PCT、CRP及6h乳酸清除率对AECOPD患者合并呼吸衰竭的诊断及预后评估分析

Analysis on PCT,CRP and 6h lactate clearance rate in the diagnosis and prognosis evaluation of patients with AECOPD combined with respiratory failure

目的分析降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)及6h乳酸清除率对慢性阻塞性肺疾病急性加重期(Acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者合并呼吸衰竭的诊断及预后评估价值。方法选取凉山彝族自治州第一人民医院2015年10月至2019年6月收治的80例AECOPD患者合并呼吸衰竭患者作为研究对象。将AECOPD合并呼吸衰竭患者作为观察组,同时选取80例AECOPD患者作为对照组,比较对照组和观察组患者治疗前后的PCT、CRP、动脉血乳酸水平及观察组患者相关指标的阳性检出率,且比较AECOPD合并呼吸衰竭不同预后患者相关指标差异,分析影响AECOPD合并呼吸衰竭预后生存的危险因素,并采用ROC曲线分析PCT、CRP、6h乳酸清除率及三者联合对AECOPD合并呼吸衰竭患者预后生存的预测价值。结果两组患者治疗前PCT、CRP、动脉血乳酸水平比较差异具有统计学意义(P<0.05);观察组血清PCT的阳性检出率高于血清CRP的阳性检出率(P>0.05);采用ROC曲线分析PCT、CRP、6h乳酸清除率及三者联合对AECOPD合并呼吸衰竭患者预后生存的预测价值,各指标曲线下面积分别为0.797、0.836、0.862、0.935,其中以联合检测的预测价值最佳。结论 AECOPD合并呼吸衰竭患者的血清PCT、CRP和动脉血乳酸水平较高,联合检测患者血清PCT、CRP、动脉血乳酸水平,并计算6h乳酸清除率,对诊断AECOPD合并呼吸衰竭患者,判断其预后有重要的临床意义。

Objective To analyze the diagnostic value and prognosis evaluation of procalcitonin(PCT),C-reactive protein(CRP)and 6 hlactate clearance rate in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with respiratory failure.Methods 80 patients with AECOPD combined with respiratory failure admitted to this hospital from October 2015 to June 2019 were selected in this study.Patients with AECOPD combined with respiratory failure were selected as the observation group,and 80 patients with AECOPD were selected as the control group.The PCT,CRP,arterial blood lactate levels in the control group and the observation group and the positive detection rate of the related indicators in the observation group were compared before and after treatment.The differences in related indicators between patients with different prognosis and with AECOPD and respiratory failure were compared,and the risk factors affecting the prognosis of AECOPD combined with respiratory failure were analyzed.The ROC curve was used to analyze the predictive value of PCT,CRP,6 hlactate clearance rate and the combination of the them for the prognostic survival of patients with AECOPD and respiratory failure.Results The difference in PCT,CRP and arterial blood lactate levels between the two groups was statistically significant after treatment(P<0.05).The positive detection rate of serum PCT in the observation group was higher than that of the serum CRP(P>0.05).The ROC curve was used to analyze the predictive value of PCT,CRP,6 hlactate clearance rate and the combination of the them for the prognostic survival of patients with AECOPD and respiratory failure.The area under the curve of each indicator was 0.797,0.836,0.862,0.935,respectively,and the predictive value of the combined test was optimal.Conclusion Patients with AECOPD and respiratory failure have higher serum PCT,CRP and arterial blood lactate levels.Combined detection of patients’ serum PCT,CRP,arterial blood lactate levels,and calculation of 6 hlactate clearance rate,have important clinical significance in the diagnosis of AECOPD patients with respiratory failure and the prognosis.