COPD 并发 PAH 发生的影响因素，受试者工作特征（ROC）曲线分析血清 CCL28
3、 和 SDF-1 对 COPD 并发 PAH 的诊断价值。结果PAH 组血清 CCL28，SDF-1 水平分别为 3.260.73pg/ml，135.2623.16mg/L，高于非PAH组（1.350.35pg/ml，68.1217.14mg/L）和对照组（0.510.16pg/ml，21.026.59mg/L），差异均有统计学意义（F=539.772，525.459，均 P 0.05）；重度组血清 CCL28，SDF-1 水平分别为 3.880.10pg/ml，140.8810.05mg/L，高于轻中度组（2.830.26 pg/ml，131.356.43mg/L），差异有统计学意义（t=1
4、5.333，3.616，P 0.05）。Logistic 回归分析显示高 COPD 急性发作次数、高 mPAP 以及血清 CCL28 和 SDF-1 高表达是 COPD 并发PAH的危险因素（P=0.0000.003）。血清CCL28，SDF-1诊断COPD并发PAH的曲线下面积（AUC）分别为0.697（95%CI：0.630 0.758），0.681（95%CI：0.614 0.744）；血清 CCL28 和 SDF-1 联合检测诊断 COPD 并发 PAH 的 AUC 为 0.937（95%CI：0.895 0.966），两者联合检测优于单独检测，差异有统计学意义（Z=6.116，5.5
5、62，P 0.001）。结论COPD 并发 PAH 患者血清 CCL28，SDF-1 水平均升高，是 COPD 并发 PAH 的危险因素，对于 COPD 并发 PAH 的诊断具有重要参考价值。关键词：慢性阻塞性肺疾病；肺脉高压；趋化因子；基质细胞衍生因子-1；CC 趋化因子配体 28 中图分类号：R563；R392.11文献标识码：A文章编号:1671-7414（2023）01-140-07doi:10.3969/j.issn.1671-7414.2023.01.026Expression of Serum CCL28 and SDF-1 in Patients with Chronic Ob
6、structive Pulmonary Disease Complicated by Pulmonary Hypertension and Its Clinical SignificanceSUN Lan,MA Ji-fang,CUI Nai-fan(Department of Clinical Laboratory，Liaoyang Central Hospital,Liaoning Liaoyang 111000,China)Abstract:ObjectiveTo investigate the expression of CC chemokine ligand 28(CCL28)and
7、 stromal cell-derived factor-1(SDF-1)in patients with chronic obstructive pulmonary disease(COPD)and pulmonary hypertension(PAH)and their clinical significance.Methods209 patients with COPD admitted to the Liaoyang Central Hospital from February 2019 to June 2021 were selected and divided into PAH g
8、roup(n=39)and non PAH group(n=170).PAH group was divided into mild to moderate group(n=23)and severe group(n=16)according to the mean pulmonary artery pressure(mPAP).53 healthy people in the same period were selected as the control group.The levels of serum CCL28 and SDF-1 were detected in each grou
9、p.The influencing factors of COPD complicated with PAH were analyzed by logistic regression.The diagnostic value of serum CCL28 and SDF-1 for COPD complicated with PAH was analyzed by the ROC curve.ResultsSerum CCL28 and SDF-1 levels in PAH group were 3.26 0.73pg/ml,135.26 23.16mg/L,respectively，hig
10、her than those in non PAH group(1.350.35pg/ml,68.1217.14mg/L)and control group(0.510.16pg/ml,21.026.59mg/L),and the differences was statistically significant(F=539.772,525.459,all P0.05).Serum CCL28 and SDF-1 levels in severe group were 3.88 0.10 pg/ml,140.88 10.05 mg/L,respectively，higher than thos
11、e in mild and moderate group(2.83 0.26 pg/ml,131.35 6.43 mg/L)，and the differences was statistically significant(t=15.333,3.616,P0.05).Logistic regression analysis showed that high number of acute 基金项目：辽宁省科技攻关项目（2019225018）。作者简介：孙澜（1982-），女，学士，主治医师，研究方向：临床检验，E-mail:。141现代检验医学杂志第 38 卷第 1 期2023 年 1 月J
12、 Mod Lab Med,Vol.38,No.1,Jan.2023exacerbations of COPD,high mPAP,high expression of serum CCL28 and SDF-1 were risk factors for COPD complicated with PAH(P=0.000 0.003).The area under the curve(AUC)of serum CCL28 and SDF-1 in diagnosis of COPD complicated with PAH was 0.697(95%CI：0.630 0.758)and 0.6
13、81(95%CI：0.614 0.744),respectively,The AUC of combined detection of serum CCL28 and SDF-1 in the diagnosis of COPD complicated with PAH was 0.937(95%CI：0.895 0.966),and the combined detection was superior to the single detection,with a statistically significant difference(Z=6.116,5.562,P0.001).Concl
14、usionThe levels of serum CCL28 and SDF-1 in patients with COPD complicated with PAH were both elevated,which would be risk factors for COPD complicated with PAH and has important reference value for the diagnosis of COPD complicated with PAH.Keywords:chronic obstructive pulmonary disease；pulmonary h
15、ypertension；chemokines；stromal cell-derived factor-1；CC chemokine ligand 28慢性阻塞性肺疾病（chronic obstructive pulmo-nary disease，COPD）是一种以持续性呼吸症状和不完全可逆气流受限为特征的慢性肺部疾病1。肺动脉高压（pulmonary arterial hypertension，PAH）是 COPD 常见并发症，可增加 COPD 恶化风险，降低患者生存率2。右心导管、心脏 MRI 和胸部CT 可用于诊断 PAH，但由于操作复杂、费用高、侵入性、辐射等原因，部分患者不能接受3。因
16、此探索相关生物标记物具有重大意义。趋化因子可驱使炎症细胞向病变部位迁移浸润，介导炎症反应，与 PAH 发病存在密切关系4。CC 趋化因子配体 28（CC chemokine ligand 28，CCL28）在黏膜组织中稳态表达，可驱使 T 淋巴细胞、嗜酸性粒细胞、浆母细胞等黏膜组织，调节黏膜免疫反应，现有研究显示哮喘小鼠肺泡上皮细胞中 CCL28 表达明显增高5，与哮喘发病有关，但是在 COPD 并发 PAH的报道十分少见。基质细胞衍生因子-1（stromal cell-derived factor-1，SDF-1）属于趋化因子家族成员，SDF-1 与受体-CXC 趋化因子受体 4（CXC chemokine receptor 4，CXCR4）结合发挥趋化作用，参与肺微血管内皮细胞和周细胞之间信号转导，趋化肺血管生成和病理性血管重塑过程6。本研究意在分析 COPD 并发 PAH 患者血清 CCL28 和 SDF-1水平变化，探讨二者对COPD并发PAH的诊断价值，以期为临床诊治提供参考。1材料与方法 1.1研究对象选取辽阳市中心医院检验科 2019年 2 月 2021 年 6 月收治的
