降钙素原、C反应蛋白和PaCO2对慢性阻塞性肺疾病急性加重期无创通气失败的预测价值  

Procalcitonin,C-reactive protein and PaCO2 predict noninvasive mechanical ventilation failure for patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：王金荣[1] 商会棉 郭淑芬[1] 邵立业 郭伟[1] 崔朝勃[1] Wang Jinrong, Shang Huimian, Guo Shufen, Shao Liye, Guo Wei, Cui Zhaobo.(Department of Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, Chin)

机构地区：[1]河北医科大学附属衡水哈励逊国际和平医院重症医学科,053000

出　　处：《国际呼吸杂志》2018年第5期346-351,共6页International Journal of Respiration

摘　　要：目的探索慢性阻塞性肺疾病急性加重期（AECOPD）无创通气（NIV）治疗失败的危险因素。方法将2014年5月至2017年3月确诊的AECOPD行NIV治疗的住院患者纳入研究。所有患者NIV前1h均行血常规、血沉、动脉血气分析、C反应蛋白（CRP）和降钙素原（PCT）检测，观察上述指标对NIV失败的预测价值。结果共筛查402例患者，最后纳入376例，其中286例NIV成功，90例NIV失败行有创机械通气治疗。成功与失败组NIV治疗前1h PCT、CRP、pH、动脉血二氧化碳分压（PaCOt）水平差异有统计学意义。PCT仅与CRP呈弱相关（r=0．18，P〈0．05），而与血气指标及其他炎性指标无任何相关性。二分类Logistic回归分析发现高PCT、CRP和PaCO。是NIV失败的独立危险因素，比值比分别为2．26[（95％可信区间（CI）：1．21～3．241、1．14（95％CI：1．15～1．28）和1．17（95％CI：1．04～1．26）。通过绘制受试者工作曲线评估3个指标对NIV失败的预测价值，约登指数最高时PCT界限值为0．31pg／L（敏感度为83．37％，特异度为83．71％）；CRP界限值为15g／L（敏感度为75．64％，特异度为93．04％）；PaCO2界限值为73．50mmHg（1mmHg=0．133kPa）（敏感度为71．16％，特异度为100％）。曲线下面积（AUC）分别是PCT0．85（95％CI：0．79～0．91）、CRP0．85（95％CI：0．79～0．91）、PaCO2 0．83（95％CI：0．76～0．90），上述3个指标同时满足时，联合预测AUC为0．98（95％CI：0．96～0．99）。结论AECOPD患者NIV失败组较成功组PCT、PaCO2和CRP水平更高，pH更低，PCT、PaCO2和CRP与NIV治疗失败独立相关，预测界限值分别为0．31μg／L、73．5mmHg和15．0g／L，三者联合预测价值更高。Objective Explore non-invasive ventilation（NIV） failure risks for patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods This study was performed between May 2014 and March 2017. Hemogram, erythrocyte sedimentation rate, ABG, serum C-reactive protein （CRP）, and procalcitonin （PCT） tests were performed one hour before NIV were used. A quantitative assessment of PCT levels was performed, and the results were evaluated at the same time. Results In the original investigation, 402 exacerbations were screened and 376 subjects were enrolled. Two hundred and eighty six of them were treated successfully with NIV, and 90 received endotracheal intubation and mechanical ventilation due to NIV failure. Baseline clinical characteristics were compared between groups, arterial carbon dioxide partial pressure （PaCO2）, serum PCT and CRP levels were higher, and pH level was lower in NIV failure group than in NIV success group. No significant correlation was found between PCT level and variable of arterial blood gas and inflammation markers, and only a weak positive correlation was found between PCT level and CRP level （ r = 0.18, P 〈 0.05）. To determine factors associated with NIV failure, binary Logistic regression analysis was carried out using the following independent variables： age, sex, PCT level, CRP level, pH and PaCO2 level at admission, only PCT level, CRP level and PaCO2 level were significantly associated with NIV failure. We performed a ROC analysis to determine the predictive level of serum PCT, CRP and PaCO2 for assessing the need of IMV therapy. The cutoff values to achieve the highest Youden index were 0.31 μg/L for PCT level （sensitivity 83.37%, specificity 83.71%）, 15 g/L for CRP level （sensitivity 75.64%, specificity 93.04%）,and 73.50 mmHg （1 mmHg=0. 133 kPa） for PaCO2 （sensitivity 71.16%, specificity 100%）. The area under the curve （AUC） for each factor was 0.85 [95 % confidence interval （ CI ） ：0.79-0. 911 for PCT, 0.85

关 键 词：无创通气 慢性阻塞性肺疾病急性加重期 降钙素原 C反应蛋白 动脉血气分析 

分 类 号：R563.9[医药卫生—呼吸系统]