AECOPD患者治疗前后血清SP-D、hs-CRP及PCT水平变化及其临床意义

Changes of levels and clinical significance of serum SP-D,hs-CRP and PCT in patients with AECOPD before and after treatment

目的:探究慢性阻塞性肺疾病急性加重期(AECOPD)患者治疗前后血清肺泡表面活性物质蛋白D(SP-D)、超敏C反应蛋白(hs-CRP)及降钙素原(PCT)水平变化及其临床意义。方法:回顾性分析2017年2月~2020年6月我院128例AECOPD患者临床资料。记录治疗前(入院时)及治疗7d后血清SP-D、hs-CRP、PCT水平及肺功能变化情况;并根据治疗28d时预后生存情况分为存活组及死亡组,比较两组性别、年龄、体质量指数(BMI)、肺功能[第一秒用力呼气量占用力肺活量比值(FEV1/FVC)、第一秒用力呼气量占预计量百分比(FEV1%)]等一般资料及入院时血清SP-D、hs-CRP、PCT水平差异,受试者工作特征曲线(ROC曲线)评估入院时肺功能及血清SP-D、hs-CRP、PCT对AECOPD患者不良预后的预测价值。结果:治疗7d后,AECOPD患者血清SP-D、hs-CRP、PCT均较治疗前降低,FEV1/FVC、FEV1%则较治疗前升高。128例AECOPD患者治疗28d时,生存99例(77.34%),纳入存活组;死亡29例(22.66%),纳入死亡组。两组性别、年龄、BMI比较,差异无统计学意义;存活组入院时FEV1/FVC、FEV1%均高于死亡组,血清SP-D、hs-CRP、PCT则低于死亡组。经ROC曲线分析,发现入院时血清SP-D、hs-CRP、PCT及FEV1/FVC、FEV1%对AECOPD患者不良预后均具有较高诊断效能,灵敏度分别为82.76%、89.66%、75.86%、89.66%、96.55%,特异度分别为62.63%、86.87%、91.92%、70.71%、73.74%,截断值分别为147.090 ng/ml、48.880 mg/L、8.935μg/L、53.500%、39.500。结论:血清SP-D、hs-CRP、PCT在AECOPD病情发展中具有重要作用,且能预测患者不良预后,临床应积极推广。

Objective To explore the changes of levels and clinical significance of serum alveolar surfactant protein D(SP-D),high-sensitivity C-reactive protein(hs-CRP)and procalcitonin(PCT)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)before and after treatment.Methods The clinical data of 128 patients with AECOPD in our hospital from February 2017 to June 2020 were retrospectively analyzed.The serum levels of SP-D,hs-CRP and PCT and changes of lung function were recorded before treatment(at admission)and after 7d of treatment.The patients were divided into survival group and death group according to the prognosis of survival at 28d of treatment.The general data of gender,age,body mass index(BMI),lung function[ratio of forced expiratory volume in first second in forced vital capacity(FEV1/FVC),percentage of forced expiratory volume in first second(FEV1%)]and levels of serum SP-D,hs-CRP and PCT at admission were compared between the two groups,and the receiver operating characteristic curve(ROC curve)was used to evaluate the predictive value of lung function and serum SP-D,hs-CRP and PCT at admission on patients with AECOPD.Results After 7d of treatment,the levels of serum SP-D,hs-CRP and PCT of AECOPD patients were decreased compared with those before treatment while the FEV1/FVC and FEV1%were increased compared with those before treatment.Among 128 patients with AECOPD at 28d of treatment,99 cases(77.34%)with survival were included in survival group,and 29 cases(22.66%)with death were included in death group.There were no significant differences in the gender,age and BMI between the two groups.The FEV1/FVC and FEV1%in survival group at admission were higher than those in death group while the levels of serum SP-D,hs-CRP and PCT were lower than those in death group.According to the ROC curve,serum SP-D,hs-CRP,PCT and FEV1/FVC and FEV1%were found to have high diagnostic efficacy in patients with AECOPD,and the sensitivities were 82.76%,89.66%,75.86%,89.66%and 96.55%respectively,and the specificities were 62.63%,86.87%,91.92%,70.71%and 73.74%,and the cutoff values were 147.090 ng/ml,48.880 mg/L,8.935μg/L,53.500%and 39.500 respectively.Conclusion Serum SP-D,hs-CRP and PCT play an important role in the development of AECOPD,and can predict the poor prognosis of patients.Thus they should be actively promoted in clinical practice.