C反应蛋白等与急性加重期慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者无创通气治疗的关系

The Relationship between C-reactive Protein and Non-Invasive Ventilation in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated with typeⅡRespiratory Failure

目的:探讨C反应蛋白(C-reactive protein,CRP)、人基质裂解素2(suppression of tumorigenicity 2,ST2)、降钙素原(procalcitonin,PCT)、乳酸水平与慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭患者无创通气治疗的关系。方法:选取2021年1月至2022年6月在我院治疗的AECOPD合并Ⅱ型呼吸衰竭患者146例作为观察组,同时选取单纯AECOPD患者100例作为对照组,比较观察组和对照组CRP、ST2、PCT及乳酸水平差异;观察组给予无创通气治疗,比较治疗失败和成功患者临床资料、CRP、ST2、PCT及乳酸水平差异。结果:观察组CRP、ST2、PCT及乳酸水平明显高于对照组(P<0.05)。观察组治疗失败患者COPD病程、急性生理学及慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health Assessment SystemⅡ,APACHEⅡ)评分、空腹血糖、CRP、ST2、PCT及乳酸水平明显高于治疗成功患者(P<0.05)。Logistic回归显示:APACHEⅡ评分、CRP、ST2、PCT及乳酸是患者无创通气治疗失败的影响因素(P<0.05)。APACHEⅡ评分、CRP、ST2、PCT、乳酸及联合预测治疗失败的ROC曲线下面积分别为0.662、0.698、0.717、0.658、0.759和0.806,P<0.05。结论:AECOPD合并Ⅱ型呼吸衰竭患者CRP、ST2、PCT及乳酸水平明显升高,根据患者病情进展联合APACHEⅡ评分、CRP、ST2、PCT及LCR进行评估,可为通气治疗效果的预测提供更全面的参考和依据。

Objective:To investigate the relationship between the levels of C-reactive protein(CRP),suppression of tumorigenicity 2(ST2),procalcitonin(PCT),lactic acid,and non-invasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with respiratory failure.Methods:A total of 146 patients with AECOPD and typeⅡrespiratory failure treated in our hospital from January 2021 to June 2022 were selected as the observation group,and 100 patients with simple AECOPD were selected as the control group.The levels of CRP,ST2,PCT and lactic acid in the observation group and the control group were compared.The observation group was given non-invasive ventilation treatment,and the clinical data,CRP,ST2,PCT and lactic acid levels of patients with treatment failure and success were compared.Results:The levels of CRP,ST2,PCT and lactic acid in the observation group were significantly higher than those in the control group(P<0.05).The course of COPD,APACHEⅡscore,fasting blood glucose,CRP,ST2,PCT and lactic acid levels of patients with treatment failure in the observation group were significantly higher than those of patients with treatment success(P<0.05).Logistic regression analysis showed that APACHEⅡscore,CRP,ST2,PCT and lactic acid were the influencing factors for the failure of noninvasive ventilation treatment(P<0.05).The area under the ROC curve of APACHEⅡscore,CRP,ST2,PCT,lactic acid and the combination of them to predict treatment failure were 0.662,0.698,0.717,0.658,0.759 and 0.806 respectively(P<0.05).Conclusion:The levels of CRP,ST2,PCT and lactic acid in AECOPD patients with typeⅡrespiratory failure increased significantly.The evaluation based on the patient's disease progress and APACHEⅡscore,CRP,ST2,PCT and LCR can provide a more comprehensive reference and basis for predicting the effect of ventilation treatment.