血清IL-7、LDH/ALB、sCD14-ST在慢性阻塞性肺疾病合并肺部感染诊断和病情评估中的应用

doi:10.3969/j.issn.1006-5725.2026.02.009

Abstract

Abstract:

Objective To explore the application of serum interleukin-7 （IL-7）， lactate dehydrogenase/albumin （LDH/ALB）， and soluble leukocyte differentiation antigen subtype 14 （sCD14-ST） in the diagnosis and disease assessment of chronic obstructive pulmonary disease （COPD） with pulmonary infection （PI）. Methods A total of 109 patients with COPD complicated by PI admitted to the hospital from June 2022 to June 2024 were included in the infection group. Additionally， 100 patients with uncomplicated COPD who visited the outpatient department during the same period were included in the control group. Both groups were incorporated into the training set. We compared the general characteristics， IL-7 levels， LDH/ALB ratios， and sCD14-ST levels between the infection group and the control group. Receiver operating characteristic （ROC） curve analysis was performed to evaluate the diagnostic value of these indicators in COPD complicated with PI. Patients in the Infection Group were divided into mild （n = 27）， moderate （n = 49） and severe （n = 33） subgroups based on the pneumonia severity index （PSI）. The IL-7， LDH/ALB， sCD14-ST levels and PSI of the three subgroups were compared， and Pearson's correlation analysis was conducted to analyze the relationship between IL-7， LDH/ALB， and sCD14-ST levels and PSI. Additionally， 59 patients with COPD complicated by PI and 50 patients with COPD alone admitted to the hospital between July 2024 and December 2024 were selected for the validation set to construct a nomogram model. Results The age， duration of COPD， history of diabetes， long-term use of antibiotics， mechanical ventilation status and length of hospital stay in the infection group were all higher than those in the conventional group （P < 0.05）. The levels of IL-7， LDH/ALB and sCD14-ST in the infection group were all higher than those in the conventional group （t = 4.551， 4.510， 4.329， P < 0.05）. The results of multivariate logistic regression analysis showed that IL-7， LDH/ALB， and sCD14-ST were all independent risk factors for COPD combined with PI （P < 0.05）. The combined diagnostic value of IL-7， LDH/ALB， and sCD14-ST for COPD combined with PI is higher than that of a single indicator diagnosis. The AUCs of serum IL-7， LDH/ALB， and sCD14-ST for COPD combined with PI alone and in combination are 0.711， 0.666， 0.700， and 0.856， respectively. The AUC of combined diagnosis was higher than that of individual diagnosis （Z_{IL-7~combined} = 4.877， Z_{LDH/ALB~combined} = 5.279， Z_{sCD14-ST~combined} = 4.371， P < 0.05）. The Kappa test showed that the Kappa values of IL-7， LDH/ALB， sCD14-ST and the combined diagnosis were 0.405， 0.265， 0.311 and 0.551 respectively. Levels of IL-7， LDH/ALB， and sCD14-ST in the severe subgroup were significantly higher than those in the moderate and mild subgroups， and levels in the moderate subgroup were significantly higher than those in the mild subgroup （P < 0.05）. PSI was higher in the severe group than in the mild and moderate groups， and was higher in the moderate group than in the mild group （P < 0.05）. Pearson correlation analysis revealed positive correlations between the levels of IL-7， LDH/ALB， sCD14-ST and disease severity in COPD patients with PI （r = 0.390， 0.444， 0.372， P < 0.001）. The risk factor selection model based on multifactor logistic regression demonstrated good predictive value for COPD with pulmonary infection. The AUC values for the training and validation sets were 0.82 （0.75 ~ 0.88） and 0.78 （0.66 ~ 0.90）， respectively. Calibration curves indicated that predicted values closely matched actual outcomes （P > 0.05）. The decision curve indicated a high positive net benefit at thresholds ranging from 50% to 100%. Conclusions The combination of IL-7， LDH/ALB， and sCD14-ST has high diagnostic value for COPD complicated with pulmonary infection. Furthermore， the levels of these three indicators are positively correlated with disease severity， which may provide a basis for clinical assessment of patient condition.

Key words: interleukin-7, lactate dehydrogenase to albumin ratio, soluble cd14 subtype, chronic obstructive pulmonary disease, pulmonary infection, diagnostic value

CLC Number:

R563.1

Fengren LIU,Pengcheng LI,Wen ZHANG,Feng LI. The application of serum IL⁃7， LDH/ALB and sCD14⁃ST in the diagnosis and disease assessment of COPD combined with PI[J]. The Journal of Practical Medicine, 2026, 42(2): 236-248.

