可溶性尿激酶型纤溶酶原激活物受体联合CD8+T淋巴细胞检测对慢性肺曲霉菌病的早期诊断及预后预测价值

doi:10.3969/j.issn.1006-5725.2026.10.011

Abstract

Abstract:

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.

Key words: soluble urokinase type plasminogen activator receptor, CD8⁺T lymphocytes, chronic pulmonary aspergillosis, diagnostic value, prognostic value

CLC Number:

R519.8

Hongzhi BIAN,Junlei HAN,Lu YANG,Jianping HU. The early diagnosis and prognostic value of suPAR combined with CD8⁺T lymphocyte detection for chronic pulmonary aspergillosis[J]. The Journal of Practical Medicine, 2026, 42(10): 1770-1778.

Figures/Tables 10

Tab.1

Comparison of suPAR and CD8+ between CPA group and non CPA group"

项目	CPA组（n = 212）	非CPA组（n = 46）	χ2/t值	P值
性别（男/女）/例	119/93	29/17	0.738	0.390
年龄（ $x ˉ ? ± ? s$ ）/岁	58.15 ± 7.86	58.34 ± 7.93	0.148	0.882
体质量指数（ $x ˉ ? ± ? s$ ）/（kg/m²）	21.55 ± 1.96	21.36 ± 1.75	0.607	0.544
文化程度			0.225	0.635
高中及以下	168（79.25）	35（76.09）
大专及以上	44（20.75）	11（23.91）
居住地			0.523	0.469
城镇	112（52.83）	27（58.70）
农村	100（47.14）	19（41.30）
婚姻情况			0.006	0.940
未婚	5（2.36）	1（2.17）
已婚	207（97.64）	45（97.83）
高血压	122（57.55）	26（56.52）	0.016	0.899
糖尿病	96（45.28）	18（39.13）	0.580	0.446
高血脂	77（36.32）	15（32.61）	0.227	0.634
慢性阻塞肺疾病	76（35.85）	14（30.43）	0.488	0.485
支气管扩张	48（22.64）	9（19.57）	0.208	0.648
吸烟史	89（41.98）	17（36.96）	0.394	0.530
饮酒史	83（39.15）	15（32.61）	0.687	0.407
收缩压（ $x ˉ ? ± ? s$ ）/（mmHg）	124.30 ± 8.35	124.15 ± 8.11	0.111	0.913
舒张压（ $x ˉ ? ± ? s$ ）/（mmHg）	80.28 ± 8.84	80.13 ± 8.17	0.106	0.916
心率（ $x ˉ ? ± ? s$ ）/（次/min）	75.67 ± 8.84	75.17 ± 8.66	0.349	0.727
住院时间（ $x ˉ ? ± ? s$ ）/d	15.62 ± 1.71	15.43 ± 1.72	0.682	0.495
低蛋白血症	67（31.60）	13（28.26）	0.197	0.657
实性结节	170（80.19）	28（60.87）	7.904	0.005
空洞	138（65.09）	11（23.91）	26.272	< 0.001
血红蛋白（ $x ˉ ? ± ? s$ ）/（g/L）	121.34 ± 10.40	121.28 ± 10.42	0.035	0.972
总胆固醇（ $x ˉ ? ± ? s$ ）/（mmol/L）	4.11 ± 0.77	4.03 ± 0.65	0.656	0.513
甘油三酯（ $x ˉ ? ± ? s$ ）/（mmol/L）	1.15 ± 0.37	1.12 ± 0.35	0.503	0.615
血钾（ $x ˉ ? ± ? s$ ）/（mmol/L）	4.56 ± 0.61	4.49 ± 0.63	0.701	0.484
血钠（ $x ˉ ? ± ? s$ ）/（mmol/L）	135.48 ± 2.69	135.14 ± 2.71	0.776	0.438
血钙（ $x ˉ ? ± ? s$ ）/（mmol/L）	2.41 ± 0.66	2.37 ± 0.59	0.379	0.705
血磷（ $x ˉ ? ± ? s$ ）/（mmol/L）	1.27 ± 0.20	1.24 ± 0.19	0.930	0.353
乳酸脱氢酶（ $x ˉ ? ± ? s$ ）/（U/L）	205.08 ± 10.20	203.98 ± 10.12	0.664	0.507
suPAR（ $x ˉ ? ± ? s$ ）/（ng/mL）	5.36 ± 1.73	3.72 ± 1.08	6.168	< 0.001
CD8⁺（ $x ˉ ? ± ? s$ ）/%	23.84 ± 4.61	20.27 ± 3.05	5.015	< 0.001

