AECOPD合并Ⅱ型呼吸衰竭无创机械通气治疗患者血清APC、HO-1水平的临床意义研究  

Clinical significance of serum APC and HO-1 levels in patients with AECOPD with typeⅡrespiratory failure treated with non-invasive mechanical ventilation

作　　者：吕林[1] 沈春鹦 刘丽 刘建红[1] 王海霞[1] LYU Lin;SHEN Chunying;LIU Li;LIU Jianhong;WANG Haixia(Department of Respiratory,Panzhihua Second People′s Hospital,Panzhihua,Sichuan 617000,China)

机构地区：[1]攀枝花市第二人民医院呼吸科,四川攀枝花617000

出　　处：《国际检验医学杂志》2024年第24期2961-2966,共6页International Journal of Laboratory Medicine

基　　金：四川省医学(青年创新)科研课题(Q20050)。

摘　　要：目的探究急性加重期慢性阻塞性肺疾病(AECOPD)合并Ⅱ型呼吸衰竭无创机械通气(NIV)治疗患者血清活化蛋白C(APC)、血红素氧合酶-1(HO-1)水平的临床意义。方法选取2021年4月至2023年4月该院收治的265例AECOPD合并Ⅱ型呼吸衰竭NIV治疗患者为研究组,另选取同期200例稳定期慢性阻塞性肺疾病(COPD)患者及200例体检健康者作为稳定期COPD组、健康组,比较3组血清APC、HO-1水平。研究组接受NIV治疗后,根据其28 d内预后情况分为预后不良组(40例)和预后良好组(225例),比较两组一般资料、实验室指标及血清APC、HO-1水平。采用多因素Logistic回归模型分析预后不良的影响因素;采用受试者工作特征(ROC)曲线分析血清APC、HO-1预测患者预后的效能。结果相较于健康组,稳定期COPD组和研究组血清APC水平降低,HO-1水平升高(P<0.05);相较于稳定期COPD组,研究组血清APC水平降低,HO-1水平升高(P<0.05)。与预后良好组比较,预后不良组血清APC、pH、NIV前动脉血氧分压(PaO2)降低,HO-1、动脉血二氧化碳分压(PaCO_(2))、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分升高(P<0.05)。多因素Logistic回归模型结果显示,PaCO_(2)、APACHEⅡ评分、HO-1升高是患者预后不良的危险因素(P<0.05),第1秒用力呼气容积占预计值百分比(FEV_(1)%)、第1秒用力呼气容积/用力肺活量(FEV_(1)/FVC)、PaO2、APC、pH升高为其保护因素(P<0.05);绘制ROC曲线发现,两项指标联合检测预测AECOPD合并Ⅱ型呼吸衰竭NIV治疗患者预后不良的曲线下面积、灵敏度、特异度依次为0.914、87.50%、94.22%,明显优于单项指标检测。结论血清APC水平降低、HO-1水平升高与AECOPD合并Ⅱ型呼吸衰竭NIV治疗患者的预后不良有关,血清APC联合HO-1检测对于上述患者的预后不良有较高的预测价值。Objective To explore the clinical significance of serum activated protein C(APC)and heme oxygenase-1(HO-1)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with typeⅡrespiratory failure treated with non-invasive mechanical ventilation(NIV).Methods A total of 265 AECOPD patients with typeⅡrespiratory failure admitted to the Second People′s Hospital of Panzhihua City from April 2021 to April 2023 were selected as the study group,and another 200 stable chronic obstructive pulmonary disease(COPD)patients and 200 healthy individuals were selected as the stable COPD group and healthy group.The serum APC and HO-1 levels of the three groups were compared.After receiving NIV treatment,the study group was divided into a poor prognosis group(40 cases)and a good prognosis group(225 cases)based on their prognosis within 28 days.General information,laboratory indicators,and serum APC and HO-1 levels were compared between the two groups.Multivariate Logistic regression model was used to analyze the influencing factors of poor prognosis.Receiver operating characteristic(ROC)curve was used to analyze the efficacy of serum APC and HO-1 in predicting patient prognosis.Results Compared with the healthy group,serum APC levels decreased in the stable COPD group,serum HO-1 levels increased(P<0.05).Compared with the stable COPD group,serum APC levels decreased in the study group,serum HO-1 levels increased(P<0.05).Compared with the good prognosis group,serum APC,pH,arterial oxygen partial pressure(PaO 2)before NIV decreased in the poor prognosis group,serum HO-1,arterial partial pressure of carbon dioxide(PaCO_(2))levels,acute physiology and chronic health evaluation(APACHE)Ⅱscores increased(P<0.05).The results of the multivariate Logistic regression model showed that PaCO_(2),APACHEⅡscore and HO-1 elevated were risk factors for poor patient prognosis,while the Forced Expiratory Volume in 1 Second/excepted value(FEV_(1)%Pred),forced expiratory volume in the first second/forced vital capacity(F

关 键 词：慢性阻塞性肺疾病急性加重期 Ⅱ型呼吸衰竭 无创机械通气 活化蛋白C 血红素氧合酶-1 

分 类 号：R446.1[医药卫生—诊断学]