Figures/Tables 22

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Tab.9

Comparison of general information for training and validation set"

临床资料	训练集（n = 209）	验证集（n = 109）	χ2/F/t值	P值
年龄/岁	64.62 ± 5.48	64.81 ± 5.23	0.298	0.766
体质量指数/（kg/m²）	24.22 ± 2.66	23.78 ± 2.74	1.386	0.167
性别/［例（%）］			0.245	0.621
男	123（58.85）	61（55.96）
女	86（45.15）	48（44.04）
文化程度/［例（%）］			4.683	0.096
小学或初中	51（24.40）	33（30.28）
中专或高中	111（53.11）	44（40.36）
大专及以上	47（22.49）	32（29.36）
COPD病情严重程度/［例（%）］			1.767	0.413
轻度	62（29.67）	32（29.36）
中度	94（44.97）	56（51.38）
重度	53（25.36）	21（19.26）
COPD家族史/［例（%）］	42（20.10）	17（15.60）	0.959	0.327
肺生长发育不良/［例（%）］	20（9.57）	10（9.17）	0.013	0.909
急性发作次数/次	3.04 ± 0.71	3.13 ± 0.67	1.094	0.275
高脂血症/［例（%）］	114（54.55）	47（43.12）	3.742	0.053
冠心病/［例（%）］	96（45.93）	39（35.78）	3.023	0.082
COPD病程/年	7.84 ± 2.43	7.5 3± 2.51	1.068	0.287
心率/（次/min）	96.53 ± 9.78	97.40 ± 9.12	0.770	0.442
收缩压/mmHg	143.51 ± 21.50	142.05 ± 21.43	0.575	0.565
舒张压/mmHg	96.92 ± 8.83	97.52 ± 7.91	0.596	0.552
居住地/［例（%）］			0.092	0.762
城镇	152（72.73）	81（74.31）
农村	57（27.27）	29（26.61）
吸烟史/［例（%）］	127（60.77）	61（55.96）	0.683	0.408
饮酒史/［例（%）］	111（53.11）	53（48.62）	0.577	0.447
糖尿病史/［例（%）］	80（38.28）	31（28.44）	3.051	0.081
高血压史/［例（%）］	120（57.42）	59（54.13）	0.315	0.575
长期使用抗生素/［例（%）］	95（45.45）	43（39.45）	1.052	0.305
机械通气情况/［例（%）］	42（20.10）	20（18.35）	0.139	0.709
住院时间/［例（%）］			0.334	0.563
≥ 15 d	124（59.33）	61（55.96）
< 15 d	85（40.67）	48（44.04）
WBC/（× 10⁹·L^-1）	8.50 ± 1.51	8.41 ± 1.55	0.500	0.617
IL-7/（pg/mL）	62.25 ± 7.26	63.31 ± 7.10	。1.245	0.214
LDH/ALB	69.33 ± 18.05	70.11 ± 17.06	0.373	0.710
sCD14-ST/（pg/mL）	117.33 ± 24.62	119.08 ± 20.24	0.638	0.524

Tab.9

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临床资料	感染组（n = 109）	常规组（n = 100）	χ2/t值	P值
年龄（x ± s）/岁	65.32 ± 5.28	63.79 ± 5.71	2.013	0.045
体质量指数（x ± s）/（kg/m²）	23.96 ± 2.73	24.51 ± 2.58	1.494	0.137
性别			0.002	0.967
男	64（58.72）	59（59.00）
女	45（41.28）	41（41.00）
文化程度			0.245	0.884
小学或初中	26（23.85）	25（25.00）
中专或高中	57（52.29）	54（54.00）
大专及以上	26（23.85）	21（21.00）
COPD病情严重程度			4.011	0.135
轻度	27（24.77）	35（35.00）
中度	49（44.95）	45（45.00）
重度	33（30.28）	20（20.00）
COPD家族史	23（21.10）	19（19.00）	0.143	0.705
肺生长发育不良	11（10.09）	9（9.00）	0.072	0.789
急性发作次数（x ± s）/次	3.13 ± 0.82	2.94 ± 0.56	1.939	0.054
高脂血症	61（55.96）	53（53.00）	0.185	0.667
冠心病	54（49.54）	42（42.00）	1.194	0.274
COPD病程（x ± s）/年	8.15 ± 2.57	7.48 ± 2.24	2.001	0.047
心率（x ± s）/（次/min）	97.46 ± 9.83	95.44 ± 9.72	1.492	0.137
收缩压（x ± s）/mmHg	145.39 ± 21.43	141.28 ± 21.55	1.381	0.169
舒张压（x ± s）/mmHg	96.85 ± 8.92	97.01 ± 8.73	0.131	0.896
居住地
城镇	78（71.56）	74（74.00）	0.157	0.692
农村	31（28.44）	26（26.00）
吸烟史	69（63.30）	58（58.00）	0.615	0.433
饮酒史	57（52.29）	54（54.00）	0.061	0.805
糖尿病史	49（44.95）	31（31.00）	4.298	0.038
高血压史	61（55.96）	59（59.00）	0.197	0.657
长期使用抗生素	57（52.29）	38（38.00）	4.298	0.038
机械通气情况	28（25.69）	14（14.00）	4.437	0.035
住院时间			4.270	0.039
≥ 15 d	72（66.06）	52（52.00）
< 15 d	37（33.94）	48（48.00）
WBC（x ± s）/（×10⁹·L^-1）	8.43 ± 1.58	8.59 ± 1.42	0.797	0.444

