COPD合并呼吸衰竭患者血清胆碱酯酶、前白蛋白水平及与预后的关系

Levels of Serum Cholinesterase and Prealbumin in Patients with Chronic Obstructive Pulmonary Disease with Respiratory Failure and their Relationships with Prognosis

目的探讨慢性阻塞性肺疾病(chronic odstructive pulmonary disease,COPD)合并呼吸衰竭患者血清胆碱酯酶(CHE)、前白蛋白(PA)水平变化及其与患者预后的关系。方法选取2015年3月~2016年6月期间笔者医院收治的173例COPD患者作为研究对象并将其分为3组,即COPD缓解期组、COPD急性加重期组、COPD合并呼吸衰竭组,同时根据住院期间是否死亡将COPD合并呼吸衰竭患者分为生存组与死亡组。检测各组患者血清CHE、PA水平,观察并检测患者临床指标。采用COX比例风险回归分析COPD合并呼吸衰竭患者预后的相关因素。结果与COPD缓解期组比较,COPD急性加重期组与COPD合并呼吸衰竭组血清ChE与PA水平显著降低(P<0.05),与COPD急性加重期组比较,COPD合并呼吸衰竭组血清CHE与PA水平显著降低(P<0.05);死亡组血清CHE与PA水平显著低于生存组(P=0.001);死亡组ALB、AST、TP与FEV1/Pred均显著低于生存组(P<0.05),而碱性磷酸酶(ALP)、超敏C反应蛋白(hs-CRP)与急性生理学及慢性健康状况评分系统评分(APACHEⅢ)均显著高于生存组(P<0.05);COX多因素分析显示,血清PA与CHE水平均为患者预后的独立危险因素。结论血清CHE与PA水平可有效监测COPD合并呼吸衰竭患者病情进展,并对其预后评估具有重要预测价值。

Objective To investigate the changes of serum cholinesterase (CHE) and prealbumin (PA) in patients with chronic obstructive pulmonary disease (COPD) with respiratory failure and their relationships with the prognosis of patients.Methods Totally 173 patients with COPD from March 2015 to June 2016 were selected as the subjects and divided into 3 groups:COPD remission group,COPD acute exacerbation group and COPD combined respiratory failure group.At the same time,the COPD combined respiratory failure patients were divided into the survival group and the death group according to whether the patients died during the hospitalization.Serum CHE and PA levels were detected,and clinical indicators were observed and detected.COX proportional risk regression was used to analyze the factors associated with the prognosis of patients with COPD combined respiratory failure.Results Compared with the COPD remission group,the levels of serum ChE and PA in the COPD acute exacerbation group and the COPD combined respiratory failure group were significantly decreased ( P <0.05).Compared with the COPD acute exacerbation group,the serum CHE and PA levels of COPD combined respiratory failure group were significantly decreased ( P <0.05).The serum CHE and PA levels in the death group were significantly lower than those in the survival group ( P <0.05).ALB,AST,TP and FEV1/Pred in death group were significantly lower than those in survival group ( P <0.05),while ALP,hs-CRP and APACHE Ⅲ scores were significantly higher than those in survival group ( P <0.05).COX multivariate analysis showed that serum PA and CHE levels were independent risk factors for prognosis.Conclusion Serum CHE and PA levels can effectively monitor the progress of patients with COPD combined respiratory failure,and have important predictive value for prognosis evaluation.