动态监测脑利尿钠肽、D-二聚体、血清白蛋白与球蛋白比值对慢性阻塞性肺疾病急性加重期患者预后的预测意义  

Prognostic significance of dynamic monitoring of B-type natriuretic peptide, D-dimer, and serum albumin to globulin ratio in patients with acute exacerbations of chronic obstructive pulmonary disease

作　　者：王丹平[1] 孟凡亮[1] 朱洪斌[1] 范小玉 颜刚林 WANG Danping;MENG Fanliang;ZHU Hongbin;FAN Xiaoyu;YAN Ganglin(Department of Respiratory and Critical Care,Chaohu Hospital of Anhui Medical University,Anhui Province,Hefei238000,China)

机构地区：[1]安徽医科大学附属巢湖医院呼吸与危重症学科,安徽合肥238000

出　　处：《中国医药导报》2024年第22期120-125,共6页China Medical Herald

基　　金：安徽省教育部高等学校科技研究项目(KJ2018 A0667)。

摘　　要：目的探究血清脑利尿钠肽(BNP)、D-二聚体(D-D)及白蛋白与球蛋白比值(AGR)在预测慢性阻塞性肺疾病急性加重期(AECOPD)患者预后中的价值。方法选取2021年1月至2023年4月于安徽医科大学附属巢湖医院住院治疗的162例AECOPD患者为研究对象,根据其治疗1年内的预后情况将其分为预后不良组(64例)和预后良好组(98例),记录并分析两组一般临床资料,采用多因素logistic回归分析AECOPD患者预后不良的影响因素。结果预后不良组吸烟史占比高于预后良好组(P<0.05);两组入院第7天血清BNP、D-D水平低于第1天,AGR水平高于第1天(P<0.05);入院第1天,预后不良组BNP、D-D水平高于预后良好组,AGR水平低于预后良好组(P<0.05);多因素logistic回归分析结果显示,有吸烟史(OR=4.125,95%CI:1.632~10.428,P=0.003)、入院第1天血清AGR低(OR=0.008,95%CI:0.001~0.071,P<0.001)、BNP高(OR=1.097,95%CI:1.045~1.151,P<0.001)、D-D高(OR=46.669,95%CI:5.374~405.269,P<0.001)是预后不良的主要危险因素;Pearson相关性分析结果显示,入院第1天血清BNP(r=0.376,P<0.001)、D-D水平(r=0.351,P<0.001)与AECOPD患者预后不良呈正相关;入院第1天AGR(r=-0.296,P<0.001)与AECOPD患者预后不良呈负相关;ROC曲线显示,入院第1天血清BNP、D-D、AGR指标联合预测AECOPD患者预后不良的AUC高于各项指标单一预测(P<0.05)。结论动态监测血清BNP、D-D和AGR水平对于AECOPD患者预后的预测具有重要意义,入院初期的血清指标具有早期预测价值。Objective To investigate the value of serum B-type natriuretic peptide(BNP),D-dimer(D-D),and albumin-to-globulin ratio(AGR)in predicting the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 162 patients with AECOPD hospitalized in Chaohu Hospital of Anhui Medical University from January 2021 to April 2023 were selected as the study subjects.They were divided into the poor prognosis group(64 cases)and the good prognosis group(98 cases)based on their prognosis within one year of treatment.The general clinical data of the two groups were recorded and analyzed,and multivariate logistic regression analysis was used to analyze the influencing factors of poor prognosis in AECOPD patients.Results The proportion of patients with a smoking history in the poor prognosis group was higher than that in the good prognosis group(P<0.05).Serum BNP and D-D levels were lower on the 7th day of admission than on the 1st day,and AGR levels were higher than the 1st day(P<0.05).The BNP and D-D levels in the poor prognosis group were higher than those the good prognosis group,while the AGR level was lower than that in the good prognosis group(P<0.05).Multivariate logistic regression analysis identified smoking history(OR=4.125,95%CI:1.632-10.428,P=0.003),low serum AGR(OR=0.008,95%CI:0.001-0.071,P<0.001),and high BNP(OR=1.097,95%CI:1.045-1.151,P<0.001),and high D-D(OR=46.669,95%CI:5.374-405.269,P<0.001)on the first day of admission as major risk factors for poor prognosis.Pearson correlation analysis showed that serum BNP(r=0.376,P<0.001)and D-D level(r=0.351,P<0.001) on the first day of admission were positively correlated with poor prognosis in AECOPD patients, while AGR(r=-0.296, P<0.001) on the first day of admission was negatively associated with poor prognosis in AECOPD patients. ROC curve analysis indicated that the combined prediction of serum BNP, D-D, and AGR levels on the first day of admission for poor prognosis in AECOPD patients had a higher AUC than any single

关 键 词：动态监测 脑利尿钠肽 D-二聚体 血清白蛋白与球蛋白比值 慢性阻塞性肺疾病急性加重期 预测价值 

分 类 号：R563[医药卫生—呼吸系统]