因素	B	SE	Wald	P值	OR值	95%CI
年龄	0.050	0.025	4.164	0.041	1.052	1.002 ~ 1.104
COPD病程	0.113	0.057	3.897	0.048	1.119	1.001 ~ 1.252
糖尿病史	0.598	0.290	4.260	0.039	1.818	1.031 ~ 3.206
长期使用抗生素	0.581	0.281	4.266	0.039	1.788	1.030 ~ 3.105
机械通气情况	0.753	0.362	4.325	0.038	2.123	1.044 ~ 4.318
住院时间	0.586	0.285	4.236	0.040	1.796	1.028 ~ 3.138
IL-7	0.107	0.022	24.367	< 0.001	1.113	1.067 ~ 1.162
LDH/ALB	0.037	0.009	16.956	< 0.001	1.038	1.020 ~ 1.057
sCD14-ST	0.028	0.006	20.778	< 0.001	1.028	1.016 ~ 1.041

因素	B	SE	Wald	P值	OR值	95%CI
年龄	-0.040	0.033	1.472	0.225	0.961	0.901 ~ 1.025
COPD病程	0.057	0.068	0.722	0.395	1.059	0.928 ~ 1.209
糖尿病史	0.076	0.760	0.010	0.920	1.079	0.243 ~ 4.785
长期使用抗生素	-0.089	0.792	0.013	0.911	0.915	0.194 ~ 4.322
机械通气情况	0.697	0.554	1.583	0.208	2.009	0.678 ~ 5.954
住院时间	0.328	0.518	0.400	0.527	1.388	0.503 ~ 3.834
IL-7	0.109	0.024	21.234	< 0.001	1.115	1.065 ~ 1.169
LDH/ALB	0.038	0.011	11.580	0.001	1.039	1.016 ~ 1.061
sCD14-ST	0.027	0.007	13.685	< 0.001	1.027	1.013 ~ 1.041

指标	AUC	标准误	95% CI	P值	Cut-off	约登指数	敏感度/%	特异度/%
IL-7	0.711^*	0.036	0.645 ~ 0.772	< 0.001	> 58.878 pg/mL	0.407	92.66	48.00
LDH/ALB	0.666^*	0.037	0.597 ~ 0.729	< 0.001	> 69.334	0.266	60.55	66.00
sCD14-ST	0.700^*	0.036	0.633 ~ 0.761	< 0.001	> 113.857pg/mL	0.312	64.22	67.00
联合	0.856	0.025	0.801 ~ 0.901	< 0.001	-	0.553	74.31	81.00
Z_IL-7~联合值	4.877
Z_{LDH/ALB~联合}值	5.279
Z_{sCD14-ST~联合}值	4.371

组别	IL-7		LDH/ALB		sCD14-ST		联合
组别	阳性（n = 152）	阴性（n = 57）	阳性（n = 100）	阴性（n = 109）	阳性（n = 103）	阴性（n = 106）	阳性（n = 100）	阴性（n = 109）
Kappa检验	0.405		0.265		0.311		0.551
感染组（n = 109）	100（91.74）	9（8.26）	66（60.55）	43（39.45）	70（64.22）	39（35.78）	81（74.31）	28（25.69）
常规组（n = 100）	52（52.00）	48（48.00）	34（34.00）	66（66.00）	33（33.00）	67（67.00）	19（19.00）	81（81.00）

The application of serum IL⁃7， LDH/ALB and sCD14⁃ST in the diagnosis and disease assessment of COPD combined with PI

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组别	IL-7/（pg/mL）	LDH/ALB	sCD14-ST/（pg/mL）
感染组（n = 109）	64.37 ± 7.38	74.52 ± 19.77	124.06 ± 27.48
常规组（n = 100）	59.82 ± 7.04	63.43 ± 15.26	109.43 ± 20.54
t值	4.551	4.510	4.329
P值	< 0.001	< 0.001	< 0.001

组别	IL-7/（pg/mL）	LDH/ALB	sCD14-ST/（pg/mL）
轻度组（n = 27）	61.27 ± 4.15^?#	71.46 ± 5.79^?#	117.62 ± 10.24^?#
中度组（n = 49）	65.41 ± 4.82^?	73.29 ± 5.83^?	121.41 ± 10.08^?
重度组（n = 33）	67.28 ± 4.43	78.37 ± 5.81	127.85 ± 10.13
F值	13.430	12.037	7.867
P值	< 0.001	< 0.001	0.001

组别	PSI指数
轻度组（n = 27）	83.43 ± 5.52^?#
中度组（n = 49）	118.65 ± 10.31^?
重度组（n = 33）	141.08 ± 10.79
F值	273.743
P值	< 0.001

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[2]	Wenfang HE,Xun ZHOU,Meizhu DING,Yiping CHEN,Qianli LIU,Xinyuan. TAN. Application of the "ASK⁃T" aspiration prevention management model in reducing the risk of aspiration in elderly patients with chronic obstructive pulmonary disease （COPD） complicated by dysphagia [J]. The Journal of Practical Medicine, 2025, 41(3): 434-441.
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