血清炎性反应、凝血功能及血气指标在AECOPD患者预后评估中的价值  

Value of serum inflammation,coagulation function and blood gas index in the prognostic evaluation of patients with AECOPD exacerbation

作　　者：陈慧芬 谢艳萍[1] CHEN Huifen;XIE Yanping(Department of Respiratory and Critical Care Medicine,Huzhou First People's Hospital,Zhejiang,Huzhou 313000,China)

机构地区：[1]湖州市第一人民医院呼吸与危重症医学科,浙江湖州313000

出　　处：《中国现代医生》2022年第26期14-17,共4页China Modern Doctor

基　　金：2017年度浙江省公益性技术应用研究实验动物计划(2017C37103)。

摘　　要：目的探讨分析血清炎性反应、凝血功能及血气指标在慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者预后评估中的价值。方法选取2019年12月至2021年12月湖州市第一人民医院呼吸与危重症医学科收治的AECOPD患者892例,根据入院后28d内的存活情况分为存活组(n=705)和死亡组(n=187),比较两组患者的血清炎性反应指标[降钙素原(procalcitonin,PCT)、C反应蛋白(C reactive protein,CRP)、白细胞(white blood cell,WBC)计数]、凝血功能(D-二聚体、血浆黏度、血浆纤维蛋白)、血气指标[动脉血氧分压(partial pressure of arterial oxygen,PaO_(2))、动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))、pH值]的差异,分析这些指标在患者预后评估中的价值。结果比较两组患者的PCT、CRP、WBC、D-二聚体、血浆黏度、血浆纤维蛋白、PaO_(2)、PaCO_(2)、pH值等指标,死亡组的PCT、CRP、WBC、D-二聚体、血浆黏度、血浆纤维蛋白、PaCO_(2)明显高于存活组,而死亡组的PaO_(2)和pH值明显低于存活组,差异均有统计学意义(P<0.05)。血清炎性反应(PCT、CRP、WBC)、凝血功能(D-二聚体、血浆黏度、血浆纤维蛋白)及血气(PaO_(2)、PaCO_(2)、pH值)指标对AECOPD预后均具有较好的评估价值,曲线下面积(area under the curve,AUC)分别为0.806、0.744、0.720、0.831、0.676、0.822、0.867、0.863、0.632,其中PaO_(2)预测AECOPD预后的价值最高(AUC=0.867,P<0.001)。结论血清炎性反应、凝血功能及血气指标对AECOPD患者的预后具有较好的评估作用,加强对血清炎性反应、凝血功能及血气指标的检测,对临床医生及早采取防治措施具有重要意义。Objective To explore the value of serum inflammation,coagulation function and blood gas indexes in the prognosis assessment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 892 AECOPD patients admitted to Department of Respiratory and Critical Care Medicine of Huzhou First People’s Hospital from December 2019 to December 2021 were enrolled in this study.The prognosis was divided into survival group(n=705)and death group(n=187)according to the survival within 28 days after admission.The differences in serum inflammatory indexes[procalcitonin(PCT),C reactive protein(CRP),white blood cell(WBC)count],coagulation function(D-dimer,plasma viscosity,plasma fibrinogen),blood gas indexes[partial pressure of arterial oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),and pH value]between the two groups were compared.Analyze the value of these indicators in the prognosis evaluation of patients.Results Compared PCT,CRP,WBC,D-dimer,plasma viscosity,plasma fibrin,PaO_(2),PaCO_(2),pH value between the two groups of patients.The PCT,CRP,WBC,D-dimer,plasma viscosity,plasma fibrin,and PaCO_(2) of the death group were significantly higher than those of the survival group,while the PaO_(2) and pH value of the death group were significantly lower than that of the survival group,and all differences were statistically significant(P<0.05).Serum inflammation(PCT,CRP,WBC),coagulation function(D-dimer,plasma viscosity,plasma fibrin)and blood gas(PaO_(2),PaCO_(2),pH value)indicators have good evaluation value for the prognosis of AECOPD,area under the curve(AUC)were 0.806,0.744,0.720,0.831,0.676,0.822,0.867,0.863,0.632 respectively,among which PaO_(2) predict AECOPD has the highest prognostic value(AUC=0.867,P<0.001).Conclusions Serum inflammation,coagulation function and blood gas indexes have a good evaluation value for the prognosis of AECOPD patients.

关 键 词：炎性反应 凝血 血气 慢性阻塞性肺疾病急性加重期 相关性 

分 类 号：R563.9[医药卫生—呼吸系统]