超敏C反应蛋白增高预示慢性阻塞性肺疾病急性加重的风险增大  

Increased High-Sensitivity C-Reactive Protein Is a Risk Predictor for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

作　　者：聂姗[1] 王浩彦[1] 徐秋芬[1] 何馨[1] 郭彤 杨小丽[1] 赵旭娟[1] 

机构地区：[1]首都医科大学附属北京友谊医院呼吸内科,北京100050 [2]北京中关村医院呼吸内科,北京100190

出　　处：《中国呼吸与危重监护杂志》2011年第2期116-120,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：北京市科委科研课题(编号:z080507030808025)

摘　　要：目的探讨系统性炎症因子预测COPD患者发生急性加重的风险。方法应用乳胶增强免疫比浊法测定血清超敏C反应蛋白(hs-CRP)水平,凝固法测定血浆纤维蛋白原(Fbg)水平。随访跟踪6个月,记录患者在随访期间发生急性加重的次数。结果选取50例稳定期COPD患者,其中48例患者完成随访,2例脱失。16例患者出现1次及以上的急性加重(A组),32例患者未出现急性加重(B组)。结果表明,A组的基础FEV1水平显著低于B组[(1.1±0.4)L比(1.4±0.5)L,P<0.05];A组的基础hs-CRP为(4.6±3.3)mg/L明显高于B组(中位数4.3 mg/L,四分位间距5.5 mg/L,P<0.05);A组的基础Fbg也明显高于B组[(3.8±0.7)g/L比(3.1±0.5)g/L,P<0.05]。根据hs-CRP水平将患者分为hs-CRP增高组(hs-CRP>3 mg/L)和hs-CRP正常组(hs-CRP≤3 mg/L)。hs-CRP增高组16例,其中9例出现急性加重,急性加重率为56.25%;hs-CRP正常组32例,其中7例出现急性加重,急性加重率为21.88%(P<0.05)。根据Fbg水平将患者分为Fbg增高组(Fbg>4 g/L)和Fbg正常组(Fbg≤4 g/L)。Fbg增高4例,均出现急性加重,急性加重率为100%;Fbg正常组44例,其中12例出现急性加重,急性加重率为27.27%(P<0.05)。在校正了年龄、体重指数(BMI)、FEV1、是否吸烟和是否合并其他慢性病影响因素后,得出稳定期COPD患者初始hs-CRP增高的急性加重发生风险是hs-CRP正常患者的9.333倍,95%CI为1.870～46.573。结论 hs-CRP可作为预测COPD患者急性加重风险的参考指标之一。Objective To determine if the levels of high-sensitivity C-reactive protein(hs-CRP) and fibrinogen(Fbg)can predict the risk of acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods hs-CRP was measured by latex-enhanced immunoturbidimetric assay and Fbg was assessed by Von Clauss method.The number of exacerbations was recorded during a 6-month follow-up period.Results Fifty patients with stable COPD were enrolled in the study,of whom 48 patients completed the trial and two patients dropped out.During the follow-up,16 patients had once or more acute exacerbations while other 32 patients had no acute exacerbation.The patients were stratified into two groups(A-exacerbation,B-no exacerbation).At the baseline,the patients of the group A had lower FEV1 than the group B [(1.1±0.4)L vs.(1.4±0.5)L,P<0.05].And the group A had higher hs-CRP and Fbg than the group B [hs-CRP:(4.6±3.3)mg/L vs.4.3 mg/L(IQR 5.5 mg/L),P<0.05];Fbg:(3.8±0.7)g/L vs.(3.1±0.5)g/L,P<0.05].Nine of 16 patients with a higher level of hs-CRP(hs-CRP>3 mg/L) had acute exacerbations.Seven of other 32 patients with normal hs-CRP level had acute exacerbations.The difference in the acute exacerbations rate between the two groups was significant(56.25% vs.21.88%,P<0.05).All four patients with a higher level of Fbg(Fbg>4 g/L) had acute exacerbations.Twelve of 44 patients with normal Fbg level(Fbg≤4 g/L) had acute exacerbations.The patients with Fbg more than 4 g/L had a higher rate of acute exacerbations(100% vs.27.27%,P<0.05).After adjusting by age,body mass index(BMI),FEV1,tobacco consumption and other chronic diseases,the risk of acute exacerbation in individuals with baseline hs-CRP>3 mg/L was 9.33 times higher than those with baseline hs-CRP≤3 mg/L(95%CI 1.870-46.573).Conclusion Higher level of hs-CRP is associated with the high risk of exacerbation in patients with COPD.

关 键 词：慢性阻塞性肺疾病 急性加重 超敏C反应蛋白 纤维蛋白原 

分 类 号：R563.9[医药卫生—呼吸系统]