慢性阻塞性肺疾病患者急性加重期降钙素原与APACHE Ⅱ评分的相关性分析

The correlation between serm procalcitonin and acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score in acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者血清降钙素原（PCT）与急性生理学与慢性健康状况Ⅱ评分（APACHEⅡ）的相关性及对预后的影响。方法采用前瞻性设计，选取88例在北京大学第三医院急诊科住院的AECOPD患者，根据APACHEⅡ评分分为高危组、中危组和低危组，检测入院后24h内的PCT、超敏C反应蛋白（hs-CRP）、白细胞计数（WBC）和血乳酸，比较各组间的差异；研究PCT与APACHEⅡ、hs—CRP、WBC和血乳酸的相关性。根据预后将患者分为存活组与死亡组，比较两组间上述各指标的差异。结果高危组PCT为（0．60±0．32）ng／ml，高于中危组（0．36±0．23）ng/ml和低危组（0．24±0．19）ng／ml，PCT在3组间的差异具有统计学意义（P〈0．01）。高危组hs—CRP M（P25，P75）为36．88（10．14，47．16）mg／L，高于中危组的15．00（3．64，30．33）mg/L和低危组的14．77（4．35，15．80）mg/L，hs—CRP在3组间的差异具有统计学意义（P=0．046）。PCT与APACHEⅡ评分和hs-CRP明显相关，差异具有统计学意义（P〈0．01）。死亡组的PCT、APACHEⅡ评分、hs—CRP和乳酸均高于存活组，差异具有统计学意义（P〈0．05）。结论AECOPD患者PCT与APACHEⅡ评分具有较好的相关性，是判断AECOPD预后的敏感指标。

Objective To investigate the correlation between serum procalcitonin （PCT） and acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ） score and prognosis in acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods A total of 88 patients with AECOPD admitted to emergency department of Peking university third hospital were prospectively studied, and were divided into three groups, namely high score group, median score group and low score group according to APACHE Ⅱ score. Serum PCT, hypersensitive C-reactive protein （ hs-CRP）, WBC and lactate were assayed within the first 24 hours after admission, the differences in those indicators between three groups were analyzed; and the correlation between PCT and APACHE Ⅱlscore, hs-CRP, WBC, lactate were investigated. The patients were divided into survival group and death group according to prognosis, and the differences in those indicators between the two groups were analyzed. Results The serum levels of PCT was higher in high score group （0. 60 ±0. 32） ng/ml than that in median score group （0. 36 _± 0. 23） ng/ml and that in low score group （0. 24 ±0. 19） ng/ml, differences between groups were statistically significant （P 〈0. 01 ）. The hs-CRP was higher in high score group M （ P25, P75 ） 36. 88 （ 10. 14, 47. 16） mg/L than that in median score group 15.00 （3.64, 30. 33） mg/L and that in low score group 14. 77 （4. 35, 15. 80） mg/L （P =0. 046）. The PCT significantly correlated with APACHE Ⅱ and hs-CRP （P 〈 0. 01 ）. The serum levels of PCT, APACHE Ⅱ score, hs-CRP and lactate were significantly higher in death group than those in survival group （P 〈 0. 05 ）. Conclusions There is a good correlation between PCT and APACHE II score in patients of AECOPD, suggesting PCT to be a sensitive predictor of prognosis.