尿素氮/白蛋白对慢性阻塞性肺疾病加重期合并肾功不全通气的预测价值

The predictive value of urea nitrogen/albumin for ventilation in patients with chronic obstructive pulmonary disease exacerbation and renal insufficiency

目的:探究尿素氮与白蛋白比值(blood urea nitrogen to serum albumin ratio,B/A)对老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并肾功能不全患者,无创机械通气(non-invasive mechanical ventilation,NIV)预后的预测价值。方法:选择2021年1月至2023年1月,在连云港市第二人民医院肾内科,收治的老年AECOPD合并肾功能不全患者接受NIV患者220例,依据患者住院NIV治疗后28 d的生存情况分为:生存组(180例)和死亡组(40例),比较两组患者的B/A,运用Logistic回归性分析和受试者工作特征曲线ROC评价入院初24 h的B/A预测AECOPD合并肾功能不全患者NIV治疗后28 d预后的价值。结果:生存组白蛋白、血红蛋白和血小板显著高于死亡组患者(P <0.05),生存组尿素氮、B/A、急性生理和慢性健康评分(acutephysiology and chronic health evaluationⅡ,APACHEⅡ)显著低于死亡组患者(P <0.05)。Logistic回归分析结果显示B/A和APACHEⅡ评分是导致患者死亡的危险因素(P <0.05)。ROC分析显示,B/A的曲线下面积、敏感度、特异度均较APACHEⅡ评分增高,B/A与APACHEⅡ评分的AUC差异无统计学意义(t=1.686,P=0.093)。结论:B/A和APACHEⅡ评分均可用于评估老年AECOPD合并肾功能不全患者NIV预后,与APACHEⅡ评分比,B/A在评估老年AECOPD患者NIV预后的效能更高。

Objective:To explore the prognostic predictive value of the blood urea nitrogen to serum albumin ratio(B/A) on the elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) combined with renal insufficiency accept non-invasive mechanical ventilation(NIV).Methods:A total of 220 elderly patients with AECOPD combined with renal insufficiency received NIV treatment from January 2021 to January 2023 in the people's hospital affiliated to Jiangsu university were collected.Based on the living conditions of patients 28 d after NIV treatment,they were divided into 2groups:The survival group(180 cases) and the death group(40 cases).The clinical data of B/A of 2 groups was compared.The Logistic regression analysis and the receiver operating characteristic(ROC) were used to evaluate the prognostic predictive value of B/A detected within 24 h of admission on the elderly patients with AECOPD combined with renal insufficiency acceptted NIV.Results:The albumin,hemoglobin and platelets and in the survival group were significantly higher than those in the death group(P < 0.05),while the blood urea nitrogen,B/A and acute physiology and chronic health evaluation II(APACHE II) scores in the survival group were significantly lower than those in the death group(P < 0.05).The Logistic regression analysis showed that B/A(OR=6.150,95%CI:2.645-14.300) and APACHE II score(OR=1.277,95%CI:1.156-1.410)were independent risk factors for patients' death 28 d after NIV treatment(P < 0.05).The ROC analysis shows that the area under the curve(AUC),sensitivity and specificity of B/A were higher than the APACHE II score of B/A,and there was no statistically significant difference in AUC between B/A and APACHE II scores(t=1.686,P=0.093).Conclusion:Both B/A and APACHE II score can be used to assess the prognosis of elderly AECOPD combined with renal insufficiency patients undergoing NIV.Compared with APACHE II score,B/A is more effective in assessing the prognosis of elderly AECOPD combined with renal insufficiency patients undergoing NIV,which is worthy of clinical promotion and application.