血清皮质醇水平与慢性阻塞性肺疾病急性加重期病情严重程度的关系

Relationship between serum cortisol level and disease severity in patients with AECOPD

目的:分析血清皮质醇(COR)与慢性阻塞性肺疾病急性加重期(AECOPD)病人病情严重程度的关系。方法:将208例COPD病人,依据病情分为稳定期COPD病人100例(稳定期COPD组)和AECOPD病人108例(AECOPD组),其中AECOPD组又依据病情严重程度分为轻度34例、中度35例和重度39例,选取同期体检健康病人100名作为对照组。比较各组促肾上腺皮质激素(ACTH)与COR水平,分析ACTH与COR水平对AECOPD的诊断价值,及与病情严重程度的相关性。结果:AECOPD组、稳定期COPD组和对照组血清中ACTH和COR水平逐渐减少,且两指标3组间差异具有统计学意义(P<0.01);ACTH与COR并联诊断AECOPD价值(AUC=0.897)优于ACTH、COR单指标诊断(AUC=0.715和0.823)及两指标串联诊断(AUC=0.837);AECOPD组轻度、中度、重度病人血清ACTH和COR水平逐渐上升,且两指标3组间差异具有统计学意义(P<0.01);ACTH、COR水平与病情严重程度正相关(r=0.532、0.467,P<0.05)。结论:AECOPD病人血清中COR水平以及ACTH水平异常上升,两者联合用于诊断AECOPD价值较好,且其与病人病情严重程度正相关。

Objective:To analyze the relationship between serum level of cortisol(COR)and disease severity of acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods:Two hundred and eight patients with COPD were divided into the stable COPD group(100 cases)and AECOPD group(108 cases)according to the condition of COPD.The AECOPD group was subdivided into the mild group(n=34),moderate group(n=35)and severe group(n=39),and 100 healthy people during the same period were set as the control group.The levels of adrenocorticotropic hormone(ACTH)and COR among three groups were compared.The diagnostic value of ACTH and COR levels in AECOPD,and correlation between ACTH and COR levels and severity of AECOPD were analyzed.Results:The serum levels of ACTH and COR in the AECOPD group,stable COPD group and control group gradually decreased,and the differences of which among three groups were statistically significant(P<0.01).The value of ACTH combined with COR in the parallel diagnosis of AECOPD(AUC=0.897)was better than that of the singe ACTH or COR(AUC=0.715 or 0.823)and tandem diagnosis of the two(AUC=0.837).The serum levels of ACTH and COR in the mild,moderate and severe AECOPD group were gradually up-regulated,and the differences of which among three groups were statistically significant(P<0.01).The levels of ACTH and COR were positively correlated with the severity of the disease(r=0.532,0.467,P<0.05).Conclusions:The serum levels of COR and ACTH in patients with AECOPD are abnormally high,and the combination of the two is of better value in the diagnosis of AECOPD,and it is positively correlated with the severity of patient′s disease.