Tab.1

Tab.2

Fig.1

Tab.3

Comparison of general information between survival group and death group"

项目	病死组（n = 34）	生存组（n = 178）	χ2/t值	P值
性别（男/女）/例	20/14	99/79	0.119	0.730
年龄/岁	60.98 ± 8.06	58.04 ± 7.23	2.132	0.034
体质量指数（ $x ˉ ? ± ? s$ ）/（kg/m²）	21.73 ± 2.07	21.52 ± 1.93	0.575	0.566
文化程度			0.804	0.370
高中及以下	25（73.53）	143（80.34）
大专及以上	9（26.47）	35（19.66）
居住地			0.151	0.697
城镇	19（55.88）	93（52.25）
农村	15（44.12）	85（47.75）
婚姻情况			0.060	0.807
未婚	1（2.94）	4（2.25）
已婚	33（97.06）	174（97.75）
高血压	18（52.94）	104（58.43）	0.352	0.553
糖尿病	21（61.76）	75（42.13）	4.440	0.035
高血脂	10（29.42）	67（37.64）	0.836	0.361
慢性阻塞性肺疾病	14（41.18）	62（34.83）	0.499	0.480
支气管扩张	7（20.56）	41（23.03）	0.097	0.755
吸烟史	17（50.00）	72（40.45）	1.069	0.301
饮酒史	15（44.12）	68（38.20）	0.419	0.517
收缩压（ $x ˉ ? ± ? s$ ）/（mmHg）	124.36 ± 8.66	124.29 ± 8.27	0.045	0.964
舒张压（ $x ˉ ? ± ? s$ ）/（mmHg）	80.17 ± 7.63	80.29 ± 7.83	0.082	0.934
心率（次/min）	75.29 ± 8.27	75.76 ± 8.93	0.284	0.776
霉菌球类型			0.599	0.439
单纯性	15（44.12）	66（37.08）
复杂性	19（55.88）	112（62.92）
住院时间（ $x ˉ ? ± ? s$ ）/d	15.76 ± 1.86	15.59 ± 1.67	0.534	0.594
低蛋白血症	19（55.88）	48（26.97）	11.043	< 0.001
实性结节	26（76.47）	144（80.90）	0.374	0.541
空洞	21（61.76）	117（65.73）	0.198	0.657
单纯药物治疗	26（76.47）	156（87.64）	2.932	0.087
药物联合手术	8（23.53）	22（12.36）	2.932	0.087
血红蛋白（ $x ˉ ? ± ? s$ ）/（g/L）	121.27 ± 10.27	121.36 ± 10.46	0.046	0.963
总胆固醇（ $x ˉ ? ± ? s$ ）/（mmol/L）	4.17 ± 0.82	4.10 ± 0.76	0.486	0.627
甘油三酯（ $x ˉ ? ± ? s$ ）/（mmol/L）	1.13 ± 0.33	1.15 ± 0.38	0.287	0.775
血钾（ $x ˉ ? ± ? s$ ）/（mmol/L）	4.47 ± 0.56	4.58 ± 0.62	0.962	0.337
血钠（ $x ˉ ? ± ? s$ ）/（mmol/L）	135.27 ± 2.55	135.54 ± 2.73	0.534	0.594
血钙（ $x ˉ ? ± ? s$ ）/（mmol/L）	2.38 ± 0.62	2.42 ± 0.67	0.323	0.747
血磷（ $x ˉ ? ± ? s$ ）/（mmol/L）	1.25 ± 0.18	1.28 ± 0.21	0.780	0.436
乳酸脱氢酶（ $x ˉ ? ± ? s$ ）/（U/L）	205.27 ± 10.35	205.04 ± 10.16	0.121	0.904
suPAR（ $x ˉ ? ± ? s$ ）/（ng/mL）	6.27 ± 1.95	4.88 ± 1.42	4.900	< 0.001
CD8⁺（ $x ˉ ? ± ? s$ ）/%	26.52 ± 4.99	22.73 ± 4.05	4.808	< 0.001

