AECOPD合并肺炎患者外周血sTREM-1、MCP-1、TNF-α的表达及其对疾病预后的预测价值OA

Objective:Prognostic evaluation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated by pneumonia remains a clinical challenge.Current assessment mainly relies on clinical symptoms,signs,and imaging findings,which have limitations such as insufficient early sensitivity and suboptimal specificity,making them inadequate for precision medicine.Moreover,there is a lack of ideal biomarkers for prognostic prediction.This study aims to investigate the expression levels of soluble triggering receptor expressed on myeloid cells-1(sTREM-1),monocyte chemoattractant protein-1(MCP-1),and tumor necrosis factor-alpha(TNF-α)in peripheral blood of patients with AECOPD complicated by pneumonia,analyze their associations with clinical characteristics and prognosis,and evaluate their predictive performance for poor outcomes,thereby providing a biological basis for early clinical assessment and individualized treatment strategies. Methods:A total of 135 patients with AECOPD complicated by pneumonia admitted to the Fourth Affiliated Hospital of Nanjing Medical University from March 2022 to March 2025 were retrospectively enrolled as a pneumonia group.Additionally,50 patients with AECOPD without pneumonia during the same period were included as a non-pneumonia group.Based on in-hospital outcomes,patients in the pneumonia group were divided into a poor prognosis group(death,n=29)and a good prognosis group(improved and discharged,n=106).Peripheral blood levels of sTREM-1,MCP-1,and TNF-α were measured using enzyme-linked immunosorbent assay(ELISA).Levels of these biomarkers and clinical characteristics were compared between groups.Multivariate Logistic regression analysis was performed to identify risk factors for poor prognosis,and receiver operating characteristic(ROC)curves were used to evaluate the predictive performance of sTREM-1,MCP-1,and TNF-α. Results:Levels of sTREM-1,MCP-1,and TNF-α in the pneumonia group were significantly higher than those in the non-pneumonia group[(96.85±15.99)pg/mL vs(89.32±11.24)pg/mL,(81.85±15.79)ng/L vs(65.12±11.26)ng/L,(35.39±6.01)ng/L vs(28.17±4.76)ng/L;all P<0.05].The proportion of patients with severe pulmonary function(grade III-IV)was higher in the poor prognosis group[62.07%vs 31.13,P<0.05].Levels of sTREM-1,MCP-1,and TNF-α were also significantly higher in the poor prognosis group than in the good prognosis group[(110.50±15.23)pg/mL vs(93.12±14.10)pg/mL,(94.77±16.41)ng/L vs(78.32±13.70)ng/L,(39.86±5.65)ng/L vs(34.17±5.52)ng/L;all P<0.05].Multivariate Logistic regression analysis showed that elevated sTREM-1(OR=2.443,95%CI 1.395 to 4.279),elevated MCP-1(OR=2.212,95%CI 1.221 to 4.006),elevated TNF-α(OR=1.914,95%CI 1.145 to 3.199),and pulmonary function grade III-IV(OR=2.496,95%CI 1.381 to 4.511)were independent risk factors for poor prognosis.The area under the curve(AUC)for predicting poor prognosis using sTREM-1,MCP-1,and TNF-α alone was 0.802(95%CI 0.724 to 0.865),0.791(95%CI 0.712 to 0.856),and 0.784(95%CI 0.706 to 0.851),respectively.The combined model yielded an AUC of 0.924(95%CI 0.865 to 0.962),with a sensitivity of 96.55%and specificity of 81.13%. Conclusion:Peripheral blood levels of sTREM-1,MCP-1,and TNF-α are closely associated with prognosis in patients with AECOPD complicated by pneumonia.Their combined assessment provides superior predictive value and may serve as reliable biomarkers for early clinical evaluation and prognostic judgment.