D-二聚体、纤维蛋白原对住院的慢性阻塞性肺疾病急性加重期患者严重程度的预测价值

The predictive value of D-dimer and fibrinogen in the severity of patients with acute exacerbation of chronic obstructive pulmonary disease in hospital

目的探讨D-二聚体(D-dimer)、纤维蛋白原(Fbg)预测住院的慢性阻塞性肺疾病急性加重期(AECOPD)患者病情严重程度的价值。方法选取2019年10月—2020年11月蚌埠医学院第二附属医院住院的75例AECOPD患者为研究对象,收集临床资料,根据临床征象分为Ⅰ级组、Ⅱ级组和Ⅲ级组,比较三组患者的基线D-dimer、基线Fbg,分析基线D-dimer、基线Fbg与基线氧合指数(PaO2/FiO2)的相关性;根据预后分为死亡组和存活组,动态观察两组患者D-dimer、Fbg的差异;应用受试者工作特征(ROC)曲线分析D-dimer、Fbg对住院AECOPD患者预后的预测价值。结果不同临床表现分级的三组患者其基线D-dimer、基线Fbg差异有统计学意义,两两比较Ⅰ级组与其他两组间差异有统计学意义,Ⅱ级组与Ⅲ级组间差异无统计学意义;基线D-dimer、基线Fbg均与基线PaO2/FiO2呈显著相关性;存活组与死亡组间基线D-dimer、基线Fbg、72 h D-dimer、72 h Fbg均显著存在差异统计学意义;ROC曲线分析基线D-dimer、基线Fbg预测AECOPD死亡的曲线下面积(AUC)>0.7,具有诊断效力,72 h D-dimer、72 h Fbg、基线D-dimer联合基线Fbg、72 h D-dimer联合72 h Fbg的AUC均>0.9,对AECOPD死亡的预测效力更强,敏感度和特异度也高。结论动态监测D-dimer和Fbg有助于辅助预测AECOPD患者的病情和预后。

Objective To explore the predictive value of D-dimer and fibrinogen(Fbg)in the clinical evaluation of the severity of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 75 patients with AECOPD who were hospitalized in the Second Affiliated Hospital of Bengbu Medical College from October 2019 to November 2020 were selected as the research objects.Clinical data were collected and the patients were divided into grade I group,grade II group and grade III group according to clinical signs.The baseline D-dimer and baseline Fbg of the three groups of patients were analyzed;the correlation between baseline D-dimer,baseline Fbg and baseline oxygenation index(PaO2/FiO2)was analyzed.They were divided into death group and survival group according to the prognosis,and the D-dimer and Fbg of the two groups of patients were dynamically observed.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of D-dimer and Fbg on the prognosis of hospitalized patients with AECOPD.Results There were significant differences in baseline D-dimer and baseline Fbg among the three groups of patients with different clinical performance grades.There was significant difference between the grade I group and the other two groups,and there was no significant difference between the grade II group and the grade III group.Baseline D-dimer and baseline Fbg were significantly correlated with baseline PaO2/FiO2;There were significant differences in baseline D-dimer,baseline Fbg,72 h D-dimer,and 72 h Fbg between the survival group and the death group;ROC curve analysisshowed the AUC of baseline D-dimer and baseline Fbg for predicting death in AECOPD>0.7,with diagnostic power,the AUC of 72 h D-dimer,72 h Fbg,baseline D-dimer combined with baseline Fbg,72 h D-dimer combined with 72 h Fbg>0.9,the predictive power of AECOPD death was stronger,and with high sensitivity and specificity.Conclusion Dynamic monitoring of D-dimer and Fbg can help predict the condition and prognosis of patients with AECOPD.