COPD合并Ⅱ型呼吸衰竭治疗前后血清CysC与β_(2)-MG水平和血气指标变化及其临床意义  

Changes and Clinical Significances of Levels of Serum CysC and β_(2)-MG and Blood Gas Indexes Before and After Treatment of COPD with TypeⅡRespiratory Failure

作　　者：罗丽[1] 罗立 LUO Li;LUO Li(Department of Respiratory and Critical Care Medicine,First People’s Hospital of Longquanyi District,Chengdu 610100,China;Department of Respiratory and Critical Care Medicine,Second Affiliated Hospital of Chengdu Medical College,Nuclear Industry 416 Hospital,Chengdu 610000,China)

机构地区：[1]成都市龙泉驿区第一人民医院呼吸与危重症医学科,四川成都610100 [2]成都医学院第二附属医院核工业四一六医院呼吸与危重症医学科,四川成都610000

出　　处：《标记免疫分析与临床》2022年第4期661-665,710,共6页Labeled Immunoassays and Clinical Medicine

摘　　要：目的探究慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭治疗前后血清胱抑素C(CysC)与β_(2)微球蛋白(β_(2)-MG)水平和血气指标变化及其临床意义。方法回顾性分析2016年6月至2020年6月于我院接受治疗的121例频繁急性加重表型COPD合并Ⅱ型呼吸衰竭患者的临床资料,均给予常规治疗,比较其治疗前后的血清CysC、β_(2)-MG及血气指标[pH值、动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))]变化;采用Pearson相关分析COPD合并Ⅱ型呼吸衰竭患者CysC与β_(2)-MG水平和血气指标之间的相关性。根据其治疗28 d死亡率,将所有患者分为有效组及无效组,比较两组血清CysC与β_(2)-MG水平,采用Spearman相关分析COPD合并Ⅱ型呼吸衰竭患者血清CysC与β_(2)-MG水平与疗效的相关性,作受试者工作特征(ROC)曲线并计算曲线下面积(AUC)分析血清CysC与β_(2)-MG水平预测患者死亡的临床价值。结果COPD合并Ⅱ型呼吸衰竭患者经治疗后其血清CysC、β_(2)-MG、PaCO_(2)水平明显下降,而pH值、PaO_(2)、SaO_(2)水平明显上升(P<0.05);经Pearson相关分析,COPD合并Ⅱ型呼吸衰竭患者血清CysC水平与pH值、PaO_(2)、PaCO_(2)、SaO_(2)指标均无相关性(P>0.05),而β_(2)-MG水平与PaO_(2)指标具有负相关性(P<0.05),与PaCO_(2)具有正相关性(P<0.05),与pH值、SaO_(2)无相关性(P>0.05)。治疗后,有效组患者血清CysC、β_(2)-MG水平明显低于无效组(P<0.05);经Spearman相关分析,COPD合并Ⅱ型呼吸衰竭患者治疗前血清CysC、β_(2)-MG水平与临床疗效均具有负相关性(P<0.05);治疗前血清CysC、β_(2)-MG及两者联合预测COPD合并Ⅱ型呼吸衰竭患者死亡的AUC分别为0.841、0.744和0.890。结论频繁急性加重表型COPD合并Ⅱ型呼吸衰竭患者经常规治疗后其血清CysC、β_(2)-MG水平明显下降,且与血气指标具有一定关联,可作为临床疗效预测指标。Objective To explore the changes and clinical significance of levels of serum cystatin C(CysC)andβ_(2)-microglobulin(β_(2)-MG)and blood gas indexes before and after treatment of chronic obstructive pulmonary disease(COPD)with typeⅡrespiratory failure.Methods A retrospective analysis was performed on clinical data of 121 patients with frequent acute exacerbation of COPD complicated with typeⅡrespiratory failure who were treated in our hospital from June,2016 to June,2020.These patients were given conventional treatment,and changes of serum CysC,β_(2)-MG and blood gas indexes[pH value,arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),and arterial oxygen saturation(SaO_(2))]were compared before and after treatment.Pearson correlation analysis was used to analyze the correlation between levels of CysC andβ_(2)-MG and blood gas indexes in COPD patients with typeⅡrespiratory failure.According to the 28d mortality rate,all patients were divided into the effective group and ineffective group.Levels of serum CysC andβ_(2)-MG were compared between the two groups.Spearman correlation analysis was used to analyze the correlation between levels of serum CysC andβ_(2)-MG and efficacy of COPD with typeⅡrespiratory failure.Receiver operating characteristic(ROC)curve was drawn and area under the curve(AUC)was calculated to analyze the clinical value of levels of serum CysC andβ_(2)-MG on predicting the death of patients.Results Levels of serum CysC,β_(2)-MG and PaCO_(2)of COPD patients with typeⅡrespiratory failure were decreased significantly after treatment,while the pH value,PaO_(2)and SaO_(2)were increased significantly(P<0.05).According to Pearson correlation analysis,level of serum CysC of COPD patients with typeⅡrespiratory failure was not correlated with PH value,PaO_(2),PaCO_(2)and SaO_(2)(P>0.05),whileβ_(2)-MG level was negatively correlated with PaO_(2)(P<0.05),and was positively correlated with PaCO_(2)(P<0.05),but was not correlated with pH value and SaO_(2

关 键 词：慢性阻塞性肺疾病 Ⅱ型呼吸衰竭 胱抑素C β_(2)微球蛋白 血气指标 临床意义 疗效 

分 类 号：R563.8[医药卫生—呼吸系统]