目的 探讨可溶性尿激酶型纤溶酶原激活物受体（suPAR）联合CD8⁺T淋巴细胞检测对慢性肺曲霉菌病（CPA）的早期诊断及预后预测价值。 方法 选取2021年6月至2024年6月医院收治的258例疑似CPA患者为对象，检测所有研究对象suPAR、CD8⁺水平，受试者工作曲线（ROC）评估suPAR联合CD8⁺在CPA中的诊断价值。所有确诊CPA患者均随访6个月，根据预后情况将研究组分为病死组和存活组，比较病死组、存活组临床资料、suPAR、CD8⁺水平。采用Cox回归分析CPA患者预后不良的影响因素，ROC曲线评估价值，Kaplan-Meier绘制生存曲线，Log-rank检验比较不同组患者的生存差异。 结果 根据临床诊断结果，258例患者分为CPA组212例和非CPA组46例，CPA组实性结节、空洞占比高于非CPA组，suPAR、CD8+水平均高于非CPA组，差异有统计学意义（χ2 = 7.904、26.272，t = 6.168、5.015，P < 0.05）；ROC曲线分析显示，suPAR、CD8⁺联合诊断CPA的AUC值高于单项检测（Z = 3.834、2.531，P < 0.05）；经6个月随访统计，212例患者中共有34例患者死亡，死亡率为16.03%，依据随访结果分为生存组178例和病死组34例；病死组年龄大于生存组，糖尿病占比、低蛋白血症占比、suPAR、CD8⁺高于生存组，差异有统计学意义（t = 2.132、4.900、4.808，χ2 = 4.440、11.043，P < 0.05）；cox回归分析显示，suPAR、CD8⁺为CPA患者预后不良的独立危险因素（P < 0.05）；ROC曲线分析显示，suPAR、CD8⁺联合评估CPA预后不良的AUC高于单项检测（Z = 3.701、2.667，P < 0.05）；Kaplan-Meier曲线显示，suPAR ≤ 8.090 ng/mL、CD8⁺ ≤ 23.846%者生存时间显著长于suPAR > 8.090 ng/mL、CD8⁺ > 23.846%者（Log-rank χ2=59.004、16.078，P < 0.001）。 结论 suPAR联合CD8+在CPA诊断及预后评估中具有较高价值。

Objective To explore the value of the combined detection of soluble urokinase-type plasminogen activator receptor （suPAR） and CD8⁺T lymphocytes in the early diagnosis and prognostic prediction of chronic pulmonary aspergillosis （CPA）. Methods A total of 258 patients with suspected CPA who were admitted to the hospital from June 2021 to June 2024 were enrolled in this study. The serum suPAR levels and the percentages of peripheral blood CD8⁺T lymphocytes were measured in all the subjects. The receiver operating characteristic （ROC） curve was employed to evaluate the diagnostic value of suPAR alone and in combination with CD8⁺T lymphocytes for CPA. All the confirmed CPA patients were followed up for 6 months and then classified into the death group and the survival group based on their prognosis. The clinical data， suPAR levels， and CD8⁺T lymphocyte percentages were compared between the two groups. Cox proportional hazards regression analysis was utilized to identify the independent risk factors for poor prognosis in CPA patients. The ROC curve was applied to assess the prognostic value of the indicators. The Kaplan-Meier method was used to plot the survival curves， and the Log-rank test was carried out to compare the survival differences between the groups. Results Among the 258 patients， 212 were diagnosed with CPA， and 46 were diagnosed with non-CPA. The proportions of solid nodules and cavitary lesions， along with suPAR levels and CD8⁺T lymphocyte percentages in the CPA group， were significantly higher compared to those in the non - CPA group （P < 0.05）. ROC curve analysis indicated that the area under the curve （AUC） of the combined detection of suPAR and CD8⁺T lymphocytes for CPA diagnosis was significantly higher than that of single detection （P < 0.05）. During the 6 - month follow-up， 34 out of the 212 CPA patients died， resulting in a mortality rate of 16.03%. The death group had significantly higher age， proportions of diabetes and hypoproteinemia， suPAR levels， and CD8⁺T lymphocyte percentages than the survival group （P < 0.05）. Cox regression analysis demonstrated that suPAR and CD8⁺T lymphocytes were independent risk factors for poor prognosis in CPA patients （P < 0.05）. The AUC of combined detection for predicting poor prognosis of CPA was significantly higher than that of single detection （P < 0.05）. Kaplan-Meier survival curves showed that patients with suPAR ≤ 8.090 ng/ml or CD8⁺T lymphocytes ≤ 23.846% had significantly longer survival time than those with suPAR > 8.090 ng/ml or CD8⁺T lymphocytes > 23.846% （Log-rank χ2 = 59.004， 16.078， P < 0.001）. Conclusions The combined detection of suPAR and CD8⁺T lymphocytes holds significant clinical value in the early diagnosis and prognostic evaluation of CPA. It can serve as a reliable quantitative indicator for the clinical assessment of CPA patients.