老年慢性阻塞性肺疾病急性加重期患者血清降钙素原、D-二聚体水平表达的临床意义及对乙酰半胱氨酸雾化治疗预后的影响  

Clinical Significance of Expression of Serum Procalcitonin and D-Dimer Levels in Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Its Effects on The Prognosis of Acetylcysteine Nebulizer Therapy

作　　者：姜艳霞[1] 刘艳娇 崔本科 罗义[1] JIANG Yanxia;LIU Yanjiao;CUI Benke;LUO Yi(Dept.of Respiratory Medicine,the People’s Hospital of Liaoning Province,Shenyang 110000,China)

机构地区：[1]辽宁省人民医院呼吸内科,沈阳110000

出　　处：《中国医院用药评价与分析》2022年第2期147-150,154,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：辽宁省自然科学基金项目(No.20170540561)。

摘　　要：目的:探讨老年慢性阻塞性肺疾病急性加重期(AECOPD)患者血清降钙素原(PCT)、D-二聚体(D-D)水平表达的临床意义及对乙酰半胱氨酸雾化治疗预后的影响。方法:选择2018年2月至2020年2月该院收治的老年AECOPD患者100例,入院时记录患者的基线资料,测定并记录血清指标(PCT、D-D);接受乙酰半胱氨酸雾化治疗,5 d为1个疗程,连续治疗2个疗程。全部患者均于出院后接受为期1年的随访,依据随访结果分为预后不良组[频繁急性加重(即急性加重频次≥1年2次)]和预后良好组(无频繁急性加重),比较两组患者的基线资料及血清指标,重点分析老年AECOPD患者治疗前血清PCT、D-D水平对预后的影响。结果:治疗完成后随访1年,100例老年AECOPD患者中有47例频繁急性加重,预后不良发生率为47.00%。预后不良组患者的肺功能Gold分级高于预后良好组,第1秒用力呼气容积、动脉血氧分压低于预后良好组,肺动脉收缩压、动脉血二氧化碳分压、PCT和D-D水平高于预后良好组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,PCT、D-D水平与老年AECOPD患者乙酰半胱氨酸雾化治疗预后不良有关(P<0.05),PCT、D-D水平升高是老年AECOPD患者乙酰半胱氨酸雾化治疗预后不良的影响因素(OR>1,P<0.05);ROC曲线图显示,入院时血清PCT、D-D单独及联合预测老年AECOPD患者乙酰半胱氨酸雾化治疗预后不良的AUC分别为0.711、0.708及0.754,均有一定预测价值。结论:老年AECOPD患者血清PCT、D-D水平表达能预测乙酰半胱氨酸雾化治疗预后不良,PCT、D-D水平升高增加了老年AECOPD患者乙酰半胱氨酸雾化治疗预后不良风险。OBJECTIVE: To probe into the clinical significance of expression of serum procalcitonin(PCT) and D-dimer(D-D) levels in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and the effect of aerosol treatment with acetylcysteine on prognosis. METHODS: Totally 100 elderly patients with AECOPD admitted into this hospital from Feb. 2018 to Feb. 2020 were selected as study subjects, the baseline data were recorded when admission, the serum parameters(PCT, D-D) were also measured and recorded, and patients were treated with acetylcysteine nebulizer for 2 courses(5 days as a course of treatment). All patients were followed up for 1 year after discharge, and were divided into poor prognosis group[frequent acute exacerbations(the frequency of acute exacerbations ≥twice a year)] and favourable prognosis group(no frequent acute exacerbations) based on the results of follow-up visit, the baseline data and serum indicators of the two groups were compared to emphatically analyze the effects of serum PCT and D-D levels on the prognosis in elderly patients with AECOPD before treatment. RESULTS: At one-year follow-up after treatment, 47 of 100 elderly patients with AECOPD had frequent acute exacerbations, with the incidence of poor prognosis was 47.00%. Patients in the poor prognosis group had higher lung function Gold grade, lower forced expiratory volume in 1 s and arterial partial pressure of oxygen, higher pulmonary artery systolic pressure, arterial partial pressure of carbon dioxide, PCT and D-D levels than those of the favourable prognosis group, with statistically significant differences(P<0.05). Results of logistic regression analysis indicated that PCT and D-D were associated with poor prognosis of acetylcysteine nebulizer therapy in elderly patients with AECOPD(P<0.05), elevated PCT and D-D were the influence factors of poor prognosis of acetylcysteine nebulizer therapy in elderly patients with AECOPD(OR>1, P<0.05);plotting ROC curves showed that the AUC for serum PCT and D-D alo

关 键 词：慢性阻塞性肺疾病急性加重期 乙酰半胱氨酸 降钙素原 D-二聚体 

分 类 号：R974[医药卫生—药品]