目的 探讨中重度稳定期慢性阻塞性肺病(COPD)患者的血清诱饵受体3(DcR3)水平,并研究DcR3与气流受限、生活质量和1年内急性发作的相关性。方法 选取2021-08至2022-08空军第986医院诊治的81例中重度稳定期COPD患者作为研究对象,采用酶联免疫吸附法测量血清DcR3水平,并使用Spearman相关性分析血清DcR3与气流限制和生活质量的相关性,二元logistic回归分析影响1年内急性发作的临床因素,受试者工作特征(ROC)曲线分析血清DcR3预测1年内急性发作的临床价值。结果 与血清DcR3≥2.45 ng/ml(中位值)组比较,血清DcR3＜2.45 ng/ml组嗜碱性粒细胞计数显著升高(P＜0.05),1年内急性发作次数和住院次数显著减少(P＜0.05)。血清DcR3与第一秒用力呼气容积(FEV₁)(r=－0.389)、FEV₁/用力肺活量(FVC)(r=－0.610)、一氧化碳弥散量(r=－0.611)、吸气量(IC)/肺总量比值(TLC)(r=－0.862)呈负相关性,P均＜0.05。血清DcR3与COPD评估试验(CAT)(r=0.638)、视觉模拟量表(VAS)-咳嗽(r=0.282)、VAS-咳痰(r=0.269)、VAS-脓痰(r=0.237)评分呈正相关性,P＜0.05。白细胞介素(IL)-6与被检者75%的最大呼气流速(r=－0.481)呈负相关,C反应蛋白(CRP)与CAT评分(r=0.521)呈正相关(P＜0.05)。经二元logistic回归,血清DcR3与COPD1年内急性发作独立相关(P＜0.05)。血清DcR3预测COPD患者1年内急性发作的曲线下面积为[0.788(95%CI:0.688～0.888)],当血清DcR3≥2.435 ng/ml时,灵敏度(0.689)和特异度(0.833)最高。结论 COPD患者中血清DcR3与气流受限、生活质量、疾病严重程度,以及1年内急性发作有关,血清DcR3水平有作为COPD患者发病机制标志物的潜力。

Objective To investigate the serum Decoy Receptor 3 (DcR3) level in patients with chronic obstructive pulmonary disease (COPD) and to investigate the correlation of DcR3 with airflow restriction, quality of life and acute exacerbations within 1 year. Methods From August 2021 to August 2022, 81 patients with moderate to severe COPD were included as study subjects. Serum DcR3 levels were measured by enzyme-linked immunosorbent assay, and the correlation of serum DcR3 with airflow restriction and quality of life was analyzed by Spearman correlation analysis. The clinical factors influencing acute exacerbations within 1 year were analyzed by binary Logistic regression, and the clinical value of serum DcR3 in predicting acute exacerbations within 1 year was analyzed by receiver operating characteristic (ROC) curve. Results Compared with the serum DcR3≥2.45 ng/ml (median) group, the basophil count in the serum DcR3<2.45 ng/ml group significantly increased (P<0.05), and the number of acute exacerbation and hospitalizations within 1 year significantly decreased (P<0.05). Serum DcR3 was negatively correlated with forced expiratory volume in the first second (FEV₁) (r=-0.389), FEV1/forced vital capacity (FVC) (r=-0.610), diffusing capacity of the lungs for carbon monoxide (r=-0.611), and inspiratory volume (IC)/total lung ratio (TLC) (r=-0.862), all P<0.05. There was a positive correlation between serum DcR3 and COPD assessment test (CAT) (r=0.638), visual analogue scale (VAS)-cough (r=0.282), VAS-sputum (r=0.269) and VAS-purulent sputum (r=0.237) scores, all P<0.05. Interleukin (IL)-6 was negatively correlated with 75% of the maximum expiratory flow rate (r=-0.481), and C-reactive protein (CRP) was positively correlated with CAT score (r=0.521), both P<0.05. By binary logistic regression, serum DcR3 was independently correlated with acute exacerbations of COPD within one year (P<0.05).The area under the curve of serum DcR3 in predicting acute exacerbations in COPD patients within 1 year was [0.788 (95%CI: 0.688～0.888)], and the sensitivity (0.689) and specificity (0.833) were the highest when serum DcR3≥2.435 ng/ml. Conclusions Serum DcR3 is associated with airflow restriction, quality of life, disease severity and acute onset within 1 year in COPD patients, and serum DcR3 level has potential as a marker of pathogenesis of COPD patients.