D-二聚体与纤维蛋白原比值对慢性阻塞性肺疾病急性加重期患者序贯机械通气治疗结局的影响

Effect of D-Dimer to Fibrinogen Ratio on the Outcome of Sequential Mechanical Ventilation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的探讨D-二聚体(D-D)与纤维蛋白原(Fib)比值对慢性阻塞性肺疾病急性加重期(AECOPD)患者序贯机械通气治疗结局的影响。方法本研究采用前瞻性随机对照分析,纳入2020年1月至2022年3月驻马店市第四人民医院收治的96例AECOPD患者为研究对象,根据序贯机械通气治疗结局分为治疗成功组和治疗失败组,收集AECOPD患者临床资料,包括年龄、性别、体重指数(BMI)、急性生理学与慢性健康状况评分系统Ⅱ评分(APACHEⅡ)、吸烟情况、基础疾病及序贯通气治疗期间C反应蛋白(CRP)、血清白蛋白(ALB)、降钙素原(PCT)、D-D/Fib值。采用logistic回归分析治疗结果的相关因素,根据受试者工作特征(ROC)曲线评价序贯机械通气治疗期间D-D/Fib值对AECOPD患者序贯机械通气治疗结局的预测价值。结果治疗成功组CRP低于治疗失败组,ALB高于治疗失败组(P<0.05);两组AECOPD患者序贯机械通气撤机前D-D、Fib、D-D/Fib低于治疗第1天(P<0.05),且治疗成功组患者D-D、Fib低于治疗失败组,D-D/Fib高于失败组(P<0.05);logistic回归分析结果显示,CRP是序贯机械通气治疗失败的危险因素(OR>1,P<0.05),ALB、序贯机械通气第1天时D-D/Fib、撤机前D-D/Fib均是序贯机械通气治疗失败的保护因素(OR<1,P<0.05);绘制ROC曲线,结果显示,序贯机械通气第1天及撤机前D-D/Fib值预测结局的曲线下面积(AUC)均>0.7,具有一定的预测价值。结论AECOPD患者序贯机械通气期间D-D/Fib值是治疗结局的独立因素,可以有效预测治疗结局情况。

Objective To investigate the effect of D-dimer(D-D)to fibrinogen(Fib)ratio on the treatment outcome of patients with acute exacerbation phase of chronic obstructive pulmonary disease(AECOPD)during sequential mechanical ventilation.Methods A prospective randomized controlled analysis was used in this study.A total of 96 patients with AECOPD who were admitted to the Fourth People’s Hospital of Zhumadian from January 2020 to March 2022 were selected as the study subjects.According to the results of sequential mechanical ventilation treatment,they were divided into successful group and failed group.Clinical data of AECOPD patients were collected,including age,sex,body mass index(BMI),acute physiology and chronic health evaluationⅡscore(APACHEⅡ),smoking,basic diseases,and C-reactive protein(CRP),serum albumin(ALB),procalcitonin(PCT),D-D/Fib values during sequential ventilation treatment.Logistic regression analysis was used to analyze the related factors of treatment results,and the predictive value of D-D/Fib value on sequential mechanical ventilation treatment outcome of AECOPD patients during sequential mechanical ventilation treatment was evaluated according to the receiver operating characteristic(ROC)curve.Results CRP in the successful group was lower than that in the failed group,and ALB was higher than that in the failed group(P<0.05).The D-D,Fib and D-D/Fib of AECOPD patients before sequential mechanical ventilation were lower than those in the first day of treatment(P<0.05).In addition,D-D and Fib in the successful group were lower than those in the failed group,while D-D/Fib were higher than those in the failed group(P<0.05).Logistic regression analysis showed that CRP was a risk factor for the failure of sequential mechanical ventilation(OR>1,P<0.05).ALB,D-D/Fib on the first day of sequential mechanical ventilation,and D-D/Fib before weaning were protective factors for the failure of sequential mechanical ventilation(OR<1,P<0.05).The ROC curve was drawn,and the results showed that the area under the curve(AUC)of the predicted outcome of D-D/Fib value on the first day of sequential mechanical ventilation and before withdrawal were greater than 0.7,which had certain predictive value.Conclusion D-D/Fib value during sequential mechanical ventilation is an independent factor of treatment outcome in AECOPD patients,which can effectively predict the treatment outcome.