血清CysC、MCP-1、ACTA水平在评估老年COPD合并呼衰预后的价值分析

The Prognostic Value of Serum CysC,MCP-1 and ACTA Levels in Elderly Patients with COPD and Respiratory Failure

目的分析血清胱抑素C(cystatin C,CysC)、单核细胞趋化蛋白-1(monocyte chemoattractant protein-1,MCP-1)、激活素A(activin A,ACTA)水平在评估老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并呼吸衰竭(respiratory failure,RF)患者预后的价值。方法回顾性收集2018年3月至2021年3月于成都市第三人民医院重症医学科接收的104例老年COPD合并RF患者,根据患者病情转归将入组患者分为存活组80例,与死亡组24例,并收集同一时期接受体检的健康患者50例作为对照组,分析各组血清CysC、MCP-1、ACTA水平与1秒钟用力呼气容积占用力肺活量百分比(FEV1/FVC)之间的相关性,并判断血清CysC、MCP-1、ACTA水平在预后评估的价值。结果老年COPD合并RF患者血清CysC、MCP-1、ACTA、FEV1/FVC水平与对照组相比均差异具有统计学意义(P<0.05);经多元逐步回归分析显示血清CysC、MCP-1、ACTA与FEV1/FVC均呈负相关(P<0.05);104例老年COPD合并RF患者中,死亡率为23.08%,其中存活组血清CysC、MCP-1、ACTA低于死亡组(P<0.05);经单因素回归分析显示血清CysC、MCP-1、ACTA水平与老年COPD合并RF患者死亡率具有明显相关性(P<0.05)。结论老年COPD合并RF血清CysC、MCP-1、ACTA水平越高,FEV1/FVC水平越低,其病情越严重,因此血清CysC、VEGF、ACTA水平升高是老年COPD合并RF患者的独立危险因素,可将其作为预后评估的标准之一。

Objective To analyze the prognostic value of serum cystatin C(CysC),monocyte chemoattractant protein-1(MCP-1)and activin A(ACTA)levels in elderly patients with chronic obstructive pulmonary disease(COPD)and respiratory failure(RF).Methods The current study retrospectively reviewed 104 elderly patients with COPD and RF treated in Chengdu Third People’s Hospital between March,2018 and March,2021.According to the outcomes,patients enrolled were divided into the survival group(80 cases)and death group(24 cases).At the same time,50 healthy individuals were selected as the control group.The correlation of serum CysC,MCP-1 and ACTA levels with FEV1/FVC was evaluated.The prognostic values of serum CysC,MCP-1 and ACTA levels were determined.Results There were statistically significant differences in levels of CysC,MCP-1,ACTA and FEV1/FVC between elderly patients with COPD and RF and the control group(P<0.05).Multiple stepwise regression analysis showed that serum CysC,MCP-1 and ACTA were negatively correlated with FEV1/FVC(P<0.05).The mortality rate in this study was 23.08%.Serum CysC,MCP-1 and ACTA in the survival group were lower than those in the death group(P<0.05).Univariate regression analysis showed that serum CysC,MCP-1 and ACTA levels were significantly correlated with the mortality rate of elderly patients with COPD and RF(P<0.05).Conclusion Our results show that the higher the levels of serum CysC,MCP-1 and ACTA in elderly with COPD and RF,the lower the FEV1/FVC ratio,and the more serious the disease.Therefore,elevated levels of serum CysC,MCP-1 and ACTA are independent risk factors for COPD with RF in elderly patients,which can be used as one of the criterion for the prognosis evaluation.