AECOPD相关生物标志物水平及意义

发布时间：2018-08-02 09:56

【摘要】：背景:随着慢性阻塞性肺疾病患病率逐年升高,据世界卫生组织报告慢性阻塞性肺疾病已经成为了继缺血性心脏病、卒中之后的全球第三大死亡原因。2016年在英国伦敦举行的欧洲呼吸学年会上,钟南山先生发表了一项最新的流行病学调查数据,在我国40岁以上的人群中慢性阻塞性肺疾病的患病率俨然已经上升至14%。慢阻肺不仅是影响患者生活质量的一大因素,更是加重社会医疗资源的紧缺,慢阻肺急性加重的发生亦加剧这一情况,而且急性加重的发生还可能会是加速疾病的进展的因素之一,但目前对于慢阻肺急性加重期的诊断仍只依赖于患者咳嗽、咳痰、呼吸困难等症状的加重,原有治疗不能有效控制病情,需更改治疗方案这些依靠患者或医生的主观判断,存在一定局限性,容易发生漏诊或误诊,因此探究有助于慢阻肺急性加重期诊断的客观指标就十分必要。目白的:分析因AECOPD住院患者血生物标志物水平变化,探讨单独及联合检测各项生物标志物的临床意义。比较各项生物标志物对明确慢性阻塞性肺疾病急性加重期诊断的意义。探讨各项指标之间是否具有相关性。方法:选择2016年1月至2016年12月于辽宁省人民医院因AECOPD住院治疗患者50例,选取同期缓解期cOPD患者50名作为对照组,分别检测临床常用的生物标志物,白细胞计数、中性粒细胞比例、CRP、PCT、D-dimer、FIB,评价各项指标对AECOPD诊断意义。结果:①AECOPD组患者白细胞计数、中性粒细胞比例、CRP、PCT、D-dimer、FIB水平分别为9.84±4.482、80.18±10.880、59.40±58.655、0.72±0.818、752.57±454.692、4.29±1.143;SCOPD组分别为5.83±1.632、63.69±12.329、10.08±14.012、0.07±0.133、495.63±203.943、3.21±0.878。②白细胞计数、中性粒细胞比例、CRP、PCT、D-dimer、FIB组数据R0C线下面积分别为 0.835、0.832、0.842、0.799、0.684、0.768。分别以 8.64、71.35、8.50、0.163、726.22、3.55为截断点,WBC的敏感性、特异性、阳性预测值、阴性预测值分别为60%、96%、94%、71%,中性粒细胞比例分别为78%、74%、75%、77%,CRP 分别为 86%、72%、75%、84%,PCT 分别为 62%、98%、97%、72%,D-二聚体分别为42%、90%、81%、61%,FIB分别为74%、70%、71%、73%。中性粒细胞比例和C-反应蛋白、纤维蛋白原分别联合后ROC曲线下面积为0.864、0.855,较单项指标有所升高。③在AECOPD组中,WBC与N%、CPR、PCT、D-dimer、FIB均存在相关性(R=0.530、0.434、0.496、0.377、0.395),N%与 CRP、PCT、D-dimer、FIB 具有一定相关性(R 分别为 0.582、0.453、0.426、0.478),CPR 与 PCT、D-dimer、FIB 均存在一定相关性(分别是 R=0.680、0.214、0.564),PCT 与D-dimer、FIB之间亦有一定相关性(R=0.312、0.506),D-dimer与FIB之间的相关系数为0.543。稳定期患者中,WBC与N%、CRP、PCT、D-dimer、FIB存在相关性(分别是R=0.316、0.460、0.617、0.383、0.330),N%与 CPR、PCT、D-dimer、FIB 存在相关性(分别是 R=0.414、0.367、0.431、0.383);CPR 与 PCT、D-dimer、FIB 之间存在相关性(分别是R=O.782、0.521、0.498),PCT与D-dimer之间存在相关性(分别是R=0.366),D-dimer与FIB之间的相关系数为0.438。结论:AECOPD组白细胞计数、中性粒细胞比例、CRP、PCT、D-dimer、FIB水平较SCOPD组均有明显升高,可为疾病诊断提供依据,其中CRP的ROC曲线下面积最大,诊断价值高于其他组数据。分别联合检测中性粒细胞比例和C-反应蛋白、纤维蛋白原能有效提高AECOPD诊断率。部分项生物标志物之间存在直线相关关系,其中CRP与PCT之间相关性最明显。
[Abstract]:Background: as the prevalence of chronic obstructive pulmonary disease is increasing year by year, according to WHO, chronic obstructive pulmonary disease has become the third major cause of global death following ischemic heart disease, the third major cause of death after stroke. At the European annual conference on respiratory studies in London, London, Mr. Zhong Nanshan published a latest epidemiology. The survey data, the prevalence rate of chronic obstructive pulmonary disease in the population over 40 years old in our country seems to have risen to 14%. slow resistance lung is not only a major factor affecting the quality of life of the patients, but also the aggravation of the social medical resources, the acute exacerbation of the chronic obstructive pulmonary disease also aggravates this situation, and the occurrence of acute exacerbation may be also likely to be It is one of the factors to accelerate the progress of the disease, but the diagnosis of the acute exacerbation of the chronic obstructive pulmonary disease is