2026 年第 1 期 第 21 卷

外周血C-C基序趋化因子配体19和可溶性分化簇163在慢性阻塞性肺疾病合并呼吸衰竭患者中的表达及临床意义

Expression and clinical significance of peripheral blood C-C motif chemokine ligand 19 and soluble differentiation cluster 163 in patients with chronic obstructive pulmonary disease complicated with respiratory failure

作者：高丽娜张威刘汶睿于书娴

英文作者：Gao Lina Zhang Wei Liu Wenrui Yu Shuxian

单位：南京医科大学第四附属医院呼吸内科，南京210000

英文单位：Department of Respiratory Medicine the Fourth Affiliated Hospital of Nanjing Medical University Nanjing 210000 China

关键词：慢性阻塞性肺疾病；呼吸衰竭；C-C基序趋化因子配体19；可溶性分化簇163；预测效能

英文关键词：Chronicobstructivepulmonarydisease;Respiratoryfailure;C-Cmotifchemokineligand19;Solubledifferentiationcluster163;Predictiveefficacy

• 摘要：

• 目的 探讨外周血C-C基序趋化因子配体19（CCL19）、可溶性分化簇163（sCD163）在慢性阻塞性肺疾病（COPD）合并呼吸衰竭患者中的表达及临床意义。方法 选取2022年1月至2025年2月南京医科大学第四附属医院呼吸科收治的196例COPD合并呼吸衰竭患者为COPD合并呼吸衰竭组，选取同期收治的98例COPD未合并呼吸衰竭患者为单纯COPD组，另选取98例同期健康体检志愿者为对照组。根据COPD合并呼吸衰竭患者入院后28 d预后分为不良预后组和良好预后组。采用酶联免疫吸附试验法检测外周血CCL19和sCD163水平。分析外周血CCL19、sCD163水平与COPD合并呼吸衰竭患者预后的关系及预测效能。结果 对照组、单纯COPD组、COPD合并呼吸衰竭组外周血CCL19、sCD163水平依次升高（均P＜0.001）。COPD合并呼吸衰竭患者28 d预后不良率为35.7%（70/196）。年龄、病情程度、过去1年急性加重次数、第1秒用力呼气容积占预计值百分比(FEV1%)、呼吸困难等级、CCL19、sCD163均与COPD合并呼吸衰竭患者预后有关（均P＜0.05）。多因素Logistic回归分析结果显示病情重度、过去1年急性加重次数增加、高CCL19水平、高sCD163水平均为COPD合并呼吸衰竭患者预后不良的独立危险因素，高FEV1%为独立保护因素（均P＜0.05）。受试者工作特征曲线显示，外周血CCL19、sCD163水平及二者联合预测COPD合并呼吸衰竭患者预后的曲线下面积分别为0.776、0.791、0.879，二者联合优于各自单独预测效能（均P＜0.05）。结论 外周血CCL19、sCD163水平升高与COPD合并呼吸衰竭患者病情加重及预后不良有关，二者联合对预后的预测效能较高。

• Objective To investigate the expression and clinical significance of C-C motif chemokine ligand 19 (CCL19) and soluble differentiation cluster 163 (sCD163) in peripheral blood of patients with chronic obstructive pulmonary disease (COPD) complicated with respiratory failure (RF). Methods A total of 196 COPD patients with RF admitted to the Department of Respiratory Medicine, the Fourth Affiliated Hospital of Nanjing Medical University from January 2022 to February 2025 were selected as the COPD with RF group, 98 COPD patients without RF admitted during the same period were selected as the simple COPD group, and 98 healthy volunteers were selected as the control group. According to the prognosis of COPD patients with RF at 28 d after admission, they were divided into poor prognosis group and good prognosis group. The levels of CCL19 and sCD163 in peripheral blood were detected by enzyme-linked immunosorbent assay. The relationship between the levels of CCL19 and sCD163 in peripheral blood and the prognosis of COPD patients with RF and its predictive efficacy were analyzed. Results The levels of CCL19 and sCD163 in the control group, the simple COPD group, and the COPD with RF group increased in sequence (all P＜0.001). The 28 d poor prognosis rate of COPD patients with RF was 35.7%(70/196). Age, severity of disease, number of acute exacerbations in the past year, forced expiratory volume in first second as a percentage of predicted value (FEV1%), dyspnea grade, CCL19 and sCD163 were associated with the prognosis of COPD patients with RF (all P＜0.05). Multivariate Logistic regression analysis showed that severe disease, increased number of acute exacerbations in the past year, high CCL19 level and high sCD163 level were independent risk factors for poor prognosis in COPD patients with RF, and high FEV1% was an independent protective factor (all P＜0.05). The receiver operating characteristic curve showed that the area under the curve of peripheral blood CCL19, sCD163 levels and their combination to predict the prognosis of COPD patients with RF were 0.776, 0.791 and 0.879, respectively, and the combination of the two was better than their single prediction efficiency (all P＜0.05). Conclusion  The increased levels of CCL19 and sCD163 in peripheral blood are related to the aggravation and poor prognosis of COPD patients with RF, and the combination of the two has a high predictive effect on the prognosis.