PD-1 阳性 T 淋巴细胞比例与 COPD 住院加重的相关性：一项前瞻性队列研究。
PD-1 T lymphocyte proportions and hospitalized exacerbation of COPD: a prospective cohort study.
机构信息
Department of Respiratory and Critical Care Medicine, Provincial School of Clinical Medicine, Fujian Provincial Hospital, Fujian Medical University, No.134 East Street, Fuzhou, Fujian, 350001, China.
Center of Health Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, 350001, China.
出版信息
Respir Res. 2024 May 24;25(1):218. doi: 10.1186/s12931-024-02847-6.
OBJECTIVE
To evaluate the predictive value of PD-1 expression in T lymphocytes for rehospitalization due to acute exacerbations of COPD (AECOPD) in discharged patients.
METHODS
115 participants hospitalized with COPD (average age 71.8 ± 6.0 years) were recruited at Fujian Provincial Hospital. PD1T lymphocytes proportions (PD1T%), baseline demographics and clinical data were recorded at hospital discharge. AECOPD re-admission were collected at 1-year follow-up. Kaplan-Meier analysis compared the time to AECOPD readmissions among groups stratified by PD1T%. Multivariable Cox proportional hazards regression and stratified analysis determined the correlation between PD1T%, potential confounders, and AECOPD re-admission. ROC and DCA evaluated PD1T% in enhancing the clinical predictive values of Cox models, BODE and CODEX.
RESULTS
68 participants (59.1%) were AECOPD readmitted, those with AECOPD readmission exhibited significantly elevated baseline PD-1CD4T/CD4T% and PD-1CD8 + T/CD8 + T% compared to non-readmitted counterparts. PD1 T lymphocyte levels statistically correlated with BODE and CODEX indices. Kaplan-Meier analysis demonstrated that those in Higher PD1 T lymphocyte proportions had reduced time to AECOPD readmission (logRank p < 0.05). Cox analysis identified high PD1CD4T and PD1CD8T ratios as risk factors of AECOPD readmission, with hazard ratios of 1.384(95%CI [1.043-1.725]) and 1.401(95%CI [1.013-1.789]), respectively. Notably, in patients aged < 70 years and with fewer than twice AECOPD episodes in the previous year, high PD1T lymphocyte counts significantly increased risk for AECOPD readmission(p < 0.05). The AECOPD readmission predictive model, incorporating PD1T% exhibited superior discrimination to the Cox model, BODE index and CODEX index, AUC of ROC were 0.763(95%CI [0.633-0.893]) and 0.734(95%CI [0.570-0.899]) (DeLong's test p < 0.05).The DCA illustrates that integrating PD1T% into models significantly enhances the utility in aiding clinical decision-making.
CONCLUSION
Evaluation of PD1 lymphocyte proportions offer a novel perspective for identifying high-risk COPD patients, potentially providing insights for COPD management.
TRIAL REGISTRATION
Chinese Clinical Trial Registry (ChiCTR, URL: www.chictr.org.cn/ ), Registration number: ChiCTR2200055611 Date of Registration: 2022-01-14.
目的
评估 PD-1 表达在 T 淋巴细胞中的预测价值，以预测出院后 COPD（AECOPD）急性加重再入院的风险。
方法
在福建省立医院招募了 115 名因 COPD 住院的患者（平均年龄 71.8±6.0 岁）。在出院时记录 PD1T 淋巴细胞比例（PD1T%）、基线人口统计学和临床数据。在 1 年随访时收集 AECOPD 再入院情况。Kaplan-Meier 分析比较了 PD1T%分层的各组之间的 AECOPD 再入院时间。多变量 Cox 比例风险回归和分层分析确定了 PD1T%、潜在混杂因素与 AECOPD 再入院之间的相关性。ROC 和 DCA 评估了 PD1T%对 Cox 模型、BODE 和 CODEX 临床预测值的增强作用。
结果
68 名患者（59.1%）发生了 AECOPD 再入院，与未再入院患者相比，AECOPD 再入院患者的基线 PD-1CD4T/CD4T%和 PD-1CD8+T/CD8+T%显著升高。PD1 淋巴细胞水平与 BODE 和 CODEX 指数呈统计学相关。Kaplan-Meier 分析表明，PD1T 淋巴细胞比例较高的患者 AECOPD 再入院时间更短（对数秩检验 p<0.05）。Cox 分析确定高 PD1CD4T 和 PD1CD8T 比值是 AECOPD 再入院的危险因素，风险比分别为 1.384（95%CI [1.043-1.725]）和 1.401（95%CI [1.013-1.789]）。值得注意的是，在年龄<70 岁且前一年 AECOPD 发作次数少于两次的患者中，高 PD1T 淋巴细胞计数显著增加了 AECOPD 再入院的风险（p<0.05）。纳入 PD1T%的 AECOPD 再入院预测模型显示出比 Cox 模型、BODE 指数和 CODEX 指数更高的区分度，ROC 的 AUC 分别为 0.763（95%CI [0.633-0.893]）和 0.734（95%CI [0.570-0.899]）（DeLong 检验 p<0.05）。DCA 表明，将 PD1T%纳入模型显著提高了模型在辅助临床决策方面的效用。
结论
评估 PD1 淋巴细胞比例为识别高危 COPD 患者提供了新视角，可能为 COPD 管理提供新见解。
试验注册
中国临床试验注册中心（ChiCTR，网址：www.chictr.org.cn/），注册号：ChiCTR2200055611，登记日期：2022-01-14。
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