COPD急性加重期合并呼吸衰竭患者血清CysC、GGT水平与循环指标变化

Serum CysC,GGT Levels and Change of Circulatory Indicators in Patients with Acute Exacerbation of COPD and Respiratory Failure

目的 探讨慢性阻塞性肺疾病(COPD)急性加重期合并呼吸衰竭患者血清胱抑素C(CysC)、γ-谷氨酰基转移酶(GGT)及凝血纤溶指标、胸腔内血容积指数、血管外肺水指数变化和意义。方法 选取COPD急性加重期合并呼吸衰竭患者76例为合并呼吸衰竭组,即观察组,COPD急性加重期未并发呼吸衰竭患者50例为对照组。采集患者入院24 h内的空腹外周静脉血,离心分离血清和血浆,检测血清CysC、GGT水平及血浆抗凝血酶Ⅲ、纤溶酶原激活物抑制物-1、组织型纤溶酶原激活物浓度。采用经肺热稀释法测定胸腔内血容积指数、血管外肺水指数。收集两组患者性别、年龄、COPD病程及并发症情况,出院后进行6个月随访,根据不良预后发生情况将患者分为预后良好组和预后不良组。结果 合并呼吸衰竭组患者血清CysC、GGT水平明显高于对照组(P<0.05)。合并呼吸衰竭组患者血浆抗凝血酶Ⅲ、组织型纤溶酶原激活物浓度明显低于对照组,血浆纤溶酶原激活物抑制物-1浓度明显高于对照组(P<0.05)。合并呼吸衰竭组患者胸腔内血容积指数明显低于对照组,血管外肺水指数明显高于对照组(P<0.05)。预后不良组患者血清CysC、GGT水平及血浆纤溶酶原激活物抑制物-1浓度、血管外肺水指数明显高于预后良好组,血浆抗凝血酶Ⅲ、组织型纤溶酶原激活物浓度及胸腔内血容积指数明显低于预后良好组(P<0.05)。ROC曲线分析显示,血清CysC、GGT水平及抗凝血酶Ⅲ、纤溶酶原激活物抑制物-1、组织型纤溶酶原激活物、胸腔内血容积指数、血管外肺水指数对患者预后均具有较高的预测价值(P<0.05),各指标联合检测的预测价值最高(AUC=0.945)。结论 COPD急性加重期合并呼吸衰竭患者血清CysC、GGT水平及血浆纤溶酶原激活物抑制物-1浓度、血管外肺水指数明显升高,血浆抗凝血酶Ⅲ、组织型纤溶酶原激活物浓度及胸腔内血容积指数明显降低,联合检测在患者预后评估中具有较高的预测价值。

Objective To investigate the changes and significance of serum levels of cystatin C(CysC)in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)and respiratory failure,γ-glutamyltransferase(GGT),coagulation and fibrinolysis indicators,intrathoracic blood volume index,and extra-vascular lung water index.Method 76 patients with acute exacerbation of COPD and respiratory failure were selected as respiratory failure group,that is observation group,while 50 patients without respiratory failure during the acute exacerbation of COPD were selected as the control group.Collect fasting peripheral venous blood from patients within 24 hours of admission,centrifuge serum and plasma,measure serum CysC and GGT levels,plasma levels of antithrombinⅢ,plasminogen activator inhibitor-1,and tissue type plasminogen activator.Determine intrathoracic blood volume index and extravascular lung water index by using lung thermal dilution method.Collect the gender,age,course of COPD and complication of patients in two groups,and conduct a 6-month follow-up after discharge.Record the occurrence of adverse prognosis and divide them into good prognosis group and poor prognosis group.Results The serum CysC and GGT levels in combined respiratory failure group were significantly higher than those in the control group(P<0.05).The plasma antithrombinⅢand tissue type plasminogen activator concentration in the combined respiratory failure group were significantly lower than those in the control group,while plasma plasminogen activator inhibitor-1 concentration in the combined respiratory failure group was significantly higher than that in the control group(P<0.05).The thoracic blood volume index in combined respiratory failure group was significantly lower than that in the control group,while the extravascular lung water index was significantly higher than that in the control group(P<0.05).The serum CysC and GGT levels,plasma plasminogen activator inhibitor-1 concentrations,and extravascular lung water index of patients in the poor prognosis group were significantly higher than those in the good prognosis group.The plasma antith-rombinⅢ,tissue plasminogen activator concentrations,and intrathoracic blood volume index were significantly lower than those in the good prognosis group(P<0.05).ROC curve analysis showed that serum CysC,GGT levels and antithrombinⅢ,plasminogen activator inhibitor-1,tissue type plasminogen activator,intrathoracic blood volume index,and extravascular lung water index had high predictive value(P<0.05),and the combined detection of all indicators had the highest predictive value(AUC=0.945).Conclusion Serum CysC,GGT levels,plasma plasminogen activator inhibitor-1 concentrations,and extravascular lung water index were significantly increased in patients with acute exacerbation of COPD complicated by respiratory failure,while plasma levels of antithrombinⅢ,tissue type plasminogen activator,intrathoracic blood volume index and extravascular lung water index were significantly reduced.Combined detection has high predictive value in patient prognosis evaluation.