血清胆碱酯酶活性及超敏C反应蛋白对鉴别COPD合并CAP与AECOPD的临床意义  

Clinical significance of serum cholinesterase activity and hypersensitivity C reaction protein for the identification of COPD combined with CAP and AECOPD

作　　者：侯琳琳 景琴 付爱双 闵沛 刘洋 孙晔 戈艳蕾 Hou Linlin;Jing Qin;Fu Aishuang(Department of Respiratory Medicine,Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,China)

机构地区：[1]华北理工大学附属医院呼吸内科,河北唐山063000

出　　处：《华北理工大学学报（医学版）》2022年第3期196-203,共8页Journal of North China University of Science and Technology：Health Sciences Edition

基　　金：河北省卫生厅课题(编号:20160221);白求恩医学科学研究基金(编号:SCZ316FN)。

摘　　要：目的探索血清胆碱酯酶(CHE)活性及超敏C反应蛋白(hs-CRP)水平在鉴别慢性阻塞性肺疾病急性加重期(AECOPD)与慢性阻塞性肺疾病(COPD)合并社区获得性肺炎(CAP)中临床意义。方法选取2019年4月~2020年4月于华北理工大学附属医院呼吸内科住院并确诊为COPD的患者334例为研究对象,根据患者胸部影像学检查将其分为COPD合并CAP组(观察组)111例、单纯AECOPD组(对照组)223例,对比两组患者性别、年龄、既往病史、白细胞计数(WBC)、中性粒细胞(NE)、淋巴细胞(LY)、降钙素原(PCT)、hs-CRP、中性粒细胞与淋巴细胞比值(NLR)及CHE活性,对两组间有统计学意义的指标进行二元Logistic回归分析,并制作受试者工作特征(ROC)曲线,评价具有临床意义的指标对COPD合并CAP的诊断效能。结果两组间的一般资料对比,单因素分析提示男性COPD患者较女性更易合并CAP(P<0.05),调整混杂因素后,多因素分析提示年龄、性别差异均无统计学意义(P>0.05),具有可比性。观察组的CHE活性较对照组明显降低(P<0.05),hs-CRP水平显著高于对照组。CHE活性对诊断COPD合并CAP的ROC曲线下面积(AUC)为0.957(95%CI:0.997~0.999)、灵敏度为91%、特异度89%;hs-CRP诊断COPD合并CAP的AUC为0.923(95%CI:0.893~0.953)、灵敏度为92%、特异度为85%,两指标联合的AUC为0.965(95%CI:0.948~0.982),其灵敏度为93%、特异度89%。结论hs-CRP、CHE活性对COPD合并CAP均具有良好的诊断预测价值。Objective Exploring the clinical significance of serum cholinesterase(CHE)activity and hypersensitivity C reactive protein(hs-CRP)levels in identifying patients with acute aggravation of chronic obstructive pulmonary disease(AECOPD)with chronic obstructive pulmonary disease(COPD)combined with community-acquired pneumonia(CAP).Methods A total of 334 patients hospitalized in the Department of Respiratory of North China University of Technology in April 2020 were selected as study subjects,divided into 111 patients with COPD with CAP and 223 with AECOPD without pneumonia based on chest imaging,General data of patients were compared between the two groups:gender,age,previous medical history,and inflammation index:white blood cell(WBC)、neutrophile granulocyte(NE)、leukomonocyte(LY)number、Calcitonin(PCT)、Hypersensitivity to the C reaction protein(hs-CRP)、The ratio of neutropils to lymphocytes(NLR)、With the difference in CHE activity,binary Logistic regression was analyzed on the statistically significant indicators between the two groups and the working characteristics of the subjects(ROC)curves to evaluate the diagnostic efficacy of clinically meaningful indicators on COPD with CAP.Results Comparing the general data between the two groups,univariate analysis suggested that male COPD patients were more likely to have CAP than women(P<0.05),After adjusting for confounding factors,multivariate analysis indicated that age and sex differences were not significant(P>0.05),which was comparable.CHE activity was significantly reduced in COPD with the CAP group compared with AECOPD alone without pneumonia,hs-CRP levels were significantly higher than in the AECOPD group without pneumonia alone(P<0.05),According to the subject working characteristics(ROC)curve,the area under the curve(AUC)for the diagnosis of COPD with CAP was 0.957(95%CI:0.997~0.999),sensitivity of 91%and 89%specificity,and the area under the curve(AUC)of hs-CRP COPD diagnosis with CAP was 0.923(95%CI:0.893~0.953),sensitivity of 92%and 85%specificity,

关 键 词：慢性阻塞性肺疾病急性加重期 胆碱酯酶 超敏C反应蛋白 社区获得性肺炎 

分 类 号：R54[医药卫生—心血管疾病]