外周血CC16、EOS及CRP水平与慢阻肺急性加重患者病情程度及预后的关系  

Correlation of peripheral blood CC16,EOS and CRP levels with the severity and prognosis of acute exacerbation of chronic obstructive pulmonary disease

作　　者：任宝恒 杨丽娟 REN Baoheng;YANG Lijuan(Department of Respiratory and Critical Care Medicine,Hospital No 3201,Hanzhong Shaanxi 723000,China)

机构地区：[1]三二○一医院呼吸与危重症医学科,陕西汉中723000 [2]安康市人民医院检验科,陕西安康725000

出　　处：《中国急救复苏与灾害医学杂志》2022年第12期1622-1625,1668,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：陕西省重点研发计划项目(编号:2021SF-044)。

摘　　要：目的探究外周血Clara细胞分泌蛋白(CC16)、嗜酸性粒细胞(EOS)及C反应蛋白(CRP)水平与慢性阻塞性肺疾病急性加重(AECOPD)患者病情程度及预后的关系。方法选取2021年1月—2021年12月汉中三二○一医院收治的208例慢阻肺急性加重患者为研究对象,依据病情严重程度分为轻度95例、中度72例和重度41例。对比不同严重程度AECOPD患者外周血CC16、EOS及CRP水平。统计住院28 d后AECOPD患者预后生存情况,并依据是否存活分为死亡组和生存组。对比死亡组和生存组患者的临床资料。Logistic多因素回归分析影响AECOPD患者预后的因素。制作受试者工作特征曲线(ROC),以曲线下面积(AUC)评价外周血CC16、EOS及CRP对AECOPD患者住院后28 d死亡的预测价值。结果中度、重度组外周血CC16、EOS水平均明显低于轻度组(P<0.05),重度组AECOPD患者血浆CC16、EOS水平明显低于中度组(P<0.05);中度、重度AECOPD患者CRP水平均明显高于轻度组(P<0.05),重度组CRP水平明显高于中度组(P<0.05)。AECOPD患者住院28 d后死亡发生率为20.19%。死亡组患者机械通气占比、AECOPD病情为重度占比、肿瘤坏死因子-α(TNF-α)、活化部分凝血活酶时间(APTT)、白蛋白及CRP水平均高于存活组(P<0.05),FEV1/FVC、外周血CC16、EOS水平则低于存活组(P<0.05)。Logistic回归分析结果显示,AECOPD病情为重度、外周血CC16、EOS及CRP均为影响AECOPD患者预后的独立危险因素(OR=2.815、3.010、3.582、3.264,P<0.05)。ROC分析显示,外周血CC16、EOS及CRP对AECOPD患者预后预测的最佳截断点分别为70.32μg/L、3.15%、69.46 g/L,三者联合的特异度为98.80%,高于外周血CC16、EOS及CRP单独进行评估的特异度,且外周血CC16、EOS及CRP三者联合预测AECOPD患者预后死亡的AUC为0.892,高于外周血CC16、EOS及CRP单独预测的AUC(P<0.05)。结论外周血CC16、EOS及CRP与AECOPD患者病情严重程度存在一定的相关性,且三者联合对AECOPD�Objective To explore the relationship between the levels of Clara cell secretory protein(CC16),eosinophils(EOS),and C-reactive protein(CRP)in peripheral blood and the severity and prognosis of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Peripheral fasting venous blood samples were collected from 208 patients with AECOPD,95 in mild condition,72 in moderate condition,and 41 in severe condition,to detect CC16 and CRP by ELISA,and EOS by fully automatic hematology analyzer.Relevant clinical data were collected.All patients were followed up for 28 days and divided into 2 groups:survival group(n=166)and death group(n=42).Logistic multivariate regression analysis was used to analyze the factors affecting the prognosis of AECOPD.A receiver operating characteristic curve(ROC)was made,and the area under the curve(AUC)was used to evaluate the predictive values of peripheral blood CC16,EOS and CRP on theprognosis of AECOPD.Results The levels of CC16 and EOS in peripheral blood ofthe moderate and severe groups were all significantly lower than those ofthe mild group(all P<0.05),and the levels of CC16 and EOS in plasma in the severe group were both significantly lower than those ofthe moderate group(both P<0.05);.The CRP levels in moderate and severe groups were significantly higher than that in the mild group(both P<0.05),and the CRP level ofthe severe group was significantly higher than that of the moderate group(P<0.05).The mortality of AECOPD patients 28 days after hospitalization was 20.19%.The proportions of mechanical ventilation and severe AECOPD condition,and the levels of tumor necrosis factor-α(TNF-α),activated partial thromboplastin time(APTT),albumin,and CRP of the survival group were all significantly higher than those of the survival group(all P<0.05),while the levels of forced expiratory volume in the first second/forced vital capacity,CC16,and EOS in peripheral blood of the death group were all significantly lower than those of the survival group(all P<0.05).Logistic multivari

关 键 词：慢性阻塞性肺疾病 CLARA细胞分泌蛋白 嗜酸性粒细胞 C反应蛋白 预后 

分 类 号：R563.3[医药卫生—呼吸系统]