Objective To observe the changes of serum levels of inducible co-stimulatory molecules(ICOS)and inducible co-stimulatory molecule ligands(ICOSL)and clinical significance in patients with chronic obstructive pulmonary disease(COPD)combined with pulmonary heart disease(PHD).Methods One hundred and seventy-two COPD patients admitted to the Department of Cardiology,Suzhou Jiulong Hospital,School of Medicine,Shanghai Jiaotong University,from June 2020 to February 2023 were selected and divided into the PHD group(82 patients)and the COPD group(90 patients)according to whether they were combined with PHD or not.PHD patients were divided into mild subgroups(30-50 mmHg,21 cases),moderate subgroups(51-70 mmHg,37 cases),and severe subgroups(≥71 mmHg,24 cases)according to pulmo-nary artery systolic pressure(PASP),and then PHD patients were divided into subgroups of grades ⅠtoⅡ(44 cases),and grades Ⅲ to Ⅳ(38 cases)according to the New York Heart Association(NYHA)classification.Enzyme-linked immunosor-bent assay(ELISA)was used to detect serum ICOS and ICOSL levels and analyze the correlation between ICOS,ICOSL and PASP,NYHA classification,and the value of ICOS and ICOSL in diagnosing COPD combined with PHD was analyzed by the subject's work characteristics(ROC)curve.Results The serum ICOS and ICOSL levels in the PHD group were higher than those in the COPD group(t=14.526,34.508,P<0.001).Serum ICOS and ICOSL levels were higher in the severe sub-group than in the moderate and mild subgroups(F/P=125.351/<0.001,163.591/<0.001,84.292/<0.001),and serum ICOS was higher in the subgroups of grade III-IV,ICOSL levels were higher than those in the subgroups of grades I-II(t/P= 11.658/<0.001,27.345/<0.001).The serum ICOS and ICOSL levels of patients with PHD were positively correlated with the PASP and NYHA grading(r=0.439,20.416,0.501,0.497,P<0.001).ICOS,ICOSL and both the area under the curve of com-bined PHD in patients with COPD diagnosis was 0.780,0.723,0.926,respectively,and the combination of the two was higher than the diagnosis of ICOS and ICOSL alone(Z=4.021,5.194,and Pall<0.001).Conclusion Serum ICOS and ICOSLlevels were significantly higher in patients with COPD combined with PHD,and were associated with pulmonary hypertension and reduced cardiac function,and the combined detection of ICOS and ICOSL could effectively evaluate the risk of PHD in pa-tients with COPD.
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