老年气管支气管结核患者CD4+/CD8+变化率与支气管镜介入治疗效果的关系及预测价值OA
Relationship between the change rate of CD4+/CD8+and the efficacy of bronchoscopic interventional therapy in elderly patients with tracheobronchial tuberculosis and its predictive value
目的 探讨老年气管支气管结核患者CD4+/CD8+变化率与肺功能、支气管镜介入治疗效果的相关性.方法 选取2020年5月—2024年12月石家庄市第五医院收治的老年气管支气管结核患者306例,予以支气管镜下介入注药治疗,依据治疗2周后治疗效果分为疗效不良组、疗效良好组.采用倾向性评分匹配(PSM)法按照1:1的匹配比例和0.02的卡钳值进行匹配后两组各33例.比较两组临床资料及治疗前后CD4+/CD8+、第1秒用力呼气容积/用力肺活量(FEV1/FVC)及其变化率.分析CD4+/CD8+变化率与FEV1/FVC变化率的相关性.采用限制性立方样条(RCS)分析CD4+/CD8+变化率与支气管镜介入治疗效果的关系.受试者工作特征(ROC)曲线分析CD4+/CD8+变化率对支气管镜介入治疗效果的预测价值.结果 治疗后,疗效不良组CD4+/CD8+、FEV1/FVC及变化率低于疗效良好组(P＜0.01).疗效不良组与疗效良好组患者CD4+/CD8+变化率均与肺功能指标FEV1/FVC变化率呈正相关(r=0.738、0.781,P＜0.05);老年气管支气管结核患者CD4+/CD8+变化率与支气管介入治疗效果呈非线性关系(P＜0.05);经阈值分析显示,当 CD4+/CD8+＜59％时,支气管介入治疗效果不良风险随着其水平升高呈下降趋势;ROC曲线分析显示,CD4+/CD8+变化率预测支气管镜介入治疗效果的曲线下面积为0.848.结论 老年气管支气管结核患者CD4+/CD8+变化率与支气管介入治疗效果呈非线性关系,且对支气管介入治疗效果具有一定预测价值.
Objective To investigate the correlation between the change rate of CD4+/CD8+and pulmonary function,the efficacy of bronchoscopic interventional therapy in elderly patients with tracheobronchial tuberculosis(TBTB).Methods A total of 306 elderly patients with TBTB admitted to the Fifth Hospital of Shijiazhuang City from May 2020 to December 2024 were selected and treated with interventional injection under bronchoscopy.According to the therapeutic efficacy at 2 weeks after treatment,they were divided into poor efficacy group and good efficacy group.Propensity score matching(PSM)was performed at a matching ratio of 1:1 with a caliper value of 0.02,leaving 33 patients in each group after matching.The clinical data,as well as the CD4+/CD8+,forced expiratory volume in one second(FEV1)/forced vital capacity(FVC)ratio and their change rates before and after treatment were compared between the two groups.The correlation between the change rate of CD4+/CD8+and the change rate of FEV1/FVC was analyzed.Restricted cubic spline(RCS)was adopted to explore the relationship between the change rate of CD4+/CD8+and the efficacy of bronchoscopic interventional therapy.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the change rate of CD4+/CD8+for the efficacy of bronchoscopic interventional therapy.Results After treatment,the CD4+/CD8+,FEV1/FVC and their change rates in the poor efficacy group were lower than those in the good efficacy group(P＜0.01).The change rate of CD4+/CD8+in the poor efficacy group and the good efficacy group was positively correlated with the change rate of pulmonary function index FEV1/FVC(r=0.738,0.781,P＜0.05).There was a nonlinear relationship between the change rate of CD4+/CD8+and the efficacy of bronchoscopic interventional therapy in elderly patients with TBTB(P＜0.05).Threshold analysis showed that when the change rate of CD4+/CD8+was＜59％,the risk of poor efficacy of bronchoscopic interventional therapy decreased with its elevation.ROC curve analysis showed that the area under the curve of the change rate of CD4+/CD8+for predicting the efficacy of bronchoscopic interventional therapy was 0.848.Conclusion The change rate of CD4+/CD8+shows a nonlinear relationship with the efficacy of bronchoscopic interventional therapy in elderly patients with TBTB,which has certain predictive value for the therapeutic efficacy of bronchoscopic interventional therapy.
孙扬;田岳飏;周吉坤;苏天鹤;申蕾蕾
石家庄市第五医院结核二科,石家庄 050200石家庄市第五医院检验科,石家庄 050200石家庄市第五医院院办室,石家庄 050200石家庄市第五医院结核二科,石家庄 050200石家庄市第五医院结核二科,石家庄 050200
气管支气管结核老年人支气管镜介入治疗CD4+/CD8+第1秒用力呼气容积用力肺活量
tracheobronchial tuberculosiselderlybronchoscopic interventional therapyCD4+/CD8+forced expiratory volume in one secondforced vital capacity
《临床误诊误治》 2026 (16)
50-56,7
河北省2025年度医学科学研究课题(20251127)
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