血清蛋白对重症慢性阻塞性肺疾病患者预后的预测价值

Influence of serum protein on prognosis of patients with severe chronic obstructive pulmonary disease

目的探讨血清蛋白(前白蛋白、白蛋白)水平对重症慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)预后的预测价值。方法选取107例重症COPD患者,测定入住重症医学科初始及72 h血清蛋白水平、按初始白蛋白水平,将患者分为白蛋白<30 g/L组和白蛋白≥30 g/L组,比较白蛋白<30 g/L组和白蛋白≥30 g/L组急性生理功能和慢性健康状况评分系统Ⅱ(acute physiology and chronichealth evaluationⅡ,APACHEⅡ)评分、初始前白蛋白水平、机械通气时间及28 d病死率。按28 d转归分为死亡组和存活组,观察死亡组和存活组血清蛋白水平的动态变化。结果白蛋白≥30 g/L组APACHEⅡ评分、机械通气时间与28 d病死率明显低于白蛋白<30 g/L组(P<0.01),初始前白蛋白水平明显高于白蛋白<30 g/L组(P<0.01)。存活组0 h和72 h前白蛋白水平及白蛋白水平均高于死亡组(P<0.01)。存活组72 h前白蛋白水平高于0 h水平(P<0.01),存活组72 h白蛋白水平与0 h比较差异无统计学意义(P>0.05),死亡组72 h前白蛋白和白蛋白水平与0 h比较差异无统计学意义(P>0.05)。结论血清蛋白水平是重症COPD患者严重程度及预后的重要预测指标。

Objective To study the predictive value of prealbumin（PA）and albumin level for prognosis of patients with severe chronic obstructive pulmonary disease（COPD）.Methods The study selected 107 patients with severe COPD,the serum protein of initial and 72 hours in intensive care unit was detected.According to the initial albumin levels,the patients were divided into albumin 0.05）.PA and albumin level of death group at 72 h also showed no significant difference as compared with those of 0 h（P 〉0.05）.Conclusion Serum protein level is an important predictor of severity and prognosis for severe COPD patients.