1、第 24 卷 第 4 期北华大学学报(自然科学版)Vol24 No42023 年 7 月JOUNAL OF BEIHUA UNIVESITY(Natural Science)Jul2023文章编号:1009-4822(2023)04-0461-05DOI:1011713/jissn1009-4822202304007COPD 急性加重期患者外周血单核细胞Toll 样受体及 MCP1、激活素 A 表达与预后的关系云俊杰，徐影(上海交通大学医学院附属第九人民医院，上海200021)摘要:目的探讨慢性阻塞性肺疾病(COPD)急性加重期患者外周血单核细胞 Toll 样受体 2、Toll 样受体 4、单
2、核细胞趋化蛋白-1(MCP-1)、激活素 A 表达与预后的关系方法选取 COPD 急性加重期患者 65 例为 COPD 急性加重期组，COPD 稳定期患者 48 例为 COPD 稳定期组，同期健康体检者 35 名为对照组采集空腹肘静脉血，肝素抗凝，应用 Ficoll 淋巴细胞分离液抽提外周血中单个核细胞，流式细胞仪检测 Toll 样受体 2、Toll 样受体 4 表达水平;采集空腹肘静脉血，离心收集血清，酶联免疫吸附法检测血清 MCP-1、激活素 A 浓度;出院后对 COPD 急性加重期患者随访 3 a，记录生存情况结果COPD 急性加重期组 Toll 样受体 2、Toll 样受体 4 表达水
3、平明显高于COPD 稳定期组和对照组，COPD 稳定期组明显高于对照组(P005);COPD 急性加重期组血清 MCP-1、激活素 A浓度明显高于 COPD 稳定期组和对照组，COPD 稳定期组明显高于对照组(P005);COPD 急性加重期组 FEV1、FEV1%、(FEV1/FVC)%明显低于 COPD 稳定期组和对照组，COPD 稳定期组明显低于对照组(P005);COPD 急性加重期患者 FEV1/FVC%与 Toll 样受体 2、Toll 样受体 4、MCP-1、激活素 A 呈负相关关系(P001)65 例 COPD急性加重期患者随访 3 a，生存 41 例(6308%)，死亡 24
4、 例(3692%)OC 曲线分析显示，Toll 样受体 2、Toll 样受体 4、MCP-1、激活素 A 单独和联合检测对 COPD 急性加重期患者预后均具有较高的评估价值(P005)，其中联合检测的评估价值最高(AUC=0951)，灵敏度、阳性预测值明显高于各指标单独检测结论COPD 急性加重期患者外周血单核细胞中 Toll 样受体 2、Toll 样受体 4 高表达，血清 MCP-1、激活素 A 高表达，且与肺功能损伤程度密切相关，联合检测可用于患者预后评估关键词:慢性阻塞性肺疾病;急性加重期;Toll 样受体 2;Toll 样受体 4;单核细胞趋化蛋白-1;激活素 A;预后中图分类号:56
5、3文献标志码:A收稿日期:2022-11-10基金项目:上海市卫生健康委员会医药科研项目(2020LP053)作者简介:云俊杰(1984)，男，主治医师，主要从事慢阻肺基础与临床研究，E-mail:379215100 qqcom;通信作者:徐影(1977)，女，主治医师，主要从事慢阻肺基础与临床研究，E-mail:xuy100047 sh9hospitalorgcnelationship between Expression of Tolllike eceptor，MCP1and Activin A in Peripheral Blood Mononuclear Cellsand Progno
6、sis in Patients with Acute Exacerbation of COPDYUN Junjie，XU Ying(Shanghai Ninth People s Hospital，School of Medicine，Shanghai Jiaotong University，Shanghai 200021，China)Abstract:ObjectiveTo investigate the relationship between the expression of Toll-like receptor 2，Toll-likereceptor 4，monocyte chemo
7、attractant protein-1(MCP-1)，activin A and prognosis in patients with acute exacerb-ation of chronic obstructive pulmonary disease(COPD)Method65 patients with acute exacerbation of COPDwere selected as the acute exacerbation of COPD group，48 patients with stable COPD were selected as the stableCOPD g
8、roup，and 35 patients with physical examination in the same period were selected as the control groupCollect fasting elbow vein blood，anticoagulate with heparin，extract mononuclear cells from peripheral blood withFicoll lymphocyte separation solution，and detect the expression level of Toll-like recep
9、tor 2 and Toll-like receptor4 by flow cytometryThe fasting elbow vein blood was collected，and the serum was collected by centrifugationTheconcentration of serum MCP-1 and activin A were detected by enzyme-linked immunosorbent assayThe patientswith acute exacerbation of COPD were followed up for 3 ye
10、ars after discharge，and the survival condition wasrecordedesultsThe expression levels of Toll-like receptor 2 and Toll-like receptor 4 in patients with acuteexacerbation of COPD group were significantly higher than those in patients with stable COPD group and controlgroup，and those in patients with
11、stable COPD were significantly higher than those in control group(P005)The concentration of serum MCP-1 and activin A in the acute exacerbation of COPD group was significantlyhigher than those in the stable phase of COPD group and the control group，and those in the stable phase ofCOPD group was sign
12、ificantly higher than those of the control group(P005)FEV1，FEV1%，(FEV1/FVC)%in the acute exacerbation of COPD group were significantly lower than those in the stable phase of COPD groupand the control group，and the stable phase of COPD group was significantly lower than that in the control group(P00
13、5)FEV1/FVC%in patients with acute exacerbation of COPD was negatively correlated with Toll-like receptor2，Toll-like receptor 4，MCP-1 and activin A(P001)Among 65 patients with acute exacerbation of COPD，41cases(6308%)survived and 24(3692%)died during the 3-year follow-upThe analysis of OC curve showe
14、dthat Toll-like receptor 2，Toll-like receptor 4，MCP-1 and activin A alone and combination detection had highevaluation value for the prognosis of patients with acute exacerbation of COPD(P 005)Among them，theevaluation value of the combined test is the highest(AUC=0951)，and the sensitivity and positi
15、ve predictive valueare significantly higher than those of the individual testsConclusionToll-like receptor 2 and Toll-like receptor 4are highly expressed in peripheral blood mononuclear cells of patients with acute exacerbation of COPD，andserum MCP-1 and activin A are highly expressed，which are clos
16、ely related to the degree of lung function injuryCombined detection can be used to evaluate the prognosis of patientsKey words:chronic obstructive pulmonary disease;acute exacerbation period;Toll-like receptor 2;Toll-likereceptor 4;monocyte chemoattractant protein-1;activin A;prognosis慢性阻塞性肺疾病(COPD)是常见的呼吸系统慢性病，目前治疗主要以控制病情反复和进展为治疗目的1 长期反复感染、缺氧等因素会引发COPD 患者病情加重，出现上呼吸道黏膜出血、水肿，分泌物增加，影响正常肺通气功能，严重时并发肺部感染2 准确评估 COPD 急性加重期患者预后是合理制定治疗方案、改善预后的关键有研究3 认为，COPD 的发病与进展主要受免疫系统和炎症反应异常的影响Toll 样受体是非特异性免疫中的模式识别受体，单