老年慢性阻塞性肺疾病急性加重期诊断与病情评估中血管内皮因子的应用价值

Clinical Application of Vascular Endothelial Growth Factor in Diagnosis and Condition Assessment of Acute Exacerbation in Elderly Patients with Chronic Obstructive Pulmonary Disease

目的探讨血管内皮因子对老年慢性阻塞性肺疾病(COPD)急性加重期患者诊断、病情评估、疗效监测及预后判断价值。方法 2011年10月—2012年10月选取稳定期COPD患者30例(稳定组)、急性加重期COPD患者60例(加重组,分为脓痰组30例和非脓痰组30例)、同期健康对照者30例(对照组),于入院后24 h内测量加重组及稳定组、对照组血管内皮因子(VEGF)、血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、白细胞(WBC)、中性粒细胞百分比(N)水平及第8天加重组以上各项指标,动态观察各项指标的变化;并记录急性加重组入院24 h内及治疗后第8天急性生理与慢性健康状况评分系统Ⅲ(APACHEⅢ)评分,对病情进行评定。结果 (1)脓痰组、非脓痰组患者第1天VEGF水平高于稳定组,稳定组高于对照组,差异有统计学意义(P<0.05);(2)VEGF指标的敏感度为88.3%,特异度为60.0%,VEGF的约登指数最高;脓痰组第1天VEGF值(233±74)高于非脓痰组(194±66),差异有统计学意义(P<0.05);(3)脓痰组及非脓痰组VEGF第1天均高于第8天,差异均有统计学意义(P<0.05);(4)无论是第1天(r=0.743)还是第8天(r=0.574),VEGF水平均与APACHE III评分呈正相关。结论 (1)血清VEGF是诊断COPD急性加重的一个较好指标,对细菌感染的敏感度和特异度的判别效果高于PCT、hs-CRP、WBC、N;(2)血清VEGF可对抗感染治疗进行疗效监测;(3)血清VEGF可作为反映其病情严重程度及预后的重要指标。

Objective To investigate the value of the vascular endothelial growth factor （VEGF） to diagnosis, condi- tion assessment, effect monitoring and prognosis judgment of patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） in the elder. Methods From October 2011 to October 2012, thirty COPD patients as the stable stage （COPD group）, thirty AECOPD patients with purulent sputhum （AE - 1 group） and thirty with no purulent sputum （AE -2 group）, as well as thirty healthy persons （control group） were enrolled. The parameters of VEGF, serum procalcitoin （PCT）, high - sensitivity C - reactive protein （ hs - CRP）, white blood cell （ WBC）, and neutrophil percentage （N） were measured within 24 hours after admission for all the subjects. The above indicators were measured again at the 8th day since the admission for the patients of the two acute groups. The scores of Acute Physiology and Chronic Health Evaluation m （ APACHE III） were record for the AECOPD patients within 24 h after admission and at 8th days since admission for assessment of the disease condi- tion. Results （ 1 ） At the 1 th day, the VEGF level was higher in the two AE groups than in the COPD group, and higher in the COPD group than in the control group （ P 〈 O. 05 ） . （2） The sensitivity of VEGF index was 88.3% and its specificity was 60. 0%, and its Youden＇s index was the highest among the indicators. At the lth day the VEGF value was （233 ±74） in the AE -1 group, being significantly higher than （194 ±66） in the AE -2 group （P 〈0.05） . （3） The VEGF values of theAE - 1 and AE - 2 groups were all higher at the lth day than at the 8th day （ P 〈 0.05 ） . （ 4 ） The VEGF level was positively correlated with APACHE III score both at the 1 th day （ r = 0. 743 ） and at 8th day （ r = 0. 574 ） . Conclusion （ 1 ） The serum VEGF is a good indicator for diagnosis of AECOPD, its differentiating effect to the sensitivity and specificity of bacterial infection is higher than those of PCT, hs -CRP, WBC, and N. （2） The serum VEGF cangserve as a monitor for the effect of anti -in- fection. （3） The serum VEGF can be a important index for reflecting the severity of the disease and its prognosis.