HCAR与临床指标对COPD并发呼吸衰竭患者预后的预测作用研究

Study on the predictive effect of high-sensitivity C-reactive protein/albumin ratio and clinical indexes on the prognosis of chronic obstructive pulmonary disease patients with respiratory failure

目的研究血清超敏C反应蛋白/白蛋白比值(HCAR)与临床指标预测慢性阻塞性肺疾病(COPD)并发呼吸衰竭患者预后的价值。方法本研究为队列研究。采用分层抽样和整群抽样相结合的方法随机抽取西部战区总医院2018年1月到2020年12月收治的236例COPD并发呼吸衰竭患者的临床资料,对患者的基线资料信息、治疗方案、实验室检查结果进行分析。按照其院内预后情况将其分为预后良好组(n=164)和预后不良组(n=72),比较2组患者性别、年龄、病程、体质量指数、基础肺功能(第1秒用力呼气容积、第1秒用力呼气容积/用力肺活量)、抗生素使用时间、1年内急性发作次数、机械通气时间、吸烟史、饮酒史、合并症、PaO_(2)、PaCO_(2)、乳酸、HCAR、中性粒细胞/淋巴细胞比值(NLR)等临床资料差异,利用受试者工作特征曲线分析HCAR、NLR、胆碱酯酶(CHE)、前白蛋白(PA)预测COPD并发呼吸衰竭患者预后的价值,将2组有差异信息纳入logistic回归分析模型,进行量化赋值明确COPD并发呼吸衰竭患者预后不良的危险因素。结果预后不良组吸烟、合并高血压、合并慢性肾脏病、Nrf2基因型为AA型的患者比例及HCAR、NLR显著高于预后良好组,CHE、PA水平低于预后良好组(P值均<0.05)。HCAR、NLR预测患者预后的曲线下面积分别为0.846、0.789,且HCAR敏感度(69.4%)明显高于NLR(63.9%)、CHE(67.6%)、PA(59.4%)。经logistic回归分析证实吸烟、合并高血压、合并慢性肾脏病、Nrf2基因型为AA型、HCAR≥1.09、NLR≥9.48、CHE≤3.976 kU/L、PA≤137.525 mg/L是COPD并发呼吸衰竭患者预后不良的危险因素。结论HCAR、NLR水平增高,CHE、PA水平偏低,及吸烟、合并高血压、合并慢性肾脏病可能引起COPD并发呼吸衰竭患者预后不良,需要临床医师对其进行密切关注。

Objective To explore the value of serum hypersensitivity C-reactive protein/albumin ratio(HCAR)and the clinical indexes in the prognosis of patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods This study was a cohort study.Stratified sampling and cluster sampling were used to randomly select the clinical data of 236 patients with COPD complicated with respiratory failure admitted to the General Hospital of Western Theater Command from January 2018 to December 2020.The baseline information,treatment plan,and laboratory examination results of the patients were analyzed.According to their short-term prognosis,they were divided into good prognosis group(n=164)and poor prognosis group(n=72).Gender,age,course of disease,body mass index,lung function[forced expiratory volume in the first second(FEV_(1)),FEV_(1)/forced vital capacity],duration of antibiotic use,number of acute episodes within one year,duration of mechanical ventilation,smoking history,drinking history,complications,partial pressure of blood oxygen,partial pressure of carbon dioxide,lactic acid,HCAR,and neutrophil/lymphocyte ratio(NLR)were compared between the two groups.Receiver operating characteristic curve was used to analyze the value of HCAR,NLR,cholinesterase(CHE),Prealbumin(PA)in predicting the short-term prognosis of patients with COPD complicated with acute respiratory failure.The different information between the two groups was included in the logistic regression analysis model,and the quantitative evaluation was performed to identify the risk factors of poor prognosis in COPD patients with acute respiratory failure.Results In the poor prognosis group,the proportion of patients with smoking,hypertension,chronic kidney disease,and Nrf2 genotype AA and the levels of HCAR and NLR were significantly higher than those in good prognosis group,and the levels of CHE and PA were lower than those in the good prognosis group(P<0.05).The area under the curve of HCAR and NLR was 0.846 and 0.789 respectively,and the sensitivity of HCAR was 69.4%,significantly higher than that of NLR(63.9%),CHE(67.6%),and PA(59.4%).Logistic regression analysis confirmed that smoking,hypertension,chronic kidney disease,Nrf2 genotype AA,HCAR≥1.09,NLR≥9.48,CHE≤3.976 kU/L,and PA≤137.525 mg/L were the risk factors of poor short-term prognosis in COPD patients with acute respiratory failure.Conclusions Increased levels of HCAR and NLR,decreased levels of CHE and PA,smoking,hypertension,and chronic kidney disease may lead to poor prognosis of COPD patients with acute respiratory failure,which needs clinicians′close attention.