肺CT联合降钙素原、C反应蛋白检测对COPDⅡ型呼吸衰竭疗效、预后评估的临床价值

Clinical value of lung CT combined with procalcitonin and C-reactive protein in the evaluation of the curative effect and prognosis of COPD Ⅱ respiratory failure

目的探讨肺CT联合降钙素原(PCT)、C反应蛋白(CRP)对慢性阻塞性肺疾病(COPD)Ⅱ型呼吸衰竭患者疗效、预后的评估价值。方法回顾性纳入沧州市人民医院2019年3月至2020年1月收治的COPDⅡ型呼吸衰竭患者120例。所有纳入者均给予综合治疗,根据情况行吸氧、支气管扩张、抗感染等处理,疗程为2周。治疗2周后评价疗效,根据治疗效果,分成有效组(96例)、无效组(24例)。分别在治疗前、治疗2周后采血检测纳入者的血清PCT、CRP水平,并在入院当日及治疗2周后行肺CT检测最大吸气末异常容积(Cvin)、最大呼气末异常容积(Cvex)、肺体积和肺横径,分析肺CT联合血清PCT、CRP对疗效的评估价值。根据患者3个月内的预后情况,分成死亡组(20例)、生存组(100例)。比较2组肺CT与血清PCT、CRP水平,分析其对预后的评估价值。结果治疗2周后,有效组肺体积减少,同一位置肺横径减少,差异均有统计学意义(P<0.05);无效组治疗前后肺体积和肺横径差异无统计学意义(P>0.05);有效组治疗2周后血清PCT、CRP及Cvin、Cvex均显著低于治疗前与无效组,差异有统计学意义(P<0.05)。血清PCT、CRP以及Cvin、Cvex评估患者疗效的曲线下面积(AUC)分别为0.674、0.687、0.709、0.658。血清PCT、CRP联合肺部CT评估疗效的AUC为0.811。生存组治疗2周后血清PCT、CRP及Cvin、Cvex均显著低于治疗前与死亡组,差异有统计学意义(P<0.05)。血清PCT、CRP以及Cvin、Cvex评估患者预后的AUC分别为0.687、0.716、0.754、0.700。血清PCT、CRP联合肺部CT评估预后的AUC为0.835。结论肺CT联合血清PCT、CRP能对COPDⅡ型呼吸衰竭患者的疗效、预后情况进行评价,值得临床推广。

Objective To explore the evaluation value of lung CT combined with procalcitonin(PCT)and C-reactive protein(CRP)in the treatment of chronic obstructive pulmonary disease(COPD)type II respiratory failure.Methods From March 2019 to January 2020,120 patients with COPD type II respiratory failure were enrolled in Cangzhou People's Hospital.All the patients were given comprehensive treatment.According to the situation,they were treated with oxygen inhalation,bronchiectasis,anti infection and so on.The course of treatment was 2 weeks.Two weeks later,the curative effect was evaluated.According to the therapeutic effect,the patients were divided into two groups:the effective group(96 cases)and the ineffective group(24 cases).The serum PCT and CRP levels of the patients were measured before and after the treatment,and on the day of admission and 2 weeks after treatment,lung CT was performed to detect the maximum abnormal end inspiratory volume(cvin),maximum abnormal end expiratory volume(cvex),lung volume and pulmonary transverse diameter,the evaluation value of lung CT combined with serum PCT and CRP was analyzed.According to the prognosis within 3 months,the patients were divided into death group(20 cases)and survival group(100 cases).The levels of lung CT,serum PCT and CRP were compared between the two groups.Results After 2 weeks of treatment,the lung volume and lung transverse diameter of the same position in the effective group decreased,and the differences were statistically significant(P<0.05);there was no statistically significant difference in the lung volume and transverse diameter before and after treatment in the invalid group(P>0.05);After 2 weeks of treatment,the serum PCT,CRP,cvin and cvex in the effective group were statistically significantly lower than those before and after treatment(P<0.05).Serum PCT,CRP and Cvin,Cvex area under curve(AUC)for evaluating the efficacy of patients were 0.674,0.687,0.709,0.658,respectively.The AUC of serum PCT,CRP combined with lung CT to evaluate the efficacy was 0.811.After 2 weeks of treatment,serum PCT,CRP,Cvin,and Cvex in the survival group were statistically significantly lower than those in the pre-treatment and death group(P<0.05).Serum PCT,CRP,and Cvin and Cvex evaluated the prognosis of patients with AUC was 0.687,0.716,0.754,0.700,respectively.The prognosis AUC of serum PCT and CRP combined with lung CT was 0.835.Conclusion Pulmonary CT combined with serum PCT and CRP can evaluate the efficacy and prognosis of patients with COPD type II respiratory failure,and it is worthy of clinical promotion.