目的 分析外周血CD64表达与老年慢阻肺急性加重期患者预后的相关性,探讨CD64表达预测患者预后的价值。方法 选择医院2017年1月至2018年11月期间收治的198例老年慢阻肺急性加重期患者作为急性加重组,纳入同期在医院接受常规检查的稳定期慢阻肺患者100例作为稳定组,同期医院接受常规体检证实为健康的100例老年人群作为健康对照组。检测并比较3组入院当天外周血CD64表达；急性加重组出院后随访1年,将再住院与死亡的患者纳入预后不良组,其他则纳入预后良好组；分别于入院时、治疗开始第3d、第7d、出院时,检测并比较不同预后患者的外周血CD64表达；检验外周血CD64表达对急性加重期患者预后的影响,分析其预测预后的价值。结果 3组中健康对照组CD64指数最低,其次为稳定组,急性加重组CD64指数最高,组间比较差异有统计学意义(P＜0.05)；入院后各时点,不同预后组患者CD64指数均较入院当天降低(P＜0.05)；但入院时及入院后各时点,预后不良组CD64指数均高于预后良好组,差异有统计学意义(P＜0.05)；外周血CD64指数高表达是增加急性加重期慢阻肺患者预后不良的影响因素(P＜0.05)；外周血CD64高表达与患者预后不良风险呈正相关(B＞0,P＜0.05)；绘制ROC曲线得到各时点曲线下面积均＞0.9,预测价值高。结论 老年慢阻肺急性加重期患者治疗后伴较高的再住院与死亡风险,住院治疗期间各时点外周血CD64表达与患者预后相关,其过表达可能提示预后不良高风险,可考虑将外周血CD64表达用于老年慢阻肺急性加重期预后不良的预测中,指导合理治疗方案的设计,以减少不良预后的发生。

Objective To analyze the correlation between expression of peripheral blood CD64 and prognosis of senile patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to investigate the value of CD64 expression in predicting the prognosis of patients. Methods 198 senile patients with AECOPD who admitted in the hospital from January 2017 to November 2018 were included into acute exacerbation group, 100 patients with stable COPD who underwent routine examination during the same period were included in stable group, and 100 healthy senile people with physical examination during the same period were included in healthy control group. The expression of peripheral blood CD64 in three groups were detected and compared on admission; Acute exacerbation group was given 1 year of follow-up after discharge, the patients who were re-hospitalized and died were included in poor prognosis group, and the others were included in good prognosis group; On admission, after treatment for 3d and 7d, and on discharge, the expression of peripheral blood CD64 in patients with different prognosis was detected and compared; The effect of peripheral blood CD64 expression on the prognosis of patients with acute exacerbation was examined, and the value of predicting the prognosis was analyzed. Results The CD64 index of healthy control group was the lowest, followed by stable group, and the CD 64 index of acute exacerbation group was the highest, and the difference was statistically significant (P<0.05); At each time after discharge, the CD64 index of patients in different prognosis group was lower than that on admission (P<0.05); On admission and at each time after admission, the CD64 index of poor prognosis group was higher than that of good prognosis group (P<0.05); The high expression of peripheral blood CD64 was the influencing factor of increasing the poor prognosis of patients with AECOPD (P<0.05); The high expression of peripheral blood CD64 had positive correlation with the risk of poor prognosis (B>0, P<0.05); The ROC curve was drawn and the area under the curve at each time point was more than 0.9, which had high predictive value. Conclusion Senile patients with AECOPD have higher risk of re-hospitalization and death after treatment, the expression of peripheral blood CD64 at each time during hospitalization is related to the prognosis of patients, and its overexpression may indicate a high risk of poor prognosis. The application of peripheral blood CD64 expression in predicting poor prognosis of senile AECOPD patients can guide the design of reasonable treatment plans and reduce the occurrence of poor prognosis.