血清降钙素原、D-二聚体、诱骗受体3对无创通气治疗慢性阻塞性肺疾病急性加重合并呼吸衰竭患者预后的评估价值分析  

Predictive value of serum procalcitonin,D-dimer and decoy receptor 3 for prognosis of patients with AECOPD and respiratory failure undergoing non-invasive ventilation

作　　者：王育林[1] 万俊[1] 李雪翔[1] 周姝[1] WANG Yulin;WAN Jun;LI Xuexiang;ZHOU Shu(Department of Emergency Medicine,The Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,P.R.China)

机构地区：[1]安徽医科大学第二附属医院急诊内科,安徽合肥230601

出　　处：《中国呼吸与危重监护杂志》2023年第3期153-158,共6页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探究血清降钙素原(procalcitonin,PCT)、D-二聚体(D-dimer,D-D)、诱骗受体3(decoy receptor 3,DcR3)对无创机械通气(non-invasive ventilation,NIV)治疗慢性阻塞性肺疾病(简称慢阻肺)急性加重合并呼吸衰竭患者预后的评估价值。方法回顾性选取2017年9月—2021年2月在我院行基础治疗与NIV的慢阻肺急性加重合并呼吸衰竭患者95例作为研究对象,根据患者治疗后预后情况分为预后良好组(n=65)和预后不良组(n=30)。收集所有患者一般资料,采用多因素Logistic回归模型分析影响慢阻肺急性加重合并呼吸衰竭患者预后的危险因素。所有研究对象治疗后均分别采用酶联免疫吸附法、胶体金比色法、免疫比浊法分别测定DcR3、PCT和D-D水平,并采用急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评估患者病情,记录动脉血氧分压(partial pressure of arterial oxygen,PaO_(2))和动脉二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2)),比较两组患者以上指标,采用Pearson相关性分析DcR3、PCT、D-D与APACHEⅡ评分、PaO_(2)、PaCO_(2)之间的关系,采用受试者操作特征(receiver operator characteristic,ROC)曲线分析DcR3、PCT、D-D预测NIV治疗慢阻肺急性加重合并呼吸衰竭患者预后的应用价值。结果预后不良组和预后良好组在性别、GOLD分级和合并基础病的比较上无明显差异(P>0.05),在年龄、治疗后DcR3、PCT、D-D、APACHEⅡ评分、PaO_(2)、PaCO_(2)等比较上差异具有统计学意义(P<0.05),预后不良组治疗后DcR3、PCT、D-D、APACHEⅡ评分及PaCO_(2)均高于预后良好组,PaO_(2)低于预后良好组(P<0.05)。Logistic回归分析显示治疗后DcR3≥5.50 ng/mL[优势比(odds ratio,OR)=21.889]、治疗后PCT≥5.00μg/L(OR=3.782)、治疗后D-D≥3.00μg/L(OR=4.162)、治疗后APACHEⅡ评分≥20分(OR=2.540)均为影响慢阻肺急性加重合并呼吸衰竭患者预后的独立危险因素(P<0.05)。PeObjective To explore the predictive value of serum procalcitonin(PCT),D-dimer(D-D)and decoy receptor 3(DcR3)for prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and respiratory failure undergoing non-invasive ventilation(NIV).Methods A total of 95 patients with AECOPD and respiratory failure undergoing basic treatment and NIV in the hospital were retrospectively enrolled between September(n=65)2017 and February 2021.According to prognosis after treatment,they were divided into a good prognosis groupand a poor prognosis group(n=30).The general data of all patients were collected.The influencing factors of prognosiswere analyzed by multivariate logistic regression model.The levels of DcR3,PCT and D-D were detected by enzymelinked immunosorbent assay,colloidal gold colorimetry and immunoturbidimetry.The patients condition was assessed byscores of acute physiology chronic health evaluation scoring systemⅡ(APACHEⅡ).The partial pressure of arterialoxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were recorded.And the above indexes between the twogroups were compared.The relationship between DcR3,PCT,D-D and APACHEⅡscore,PaO_(2),PaCO_(2)was analyzed byPearson correlation analysis.The prognostic value of DcR3,PCT and D-D was analyzed by receiver operatingcharacteristic(ROC)curve.Results There was no significant difference in gender,GOLD grading or underlying diseasesbetween the poor prognosis group and the good prognosis group(P>0.05),but there were significant differences in age,DcR3,PCT,D-D,APACHEⅡscore,PaO_(2)and PaCO_(2)after treatment(P<0.05).DcR3,PCT,D-D,APACHEⅡscore andPaCO_(2)in the poor prognosis group were higher than those in the good prognosis group,while PaO_(2)was lower than that inthe good prognosis group(P<0.05).Logistic regression analysis showed that DcR3≥5.50 ng/mL(OR=21.889),PCT≥5.00μg/L(OR=3.782),D-D≥3.00μg/L(OR=4.162)and APACHEⅡscore≥20 points(OR=2.540)were all influencingfactors of prognosis(P<0.05).The results of Pea

关 键 词：慢性阻塞性肺疾病 降钙素原 D-二聚体 诱骗受体3 无创通气 呼吸衰竭 预后 

分 类 号：R563.9[医药卫生—呼吸系统]