血清肾上腺髓质素原、降钙素原、D-二聚体水平对急诊慢性阻塞性肺疾病急性加重并Ⅱ型呼吸衰竭患者预后的预测价值  

Predictive Value of Serum Levels of pro-ADM,PCT and D-dimer on Prognosis in Emergency AECOPD Patients Complicated with Type Ⅱ Respiratory Failure

作　　者：安铁峰[1] 谢苗荣[2] 王文科[1] 程泽君 赵琳[1] 陈兴 李红[3] AN Tiefeng;XIE Miaorong;WANG Wenke;CHENG Zejun;ZHAOLin;CHEN Xing;LI Hong(Emergency Department,Beijing Chuiyangliu Hospital,Beijing 100022,China;Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China;North China Petroleum Administration General Hospital,Renqiu 062550,China)

机构地区：[1]北京市垂杨柳医院急诊科,100022 [2]首都医科大学附属北京友谊医院,北京100050 [3]华北石油管理局总医院,河北任丘062550

出　　处：《实用心脑肺血管病杂志》2019年第6期62-67,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：华北油田矿区医疗卫生临床新技术应用研究(017-HB-G0902)

摘　　要：目的 分析血清肾上腺髓质素原(pro-ADM)、降钙素原(PCT)、D-二聚体水平对急诊慢性阻塞性肺疾病急性加重(AECOPD)并Ⅱ型呼吸衰竭患者预后的预测价值。方法 选取2017年1月—2018年7月于北京市垂杨柳医院急诊科就诊留观及急诊重症监护病房(EICU)住院的AECOPD并Ⅱ型呼吸衰竭患者102例,根据28d存活情况分为存活组71例和死亡组31例。比较两组患者就诊24h内CURB-65评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及确诊后第1、4天血清pro-ADM、PCT、D-二聚体、C反应蛋白(CRP)水平,绘制ROC曲线以分析确诊后第1天血清pro-ADM、PCT、D-二聚体、CRP水平对急诊AECOPD并Ⅱ型呼吸衰竭患者预后的预测价值,并根据机械通气情况进行亚组分析。结果 (1)死亡组患者就诊24h内CURB-65评分、APACHEⅡ评分高于存活组(P<0.05)。(2)死亡组患者确诊后第1、4天血清pro-ADM、PCT、D-二聚体水平及确诊后第4天血清CRP水平高于存活组,而确诊后第1天血清CRP水平低于存活组(P<0.05)。(3)存活组患者中行机械通气者11例,未行机械通气者60例。存活组患者中是否行机械通气者就诊24h内CURB-65评分、APACHEⅡ评分比较,差异无统计学意义(P>0.05);存活组患者中行机械通气者确诊后第1、4天血清pro-ADM水平高于未行机械通气者(P<0.05),而存活组患者中是否行机械通气者确诊后第1、4天血清PCT、D-二聚体、CRP水平比较,差异无统计学意义(P>0.05)。(4)ROC曲线显示,确诊后第1天血清pro-ADM、PCT、D-二聚体、CRP水平预测急诊AECOPD并Ⅱ型呼吸衰竭患者预后的曲线下面积(AUC)分别为0.983〔95%CI(0.963,1.000)〕、0.718〔95%CI(0.670,0.819)〕、0.918〔95%CI(0.863,0.972)〕、0.325〔95%CI(0.198,0.451)〕;确诊后第1天血清pro-ADM、PCT、D-二聚体、CRP水平预测28d存活的急诊AECOPD并Ⅱ型呼吸衰竭患者机械通气的AUC分别为0.720〔95%CI(0.553,0.888)〕、0.664〔95%CI(0.512,0.817)〕、Objective To analyze the predictive value of serum levels of pro-ADM,PCT and D-dimer on prognosis in emergency AECOPD patients complicated with type Ⅱ respiratory failure. Methods From January 2017 to July 2018,a total of 102 AECOPD patients complicated with type Ⅱ respiratory failure(remained for observation and hospitalized EICU) were selected in Emergency Department,Beijing Chuiyangliu Hospital,and they were divided into survival group(n=71) and death group(n=31)according to the 28-day survival status. CURB-65 score and APACHE Ⅱ score within 24 hours after admission,serum levels of pro-ADM,PCT,D-dimer and CRP 1 day and 4 days after confirmation were compared between the two groups,ROC curve was drawn to analyze the predictive value of serum levels of pro-ADM,PCT,D-dimer and CRP 1 day after confirmation on prognosis in emergency AECOPD patients complicated with type Ⅱ respiratory failure,and subgroup analysis was conducted according to mechanical ventilation condition. Results (1)CURB-65 score and APACHE Ⅱ score in death group were statistically significantly higher than those in survival group within 24 hours after admission(P<0.05).(2) Serum levels of pro-ADM,PCT and D-dimer 1 day and 4 days after confirmation and serum CRP level 4 days after confirmation in death group were statistically significantly higher than those in survival group (P<0.05),while serum CRP level in death group was statistically significantly lower than that in survival group 1 day confirmation(P<0.05).(3)There were 11 cases underwent mechanical ventilation in survival group,the other 60 cases did not. In survival group,no statistically significant difference of CURB-65 score or APACHE Ⅱ score was found in patients underwent mechanical ventilation or not within 24 hours after admission(P>0.05);serum pro-ADM level in patients underwent mechanical ventilation was statistically significantly higher than that in patients did not 1 day and 4 days after confirmation,respectively(P<0.05),while no statistically significant difference

关 键 词：慢性阻塞性肺疾病 老年人 肾上腺髓质素原 降钙素原 D-二聚体 预后 

分 类 号：R563.9[医药卫生—呼吸系统] R592[医药卫生—内科学]