血清趋化因子CXCL12与LCR用于老年COPD合并呼吸衰竭患者预后预测的临床价值  

The predictive value of serum CXCL12 and LCR in the prognosis of elderly patients with COPD complicated with respiratory failure

作　　者：郭青春[1] 张杰根[1] 华军霞[1] 郑贵军[1] 刘振坤[1] 王会芳[1] GUO Qingchun;ZHANG Jiegen;HUA Junxia;ZHENG Guijun;LIU Zhenkun;WANG Huifang(Department of Respiratory Critical Care Medicine,Zhuozhou City Hospital,Hebei Zhuozhou 072750,China)

机构地区：[1]涿州市医院呼吸危重症医学科

出　　处：《新疆医科大学学报》2019年第9期1163-1166,1170,共5页Journal of Xinjiang Medical University

基　　金：保定市科技支撑计划项目(17ZF290)

摘　　要：目的研究血清趋化因子CXCL12水平和动脉血乳酸清除率(LCR)用于老年慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者预后预测的临床价值。方法选取2017年12月-2018年12月涿州市医院呼吸危重症医学科收治的100例老年COPD合并Ⅱ型呼吸衰竭患者为研究对象。根据患者治疗28 d的预后情况分为生存组患者67例,死亡组患者33例。患者确诊入院后立即采集动脉血检测乳酸水平,6 h后重复检测,计算动脉血乳酸清除率。在患者入院第1、3、5天分别采集空腹静脉血并采用酶联免疫吸附试验检测血清趋化因子CXCL12水平,并对患者进行急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分。比较2组患者LCR、CXCL12水平及APACHEⅡ评分各指标差异,采用Pearson相关分析法评价LCR、血清CXCL12水平与APACHEⅡ评分的相关性,分析血清CXCL12水平和LCR预测患者预后的临床价值。结果入院6 h后生存组患者LCR高于死亡组患者,差异有统计学意义(P<0.01)。与死亡组患者比较,生存组患者入院第1天血清CXCL12水平差异无统计学意义(P>0.05);生存组患者入院第3、5天血清CXCL12水平降低,差异有统计学意义(P均<0.01)。与死亡组患者比较,生存组患者入院第1天APACHEⅡ评分差异无统计学意义(P>0.05);生存组患者入院第3、5天APACHEⅡ评分降低,差异均有统计学意义(P<0.01)。Pearson相关分析表明LCR与APACHEⅡ评分呈负相关(r值为-0.821,P<0.05);第1、3、5天血清CXCL12水平与APACHEⅡ评分均为正相关[r值分别为0.906(P<0.01)、0.795(P<0.01)和0.855(P<0.01)]。LCR的最佳截断值为10.00%,敏感度为83.8%,特异度为74.6%。第1、3、5天血清CXCL12水平的最佳截断值分别为:293.45、310.28、315.44 pg/mL,敏感度分别为:51.6%、72.9%、82.6%,特异度分别为85.7%、83.4%、75.3%。结论血清CXCL12水平和LCR对老年慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者的预后具有较高的预测价值。Objective To study the clinical value of serum CXCL12 level and arterial lactate clearance rate(LCR) in predicting the prognosis of elderly patients with chronic obstructive pulmonary disease(COPD) and respiratory failure. Methods One hundred elderly patients with COPD and type II respiratory failure admitted to the Department of Respiratory Critical Care Medicine of Zhuozhou Hospital from December 2017 to December 2018 were selected as the study subjects. According to the prognosis of 28 days after treatment, the patients were divided into survival group(67 cases) and death group(33 cases). The level of lactate in arterial blood was detected immediately after diagnosis and admission. The LCR of arterial blood was calculated after 6 hours re-detection. Fasting venous blood was collected on the 1 st, 3 rd and 5 th day of admission, and serum chemokine CXCL12 level was detected by ELISA, and APACHE II score was given to the patients. The differences of LCR, CXCL12 levels and APACHE II scores between the two groups were compared. Pearson correlation analysis was used to evaluate the correlation between LCR, serum CXCL12 levels and APACHE II scores, and analyze the clinical value of serum CXCL12 levels and LCR in predicting the prognosis of patients. Results The LCR of the survival group was higher than that of the death group after 6 hours of admission(P<0.01). Compared with the death group, there was no significant difference in the serum CXCL12 level on the 1 st day of admission in the survival group(P>0.05);the serum CXCL12 level decreased on the 3 rd and 5 th day of admission in the survival group(P<0.01). Compared with the death group, the APACHE II score of the survival group had no significant difference on the 1 st day of admission(P>0.05);the APACHE II score of the survival group decreased on the 3 rd and 5 th day of admission(P<0.01). Pearson correlation analysis showed that LCR was negatively correlated with APACHE II score, with R value of-0.821(P<0.05);serum CXCL12 level was positively correlated with A

关 键 词：老年慢性阻塞性肺疾病 呼吸衰竭 血清CXCL12 乳酸清除率 

分 类 号：R563[医药卫生—呼吸系统]