still dependent on the aggravation of the patient's cough, expectoration, and dyspnea. The original treatment can not effectively control the condition. It is necessary to change the treatment plan by relying on the subjective judgment of the patient or the doctor. There are some limitations, and it is easy to have missed diagnosis or misdiagnosis. Therefore, it is necessary to explore the objective indicators that can help the diagnosis of acute exacerbation of the chronic obstructive pulmonary disease. Methods: 50 cases of AECOPD hospitalized patients in Liaoning people's Hospital from January 2016 to December 2016 were selected and 50 patients in the same period of remission period cOPD were selected as the control group. The clinical biomarkers, leukocyte count, neutrophils ratio, CRP, PCT, D-dime were detected respectively. R, FIB, evaluate the diagnostic significance of each index to AECOPD. Results: (1) the levels of leukocyte count, neutrophils ratio, CRP, PCT, D-dimer, FIB in group AECOPD were 9.84 + 4.482,80.18 + 10.880,59.40 + 58.655,0.72 + 0.818752.57 + 1.143, respectively, and 5.83 +. 203.943,3.21 + 0.878., neutrophils count, neutrophils ratio, CRP, PCT, D-dimer, FIB, the area under the R0C line is 0.835,0.832,0.842,0.799,0.684,0.768., respectively, 8.64,71.35,8.50,0.163726.22,3.55 as a truncation point, WBC sensitivity, specificity, positive predictive values, negative predictive values of 60%, 96%, 94%, 71%, neutrophils, respectively. The proportion of cells were 78%, 74%, 75%, 77%, and CRP were 86%, 72%, 75%, 84%, respectively 62%, 98%, 97%, 72%, respectively, D- two polymers, respectively, FIB respectively, 73%. neutrophils ratio and C- reactive protein, the area under the ROC curve of fibrinogen was 0.864,0.855, higher than the single index. Third, AE In group COPD, there are correlations between WBC and N%, CPR, PCT, D-dimer, FIB, N% and CRP, PCT, D-dimer, there are certain correlations. R=0.312,0.506, the correlation coefficient between D-dimer and FIB is in the 0.543. stable period patients, WBC and N%, CRP, PCT, D-dimer, FIB are correlated (respectively R=0.316,0.460,0.617,0.383,0.330). There was a correlation between PCT and D-dimer (R=0.366), and the correlation coefficient between D-dimer and FIB was 0.438. conclusion: the leukocyte count, the proportion of neutrophils, CRP, PCT, D-dimer, and the FIB level were significantly higher than those of the D-dimer group, which could provide the basis for the diagnosis of disease. The value of diagnosis was higher than that of other groups. The ratio of neutrophils and C- reactive protein were detected, and fibrinogen could effectively improve the diagnostic rate of AECOPD. There was a linear correlation between some biomarkers, among which the correlation between CRP and PCT was the most obvious.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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