Tab.3

Tab.4

Fig.2

Tab.5

Fig.3

Fig.4

Fig.5

References 22

[1]	SEJGAL I S， DHOORIA S， MUTHU V， et al. An overview of the available treatments for chronic cavitary pulmonary aspergillosis［J］. Expert Rev Respir Med， 2020， 14（7）： 715-727.doi： 10.1080/17476348.2020.1750956 . doi: 10.1080/17476348.2020.1750956
[2]	BALUKU J B， NUWAGIRA E， BONGOMIN F， et al. Pulmonary TB and chronic pulmonary aspergillosis： Clinical differences and similarities［J］. Int J Tuberc Lung Dis， 2021， 25（7）： 537-546.doi： 10.5588/ijtld.21.0034 . doi: 10.5588/ijtld.21.0034
[3]	BARATELLA E， DI LUCA V， OLIVA A， et al. CT Imaging Features of Pulmonary Sarcoidosis： Typical and Atypical Radiological Features and Their Differential Diagnosis［J］. Medicina， 2025， 61（12）： 2094..doi： 10.3390/medicina61122094 . doi: 10.3390/medicina61122094
[4]	BARAC A， VUJOVIC A， DRAZIC A， et al. Diagnosis of chronic pulmonary aspergillosis： Clinical， radiological or laboratory？［J］. J Fungi （Basel）， 2023， 9（11）： 1084..doi： 10.3390/jof9111084 . doi: 10.3390/jof9111084
[5]	ISMAIL A， HAYEK S S. Role of soluble urokinase-type plasminogen activator receptor in cardiovascular disease［J］. Curr Cardiol Rep， 2023， 25（12）： 1797-1810.doi： 10.1007/s11886-023-01991-7 . doi: 10.1007/s11886-023-01991-7
[6]	DOWSETT J， FERKINGSTAD E， RASMUSSEN L J H， et al. Eleven genomic loci affect plasma levels of chronic inflammation marker soluble urokinase-type plasminogen activator receptor［J］. Commun Biol， 2021， 4（1）： 655.doi：10.1038/s42003-021-02144-8 . doi: 10.1038/s42003-021-02144-8
[7]	KUMAR V. Cytotoxic T cells： Kill， memorize， and mask to maintain immune homeostasis［J］. Int J Mol Sci， 2025， 26（18）： 8788.doi：10.3390/ijms26188788 . doi: 10.3390/ijms26188788
[8]	PATTERSON T F， THOMPSON G R 3rd， DENNING D W， et al. Practice guidelines for the diagnosis and management of aspergillosis： 2016 update by the Infectious Diseases Society of America［J］.Clin Infect Dis， 2016， 63（4）： e1-e60.doi：10.1093/cid/ciw326 doi: 10.1093/cid/ciw326
[9]	MEI Z X， HAN J F， YU H W， et al. Detection of serum Aspergillus-specific IgM and IgG antibody levels for the diagnosis of chronic pulmonary aspergillosis developed in patients with tuberculosis［J］.Eur J Clin Microbiol Infect Dis， 2023， 42（9）： 1081-1089. doi： 10.1007/s10096-023-04637-2 . doi: 10.1007/s10096-023-04637-2
[10]	顾永丽，程聪，孙莹，等. 伏立康唑与伊曲康唑治疗慢性阻塞性肺疾病合并肺曲霉菌感染的循证药物经济学评价［J］.中国医院药学杂志， 2020， 40（21）： 2255-2259. doi：10.13286/j.1001-5213.2020.21.10 . doi: 10.13286/j.1001-5213.2020.21.10
[11]	汤健丽，李征途，叶枫.流感相关肺曲霉病的流行病学和诊治进展［J］.华西医学，2020，35（1）：1-4.doi：10.7507/1002-0179.202001079 . doi: 10.7507/1002-0179.202001079
[12]	朱龙银，王海霞，程伟，等.血浆suPAR及尿NGAL，KIM-1对成人心脏手术相关性急性肾损伤的早期诊断价值［J］.解放军医学杂志， 2021， 46（12）：1205-1212.doi：10.11855/j.issn.0577-7402.2021.12.06 . doi: 10.11855/j.issn.0577-7402.2021.12.06
[13]	ULAJ A， IBSEN A， AZURMENDI L， et al. Improving prognostication of pneumonia among elderly patients： Usefulness of suPAR［J］. BMC Geriatr， 2024， 24（1）： 709.doi： 10.1186/s12877-024-05270-0 . doi: 10.1186/s12877-024-05270-0
[14]	ZÖPHEL D， ANGENENDT A， KASCHEK L， et al. Faster cytotoxicity with age： Increased perforin and granzyme levels in cytotoxic CD8⁺ T cells boost cancer cell elimination［J］. Aging Cell， 2022， 21（8）： e13668.doi：10.1111/acel.13668 . doi: 10.1111/acel.13668
[15]	REISINGER A C， HATZL S， PRATTES J， et al. Soluble urokinase plasminogen activator receptor （suPAR） in bronchoalveolar fluid and blood in critically ill patients—A prospective cohort study［J］. Infection， 2024， 52（1）： 249-252.doi：10.1007/s15010-023-02127-3 . doi: 10.1007/s15010-023-02127-3
[16]	SHEPHERD F R， MCLAREN J E. T cell immunity to bacterial pathogens： Mechanisms of immune control and bacterial evasion［J］. Int J Mol Sc， 2020， 21（17）： 6144..doi：10.3390/ijms21176144 . doi: 10.3390/ijms21176144
[17]	MINATO N， HATTORI M， HAMAZAKI Y. Physiology and pathology of T-cell aging［J］. Int Immunol， 2020， 32（4）： 223-231.doi：10.1093/intimm/dxaa006 . doi: 10.1093/intimm/dxaa006
[18]	彭妙官，邓雪峰. 静脉注射激素对合并2型糖尿病的重度慢性阻塞性肺疾病急性加重期患者疗效及安全性［J］.实用医学杂志， 2022， 38（20）： 2590-2596. doi：10.3969/j.issn.1006-5725.2022.20.015 . doi: 10.3969/j.issn.1006-5725.2022.20.015
[19]	脱鸣富，习静，魏育芳，等. 我国AECOPD患者继发肺部真菌感染危险因素的Meta分析［J］. 中国医院药学杂志， 2020， 40（4）： 412-418. doi：10.13286/j.1001-5213.2020.04.11 . doi: 10.13286/j.1001-5213.2020.04.11
[20]	HAMADA M， VARKOLY K S， RIYADH O， et al. Urokinase-type plasminogen activator receptor （uPAR） in inflammation and disease： A unique inflammatory pathway activator［J］. Biomedicines， 2024， 12（6）： 1167.doi：10.3390/biomedicines12061167 . doi: 10.3390/biomedicines12061167
[21]	VERDON D J， MULAZZANI M， JENKINS M R. Cellular and molecular mechanisms of CD8⁺ T cell differentiation， dysfunction and exhaustion［J］. Int J Mol Sci， 2020， 21（19）： 7357. doi：10.3390/ijms21197357 . doi: 10.3390/ijms21197357
[22]	马芳，孙傲，许亚朋，等.非粒细胞缺乏的慢阻肺合并侵袭性肺曲霉菌病诊断及预后分析［J］.临床肺科杂志， 2024， 29（5）： 649-653. doi：10.3969/j.issn.1009-6663.2024.05.001 . doi: 10.3969/j.issn.1009-6663.2024.05.001

