降钙素原、D-二聚体、N-末端脑钠肽前体对重度慢性阻塞性肺疾病急性加重期患者预后的意义

Prognostic significance of procalcitonin,D-dimer and N-terminal pro-brain natriuretic peptide in patients with severe acute exacerbation of chronic obstructive pulmonary disease

目的:探讨降钙素原、D-二聚体、N-末端脑钠肽前体(NT-proBNP)对重度慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者预后的意义。方法:回顾性分析102例重度AECOPD的临床资料。根据患者预后情况分为预后不良组(36例)和预后良好组(66例),检测对比两组的降钙素原、D-二聚体和NT-proBNP,采用logistic回归分析进行多因素分析,并以ROC曲线评价预后预测价值。结果:预后不良组降钙素原、D-二聚体、NT-proBNP的浓度均明显高于预后良好组(P<0.01)。降钙素原、D-二聚体和NT-proBNP在logistic回归分析中的P值均<0.05。降钙素原、D-二聚体和NT-proBNP的AUC分别为0.743、0.778、0.708(P<0.01)。降钙素原联合D-二聚体、降钙素原联合NT-proBNP、D-二聚体联合NT-proBNP的AUC分别为0.847、0.815和0.798(P<0.01)。3项指标联合检测的AUC为0.862(P<0.01)。结论:降钙素原、D-二聚体和NT-proBNP均是重度AECOPD预后不良的独立危险因素,并在重度AECOPD预后预测中均有一定的价值,其中三者联合检测的预后预测效能最高。

Objective:To investigate the Prognostic significance of procalcitonin,D-dimer and N-terminal pro-brain natriuretic peptide(NT-proBNP)in patients with severe acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:The clinical data of 102 patients with severe AECOPD were analyzed retrospectively.The patients were divided into poor prognosis group(36 cases)and good prognosis group(66 cases)based on different prognoses.The procalcitonin,D-dimer and NT-proBNP were detected and compared between the two groups.Logistic regression analysis was used for multivariate analysis and ROC curve was used to evaluate the prognostic value.Results:The concentrations of procalcitonin,D-dimer and NT-proBNP in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.01).The P values of procalcitonin,D-dimer and NT-proBNP in logistic regression analysis were all lower than 0.05.AUC of procalcitonin,D-dimer and NT proBNP were 0.743,0.778 and 0.708 respectively(P<0.01).AUC of procalcitonin combined with D-dimer,procalcitonin combined with NT-proBNP,D-dimer combined with NT proBNP were 0.847,0.815 and 0.798,respectively(P<0.01).The AUC of Joint testing of three indicators was 0.862(P<0.01).Conclusion:Procalcitonin,D-dimer and NT-proBNP are independent risk factors for poor prognosis of severe AECOPD,which have certain predicting value in the prognosis of severe AECOPD,and the combined detection of the three could achieve the best prognostic effect.