COPD急性发作期SIRS评分与患者预后的关系

Investigation of the relationships among CRP, SF, BS and SIRS in COPD patients in acute stage and its clinical significance

目的探讨慢性阻塞性肺疾病(COPD)急性发作期患者全身炎性反应综合征(SIRS)与血清C-反应蛋白(CRP)、铁蛋白(SF)、空腹血糖(BS)的关系及其对患者预后的影响。方法检查对照组及COPD急性发作期病人体温、心率、呼吸频率、血白细胞计数、CRP、SF、BS等指标,记录SIRS评分,并做预后追踪。结果SIRS评分越高,死亡率越高,但2分、3分之间的差异无显著性,4分与3分之间存在显著性差异(P<0.05);SIRS评分与CRP成正比,且2分与3分之间均存在显著性差异(P<0.05);SIRS评分为4分时血清SF水平显著升高,与其他几组之间存在显著性差异,1分、2分、3分均与对照组无显著性差异。SIRS评分中存在白细胞或体温异常者,死亡率最高,达9.9%和8.1%,CRP、SF亦显著升高,与其他两项比较均存在显著性差异(P<0.05)。SIRS评分与空腹静脉血糖之间无明显统计学关系。结论SIRS评分对COPD急性加重期病人的预后判定具有一定的临床意义,但亦有一定的局限性,应结合CRP、SF等指标综合分析。体温异常、白细胞异常两指标与预后关系更为密切。

Objective To investigate the relationships among CRP SF BS and SIRS in patients with COPD at acute stage and its clinical significance. Methods Body temperature, heart rate, respiration rate, WBC, CRP, SF, BS and so on were measured in patients with COPD at acute stage and in controls. The SIRS scores were recorded and the follow up was conducted. Results The higher SIRS scores, the higher of mortality rate. But there was no significant difference between patients with 2 and 3 SIRS scores, The difference between 3 and 4 SIRS scores was obvious （P〈0.05）. SIRS scores were correlated positively with the serum level of CRP. The differences between 2 and 1 and between 4 and 3 SIRS scores were remarkable （P〈0.05）. The serum SF level was greatly higher when the SIRS score was 4. There were significant differences between the groups. There were no difference between other groups and control group. Mortality rate in patients with abnormal WBC and temperature were 9. 9% and 8.1%, the highest ones in SIRS scores. CRP and SF were very higher. There were dramatical difference compared with the other two factors （P〈0. 05）. There was no relationship between SIRS scores and BS. Conclusion SIRS score has played clinical roles in evaluation of patients with COPD at acute stages, but with limitations. It should be analyzed with CRP SF et al. Abnormal T and WBC are correlated more with the prediction of patients.