血清降钙素原、磷评估老年慢性阻塞性肺疾病合并呼吸衰竭患者预后的价值  

Prognostic Value of Serum PCT,P in Elderly Patients with COPD Complicated with Respiratory Failure

作　　者：李宁宁 翟展艺 李春苗 李海明 LI Ningning;ZHAI Zhanyi;LI Chunmiao;LI Haiming(Respiratory and Critical Care Medicine Department,Zhumadian Central Hospital,Zhumadian 463000,China)

机构地区：[1]驻马店市中心医院呼吸与危重症医学科,驻马店463000

出　　处：《福建医科大学学报》2024年第6期402-406,共5页Journal of Fujian Medical University

摘　　要：目的探讨血清降钙素原(PCT)、磷(P)评估老年慢性阻塞性肺疾病(COPD)合并呼吸衰竭(RF)患者预后的价值。方法收集2021年2月-2024年2月425例老年COPD合并RF患者的临床资料,包括性别、年龄、体质量指数、糖尿病、冠状动脉粥样硬化性心脏病(冠心病)、高血压病病史、急性生理与慢性健康评分Ⅱ(APACHEⅡ)量表评分、PCT、P、高迁移率族蛋白B1(HMGB1)、心率、呼吸频率、平均动脉压(MAP)和乳酸。根据患者预后分为预后不良组和预后良好组。比较2组患者的临床资料;采用非条件logistic逐步回归分析老年COPD合并RF患者预后不良的危险因素;采用受试者工作特征(ROC)曲线分析APACHEⅡ评分、PCT、P、HMGB1、乳酸单独及联合预测老年COPD合并RF患者预后不良的价值。结果425例患者中,预后不良17例,预后良好408例。预后良好组的APACHEⅡ评分、PCT、HMGB1、乳酸[(16.11±2.97)分、(0.91±0.28)ng/mL、(90.58±9.62)μg/L、(3.56±0.83)mmol/L]显著低于预后不良组[(18.12±3.25)分、(1.72±0.53)ng/mL、(122.74±12.79)μg/L、(4.17±0.95)mmol/L](P<0.05),预后良好组的P[(1.12±0.33)mmol/L]显著高于预后不良组[(0.59±0.17)mmol/L](P<0.05)。多因素logistic逐步回归分析显示,高APACHEⅡ评分、高PCT、低P、高HMGB1、高乳酸水平是老年COPD合并RF患者预后不良的危险因素(P<0.05)。ROC曲线分析结果显示,APACHEⅡ评分、PCT、P、HMGB1、乳酸预测老年COPD合并RF患者预后不良的曲线下面积(AUC)分别为0.845、0.896、0.861、0.805、0.868,灵敏度分别为0.824、0.882、0.824、0.765、0.882,且P<0.05。APACHEⅡ评分、PCT、P、HMGB1、乳酸联合预测老年COPD合并RF患者预后不良的AUC为0.957,灵敏度为0.941。结论APACHEⅡ评分、PCT、P、HMGB1、乳酸在老年COPD合并RF患者的预后预测中有一定价值,是其预后的影响因素。Objective To investigate the prognostic value of serum procalcitonin(PCT),phosphorus(P)in elderly patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure(RF).Methods 425 elderly patients with COPD complicated with RF admitted to our hospital from February 2021 to February 2024 were included.Clinical data were collected,including gender,age,body mass index,diabetes mellitus,coronary heart disease,hypertension,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scale score,PCT,P,high mobility group protein B1(HMGB1),heart rate,respiratory rate,mean arterial pressure(MAP),lactic acid.Patients were divided into poor prognosis group and good prognosis group according to their prognosis.The clinical data of the two groups were compared.The risk factors of poor prognosis in elderly patients with COPD complicated with RF were analyzed by unconditional logistic stepwise regression.Receiver operating characteristic(ROC)curve was used to analyze the value of APACHEⅡscore,PCT,P,HMGB1 and lactic acid alone and combined in predicting poor prognosis in elderly patients with COPD complicated with RF.Results Among the 425 patients,17 had poor prognosis and 408 had good prognosis.APACHEⅡscore,PCT,HMGB1,lactic acid in good prognosis group[(16.11±2.97)points,(0.91±0.28)ng/mL,(90.58±9.62)μg/L,(3.56±0.83)mmol/L]were significantly lower than those in the poor prognosis group[(18.12±3.25)points,(1.72±0.53)ng/mL,(122.74±12.79)μg/L,(4.17±0.95)mmol/L](P<0.05),and the P[(1.12±0.33)mmol/L]in good prognosis group was significantly higher than that in poor prognosis group[(0.59±0.17)mmol/L](P<0.05).Multivariate logistic stepwise regression analysis showed that high APACHEⅡscore,high PCT,low P,high HMGB1 and high lactic acid level were risk factors for poor prognosis in elderly COPD patients complicated with RF(P<0.05).ROC curve analysis results showed that the area under curve(AUC)of APACHEⅡscore,PCT,P,HMGB1 and lactic acid in predicting poor prognosis of elderly COPD patients w

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 降钙素原 

分 类 号：R56[医药卫生—呼吸系统]