超敏C反应蛋白/白蛋白比值对无创通气治疗AECOPD合并呼吸衰竭患者的预后评估价值  

The prognostic value of high sensitivity C-reactive protein to albumin ratio in chronic obstructive pulmonary disease patients with respiratory failure treated by non-invasive ventilation

作　　者：张婷[1] 史菲 酆孟洁[1] 

机构地区：[1]暨南大学医学院第二附属医院深圳市人民医院呼吸与危重症医学科,广东深圳518020 [2]暨南大学医学院第二附属医院深圳市人民医院急诊科,广东深圳518020

出　　处：《广东医学》2018年第4期533-536,共4页Guangdong Medical Journal

基　　金：广东省自然科学基金资助项目(编号:2014A030313756);深圳市科技计划项目(编号:JCYJ20150403102020224)

摘　　要：目的探讨超敏C反应蛋白/白蛋白(hs-CRP/Alb)比值对慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者行无创通气(NIV)治疗的预后评估价值。方法连续收集行NIV治疗的AECOPD合并呼吸衰竭患者共50例,记录APACHEⅡ评分、动脉血p H值、血氧分压(PaO_2)、二氧化碳分压(Pa CO_2)、hs-CRP、血清Alb及治疗预后。分析预后良好组与预后不良组间p H值、PaO_2、PaCO_2、hs-CRP/Alb及APACHEⅡ评分的差异,判断hs-CRP/Alb与各项指标之间的相关性,评估hs-CRP/Alb对AECOPD合并呼吸衰竭患者预后的预测能力。结果预后不良组的hs-CRP/Alb值、APACHEⅡ评分显著高于预后良好组(P=0.000、0.005),其p H值也明显低于预后良好组(P=0.000)。同时,hs-CRP/Alb与APACHEⅡ、PaCO_2显著相关(r=0.310、-0.286,P=0.028、0.044),与p H值及PaO_2则无显著相关性(r=-0.236、-0.006,P=0.099、0.966)。p H值、PaO_2、PaCO_2、hs-CRP/Alb及APACHEⅡ评分的ROC曲线下面积分别为0.080、0.401、0.583、0.848及0.743;hs-CRP/Alb预测患者NIV后发生预后不良的界值为2.10,具有较高的敏感度(0.769)和特异度(0.892)。结论 hs-CRP/Alb比值有助于判断AECOPD合并呼吸衰竭患者行NIV治疗的效果,具有良好的预后预测价值。Objective To investigate the prognostic value of high sensitivity C - reactive protein （ hs - CRP） to albumin （Alb） ratio in acute exacerbation of chronic obstructive pulmonary disease （AECOPD） patients with respiratory failure treated by non - invasive ventilation （NIV）. Methods Fifty AECOPD patients with respiratory failure were en- rolled. They were treated by NIV. The APACHEⅡscores, arterial blood pH, PO2, PaCO2, hs - CRP, Alb, and thera- peutic prognosis were recorded. The pH, PaO2, PaCO2, hs - CRP/AIb, and APACHE Ⅱ scores were compared between patients with good prognosis and poor prognosis. The relevances of hs - CRP/Alb to other indicators （ eg. pH, PaO2 , PaCO2, and APACHE scores） were analyzed, and the prognostic value of hs - CRP/Alb was assessed by the receiver operating characteristics curve. Results The poor - prognosis group had significantly higher values of hs - CRP/AIb and APACHE Ⅱ scores than the good - prognosis group （ P = 0. 000, 0. 005）, while the pH level was significantly lower than that of the good - prognosis group （P = 0. 000）. In the meantime, hs - CRP/Alb was significantly correlated to APACHE Ⅱand PaCO2 （r = 0. 310, -0. 286; P = 0. 028, O. 044）, while no significant correlation between hs - CRP/Alb and pH （ or PO2 ） was found （r = - 0. 236, - 0. 006 ; P = 0. 099, 0. 966）. The AUCs of pH, PO2, PaCO2, hs - CRP/Alb, and APACHE Ⅱ score were 0. 080, 0. 401, 0. 583, 0. 848, and 0. 743, respectively. The cut - off value of hs - CRP/Alb for prognosis of AECOPD patients with respiratory failure was 2. 10, with high sensitivity （0. 769） and specificity （0. 892）. Conclusion Hs - CRP to Alb ratio can contribute to indicate the effects of NIV for AECOPD with respiratory failure, and plays an important role in the predicting the prognosis.

关 键 词：超敏C反应蛋白/白蛋白比值 慢性阻塞性肺疾病急性加重期 呼吸衰竭 无创通气 预后 

分 类 号：R563.8[医药卫生—呼吸系统] R563.9[医药卫生—内科学]