血清同型半胱氨酸、胱抑素C水平对COPD合并呼吸衰竭患者预后的影响

EFFECT OF HOMOCYSTEINE AND CYSTATIN C LEVELS ON THE PROGNOSIS OF COPD PATIENTS WITH RESPIRATORY FAILURE

目的研究慢性阻塞性肺疾病(COPD)合并呼吸衰竭不同血清同型半胱氨酸(Hcy)、胱抑素C(Cys C)水平患者的预后结局。方法选取2017年1月—2018年1月该院收治的97例COPD合并呼吸衰竭患者,检测所有患者入院时的血清Hcy、Cys C水平,根据Hcy、Cys C水平将入选患者划分为高Hcy组、正常Hcy组与高Cys C组、正常Cys C组;分别比较二组患者临床情况:酸碱度(pH)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、机械通气时间、住院时间、入院时慢性健康状况评价系统Ⅱ(APACHEⅡ)评分和慢性阻塞性肺疾病和支气管哮喘生理评分(CAPS),及随访6个月患者预后结果。结果高Hcy组患者血清Cys C水平、APACHEⅡ评分、CAPS评分均高于正常Hcy组,差异均有统计学意义(均P<0.05);正常Hcy组患者pH值、PaO2、PaCO2、机械通气时间、住院时间均优于高Hcy组,差异均有统计学意义(均P<0.05)。高Cys C组患者血清Hcy水平、APACHEⅡ评分、CAPS评分均高于正常Cys C组,差异均有统计学意义(均P<0.05);正常Cys C组患者pH值、PaO2、PaCO2、机械通气时间、住院时间均优于高Cys C组,差异均有统计学意义(均P<0.05)。随访6个月,高Hcy组病死率为26.98%,正常Hcy组病死率为2.94%,高Hcy组预后病死率高于正常Hcy组,差异有统计学意义(P<0.05);高Cys C组病死率为27.42%,正常Cys C组病死率为2.86%,高Cys C组预后病死率高于正常Cys C组,差异有统计学意义(P<0.05)。结论COPD患者合并呼吸衰竭且合并高同型半胱氨酸和/或高胱抑素C患者的临床情况较差,预后死亡比例升高。

Objective To study the prognosis of COPD patients with different levels of serum homocysteine and cystatin C.Methods Ninety-seven COPD patients with respiratory failure admitted to First Affiliated Hospital of Army Medical U niversity from January 2017 to January 2018 were selected to detect the serum homocysteine(Hcy)and cystatin C(Cys C)levels at the time of admission.According to the Hcy and Cys C levels,the selected patients were divided into high Hcy group,normal Hcy group,high Cys C group and normal Cys C group,The clinical conditions of the two groups were compared:pH,PaO2,PaCO2,mechanical ventilation time,length of hospital stay,and APACHEⅡscore and chronic obstructive pulmonary disease and bronchial asthma physiological score(CAPS),and the result of the prognosis of patients with follow-up of 6 months.Results The serum Cys C level,APACHEⅡ,CAPS in high Hcy group were higher than those in normal Hcy group,the differences were statistically significant(P<0.05);the pH value,PaO2,PaCO2,mechanical ventilation time and hospitalization time of patients in the normal Hcy group were all better than those in the high Hcy group,the differences were statistically significant(P<0.05).The serum Hcy levels and APACHEⅡ,CAPS in high Cys C group were higher than those in normal Cys C group,the differences were statistically significant(P<0.05);pH value,PaO2,PaCO2,mechanical ventilation time and hospitalization time of patients in the normal Cys C group were all better than those in the high Cys C group,withstatistically significant differences(P<0.05).After 6 months of follow-up,the mortality rate of the high Hcy group was 26.98%,higher than that of the normal(2.94%),with statistically significant differences(P<0.05).The mortality rate of the high Cys C group was 27.42%,higher than that of the normal Cys C group(2.86%).The prognostic mortality rate of the high Cys C group was higher than that of the normal Cys C group,and the difference was statistically significant(P<0.05).Conclusion The clinical situation of COPD patients with respiratory failure and homocysteine or homocystatin C is poor,and the proportion of death after prognosis is increased.