| 张秋英.支气管扩张合并感染患者血清TL1A、LTB4、DcR3水平及其预后价值[J].安徽医药,待发表. |
| 支气管扩张合并感染患者血清TL1A、LTB4、DcR3水平及其预后价值 |
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| 投稿时间：2026-09-17 录用日期：2026-11-14 |
| DOI： |
| 中文关键词: 支气管扩张合并感染 肿瘤坏死因子样配体1A 白细胞三烯B4 诱骗受体3 预后 |
| 英文关键词: |
| 基金项目:河北省2024年度医学科学研究课题计划(编号:20241356) |
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| 中文摘要: |
| 目的 探讨支气管扩张合并感染患者血清肿瘤坏死因子样配体1A（TL1A）、白细胞三烯B4（LTB4）、诱骗受体3（DcR3）水平及其预后价值。方法 选取2023年6月~2025年6月在河北省生殖健康医院收治的支气管扩张合并感染的患者152例为疾病组，根据感染程度分为轻度感染组69例，中度感染组35例，重度感染组48例；所有患者出院后随访6个月，根据结果分为预后不良组（n=53）和预后良好组（n=99）；另纳入同期健康体检者109例为对照组。ELISA法检测血清TL1A、LTB4、DcR3水平；多因素Logistic回归分析影响预后的因素；ROC曲线分析血清TL1A、LTB4、DcR3水平对预后的辅助评估价值；采用bootstrap法对联合模型进行内部验证；DCA曲线分析模型临床适用性。结果 疾病组血清TL1A、LTB4、DcR3水平均高于对照组（P＜0.05），且随感染程度加重逐渐升高（P＜0.05）；预后不良组肺功能FEV1＜50%比例、mMRC评分、TL1A、LTB4、DcR3、CRP、PCT水平及铜绿假单胞菌检出率均较高，FVC%pred和FEV1/FVC均较低（P＜0.05）；多因素Logistic回归分析显示，血清TL1A、LTB4、DcR3水平升高是影响预后不良的危险因素（P＜0.05）；ROC曲线分析显示，血清TL1A、LTB4、DcR3三者联合辅助评估预后的AUC（0.946）显著高于单一指标辅助评估的AUC（0.829、0.814、0.831）；内部验证结果显示，该联合模型校准度较好；当阈值概率介于0.12~0.93之间时，整合了血清TL1A、LTB4、DcR3联合模型，其净临床获益持续高于各单项指标，具有较高的临床适用性。结论 支气管扩张合并感染患者血清TL1A、LTB4、DcR3水平升高，与感染程度及预后相关，三者联合检测对预后具有一定的辅助评估价值。 |
| 英文摘要: |
| Objective: To investigate serum levels of tumor necrosis factor-like ligand 1A (TL1A), leukotriene B4 (LTB4), and decoy receptor 3 (DcR3) in patients with bronchiectasis complicated by infection, and to evaluate their prognostic value. Methods: A total of 152 patients with bronchiectasis complicated by infection who were admitted to Hebei Provincial Reproductive Health Hospital between June 2023 and June 2025 were selected to form the disease group. They were assigned into the mild infection group (69 cases), the moderate infection group (35 cases), and the severe infection group (48 cases) complying with the degree of infection.All patients were followed up for 6 months after discharge and, according to the outcomes, were divided into a poor prognosis group (n=53) and a good prognosis group (n=99). Another 109 healthy individuals who underwent physical check ups during the same period were included as the control group. The levels of serum TL1A, LTB4 and DcR3 were detected by ELISA. Multivariate Logistic regression was used to explore the factors influencing prognosis. ROC curve analysis was performed to assess the prognostic value of serum TL1A, LTB4, and DcR3 levels; the bootstrap method was used for internal validation of the combined model; and DCA curve analysis was conducted to evaluate the model’s clinical applicability. Results: Serum levels of TL1A, LTB4, and DcR3 were higher in the disease group than in the control group (P<0.05) and increased progressively as the severity of infection worsened (P<0.05).In the poor-prognosis group, the proportion of patients with FEV1 < 50%, as well as mMRC scores, TL1A, LTB4, DcR3, CRP, and PCT levels, and the detection rate of Pseudomonas aeruginosa were all higher, while FVC%pred and FEV1/FVC were both lower (P<0.05). Multivariate logistic regression analysis showed that elevated serum levels of TL1A, LTB4, and DcR3 were risk factors for poor prognosis (P<0.05). ROC curve analysis showed that the AUC (0.946) for the combined use of serum TL1A, LTB4, and DcR3 as prognostic predictors was significantly higher than the AUCs (0.829, 0.814, 0.831) for the use of each marker individually. Internal validation results show that this combined model has good calibration. When the threshold probability falls between 0.12 and 0.93, the combined model incorporating serum TL1A, LTB4, and DcR3 consistently demonstrates a net clinical benefit that exceeds that of any single marker, indicating high clinical applicability. Conclusion: Patients with bronchiectasis complicated by infection have elevated serum levels of TL1A, LTB4, and DcR3, which are associated with the severity of infection and prognosis; the combined measurement of these three markers has some value in assisting with prognostic assessment. |
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