指标	AUC	标准误差	95%CI	P值	截断值	约登指数	敏感度/%	特异度/%
suPAR	0.710^*	0.036	0.651 ~ 0.765	< 0.001	> 4.351 ng/mL	0.377	59.43	78.26
CD8⁺	0.757^*	0.033	0.700 ~ 0.808	< 0.001	> 23.020%	0.469	59.91	86.96
联合检测	0.819	0.029	0.767 ~ 0.864	< 0.001	0.855	0.547	65.57	89.13

因素	B	SE	Wald	P值	HR	95%CI
年龄	0.017	0.020	0.750	0.386	1.018	0.978 ~ 1.058
糖尿病	0.180	0.424	0.179	0.672	1.197	0.521 ~ 2.749
低蛋白血症	0.604	0.424	2.024	0.155	1.829	0.796 ~ 4.200
suPAR	0.268	0.092	8.525	0.004	1.307	1.092 ~ 1.565
CD8⁺	0.138	0.039	12.648	< 0.001	1.148	1.064 ~ 1.239

指标	AUC	标准误差	95%CI	P值	截断值	约登指数	敏感度/%	特异度/%
suPAR	0.646^*	0.059	0.577 ~ 0.710	< 0.001	> 8.090 ng/mL	0.294	35.29	79.21
CD8⁺	0.723^*	0.049	0.658 ~ 0.782	< 0.001	> 23.846%	0.335	70.59	62.92
联合检测	0.846	0.039	0.790 ~ 0.892	< 0.001	0.279	0.545	64.71	89.89

The early diagnosis and prognostic value of suPAR combined with CD8⁺T lymphocyte detection for chronic pulmonary aspergillosis

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The early diagnosis and prognostic value of suPAR combined with CD8+T lymphocyte detection for chronic pulmonary aspergillosis

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The early diagnosis and prognostic value of suPAR combined with CD8⁺T lymphocyte detection for chronic pulmonary aspergillosis