GSH-Px、TLR4与NPPV治疗AECOPD效果的关系  

Association of GSH-Px and TLR4 with the therapeutic effect of NPPV on treating AECOPD

作　　者：刘元元 李毅[1] 曾建明[1] 曾春芳[1] LIU Yuanyuan;LI Yi;ZENG Jianming;ZENG Chunfang(Department of Respiratory and Critical Care Medicine,Deyang People's Hospital,Deyang 618000,Sichuan,China)

机构地区：[1]德阳市人民医院呼吸与危重症医学科,四川德阳618000

出　　处：《贵州医科大学学报》2024年第10期1555-1560,共6页Journal of Guizhou Medical University

基　　金：四川省卫生健康委员会科研课题(19PJ046)。

摘　　要：目的探讨血清谷胱甘肽过氧化物酶(GSH-Px)及Toll样受体-4(TLR4)与无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者效果的关系。方法NPPV治疗的162例AECOPD患者,根据治疗第7天时的疗效分为预后良好组(100例)和预后不良组(62例);比较2组患者治疗第1、第3及第7天时的血清GSH-Px、TLR4水平,分析预后不良患者治疗第7天时血清GSH-Px及TLR4水平与血气指标、急性生理与慢性健康(APACHEⅡ)评分的相关性,采用logistic回归模型分析NPPV治疗AECOPD预后不良的影响因素。结果在治疗第1、第3及第7天时,预后良好组患者的GSH-Px水平逐渐升高,预后不良组的GSH-Px水平逐渐降低,差异具有统计学意义(P<0.05);在治疗第3和第7天时,预后良好组患者的TLR4水平逐渐降低,预后不良组的TLR4水平逐渐升高,差异具有统计学意义(P<0.05);预后不良组患者的血清GSH-Px水平与APACHEⅡ评分呈显著负相关关系(P<0.05),血清GSH-Px水平与PaO_(2)、pH、SaO_(2)呈显著正相关关系(P<0.05);预后不良组患者的TLR4水平与PaO2、pH呈显著负相关关系(P<0.05);年龄增大、APACHEⅡ评分及TLR4升高和合并冠心病是AECOPD患者NPPV治疗失败的独立危险因素(P<0.05);PaO_(2)、pH值(7.20~7.45)、SaO_(2)、ALB及GSH-Px升高是AECOPD患者NPPV治疗有效的保护性因素(P<0.05)。结论GSH-Px、TLR4与NPPV治疗AECOPD患者的疗效预后有关,与NPPV治疗失败患者的血气水平、APACHEⅡ评分有关。Objective To explore the association of serum glutathione peroxidase(GSH-Px)and toll-like receptor 4(TLR4)with the therapeutic effect of non-invasive positive pressure ventilation(NIPPV)on treating acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 162 AECOPD patients treated with NPPV were divided into a good prognosis group(100 cases)and a poor prognosis group(62 cases)based on the efficacy on the 7 th day of treatment.Serum GSH-Px and TLR4 levels were compared between two groups on the 1 st,3 rd,and 7 th days of treatment.The associations of serum GSH Px level,TLR4 level with blood gas indicators and acute physiology and chronic health evaluation(APACHEⅡ)score were analyzed in patients with poor prognosis on the 7 th day of treatment.Logistic regression model was used to analyze the influencing factors of poor prognosis in AECOPD patients treated with NPPV.Results On the 1 st,3 rd,and 7 th days of treatment,GSH-Px level of the patients with good prognosis was gradually increased,while GSH-Px level of those with poor prognosis was gradually decreased(P<0.05).On the 3 rd and 7 th days of treatment,TLR4 level of the patients with good prognosis was gradually decreased,while TLR4 level of those with poor prognosis was gradually increased(P<0.05).Serum GSH-Px level in patients with poor prognosis was significantly negatively correlated with APACHE II score(P<0.05),positively correlated with PaO_(2),pH and SaO_(2)(P<0.05).TLR4 level in patients with poor prognosis was significantly negatively correlated with PaO_(2)and pH(P<0.05).Age increase,APACHEⅡscore,TLR4 elevation and concomitant coronary heart disease were independent risk factors for NPPV treatment failure in the patients with AECOPD(P<0.05).The elevation of PaO_(2),pH value(7.20-7.45),SaO_(2),ALB and GSH-Px were effectively protective factors for NPPV treatment in the patients with AECOPD(P<0.05).Conclusion GSH-Px,TLR4 are associated with the efficacy and prognosis of NPPV treatment in AECOPD patients,and are related

关 键 词：谷胱甘肽过氧化物酶 TOLL样受体-4 无创正压通气 慢性阻塞性肺疾病 急性加重期 预后 

分 类 号：R563.9[医药卫生—呼吸系统]