格拉斯哥及改良格拉斯哥预后评分对特发性肺纤维化急性加重患者预后的意义

Prognostic significance of Glasgow prognostic score and modified Glasgow prognostic score in patients with acute exacerbation of idiopathic pulmonary fibrosis

目的探究格拉斯哥预后评分(GPS)、改良格拉斯哥预后评分(mGPS)对特发性肺纤维化急性加重(AE-IPF)患者预后的临床价值。方法收集2012年7月~2020年6月郑州大学第二附属医院61例AE-IPF患者的一般临床资料、血清学指标,行GPS、mGPS评分。根据患者3月内生存结局,分为幸存组(33例)和死亡组(28例),比较两组间各因素差异,分别比较不同GPS、mGPS分值与各因素的关联,行单因素及多因素生存分析。结果两组外周血前白蛋白(PA)、白蛋白(ALB)、总蛋白(TP)、C-反应蛋白(CRP)、白介素-6(IL-6)、乳酸脱氢酶(LDH)水平有统计学差异(P<0.05);PA、ALB、TP、CRP、WBC、嗜酸性粒细胞绝对值(EOS)、IL-6、LDH与GPS、mGPS分值均有关联(P<0.05);PA、ALB、CRP、IL-6、LDH、GPS、mGPS与总生存期(OS)相关(P<0.05);低PA、高LDH水平、GPS 1(OR 10.652,95%CI 2.468~45.971,P=0.002)、GPS 2(OR 14.655,95%CI 1.881~114.188,P=0.01)、mGPS 1(OR 9.703,95%CI 2.703~34.826,P<0.001)、mGPS 2(OR 8.412,95%CI 1.230~57.511,P=0.03)评分与OS的降低相关。结论低PA、高LDH水平、GPS1-2、mGPS1-2是AE-IPF患者的独立预后因素;高GPS评分与AE-IPF患者死亡的危险度呈正相关,要优于mGPS。

Objective To explore the clinical value of Glasgow prognostic score(GPS)and modified Glasgow prognostic score(mGPS)for the prognosis of patients with acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF).Methods The general clinical data and serological indicators of 61 patients with AE-IPF at the Second Affiliated Hospital of Zhengzhou University from July 2012 to June 2020 were collected,and their GPS and mGPS scores were also collected.According to the survival outcome of patients within 3 months,they were divided into the surviving group(33 cases)and the death group(28 cases).Differences in various factors between the two groups were compared,and the correlation between different GPS and mGPS scores and various factors was compared.Univariate and multivariate survival analysis were performed.Results The levels of prealbumin(PA),albumin(ALB),total protein(TP),C-reactive protein(CRP),interleukin-6(IL-6),and lactate dehydrogenase(LDH)in peripheral blood were statistically different between the two groups(P<0.05).PA,ALB,TP,CRP,WBC,Eosinophil absolute value(EOS),IL-6 and LDH were correlated with GPS and mGPS scores(P<0.05).PA,ALB,CRP,IL-6,LDH,GPS,and mGPS were related to overall survival(OS)(P<0.05).Lower PA,higher LDH,GPS 1(OR 10.652,95%CI:2.468~45.971,P=0.002),GPS 2(OR 14.655,95%CI:1.881~114.188,P=0.01),mGPS 1(OR 9.703,95%CI:2.703~34.826,P<0.001),mGPS 2(OR 8.412,95%CI:1.230~57.511,P=0.03)scores were related to the decrease of OS.Conclusion Lower PA,higher LDH,GPS1-2 and mGPS1-2 are independent prognostic factors for AE-IPF patients.Higher GPS score is positively correlated with the risk of death in AE-IPF patients,which is better than mGPS.