慢性阻塞性肺疾病急性加重死亡相关因素及三种评分临床应用价值的研究

发布时间：2018-03-02 01:27

本文关键词： 慢性阻塞性肺疾病急性加重危险因素 CURB-65评分 BAP-65评分 DECAF评分　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析慢性阻塞性肺疾病急性加重患者死亡相关的危险因素及探讨CURB-65评分、BAP-65评分、DECAF评分对慢性阻塞性肺疾病急性加重住院患者预后的应用价值。方法:收集2014年1月至2016年1月天津医科大学第二医院呼吸科诊断为慢性阻塞性肺疾病急性加重的住院患者302例。收集在入院24小时临床资料及实验室数据,根据存活情况分为生存组与死亡组,分别比较生存组与死亡组临床资料,分析死亡相关危险因素并进行CURB-65评分、BAP-65评分及DECAF评分,分别计算患者三种评分不同时患者的死亡率,构建ROC曲线分析CURB-65评分、BAP-65评分、DECAF评分对AECOPD患者院内死亡率的预测价值。结果:1、单因素分析结果示AECOPD患者死亡组在合并肺实变、合并房颤、严重呼吸困难、意识障碍所占比例均多于生存组,死亡组患者的血嗜酸性粒细胞数值、动脉血PH值、白蛋白、FEV1%占预计值的平均值较生存组低,血中性粒细胞百分百比、C-反应蛋白的平均值较生存组高,上述差异均有统计学意义(P0.05)。死亡组与生存组在年龄、白细胞数值、血红蛋白、纤维蛋白原、D-二聚体、动脉血氧分压、二氧化碳分压、肌酐、血尿素氮、吸烟史无统计学差异(P0.05)。2、多因素分析结果显示患者出现严重呼吸困难、意识障碍,合并肺实变、房颤,白蛋白低、嗜酸性粒细胞减少、PH值减低、CRP增高为患者院内死亡的独立危险因素。3死亡组CURB-65评分、BAP-65评分、DECAF评分分值均高于生存组,差异具有统计学意义(P㩳0.05)。4、随着三种评分分值的增加,患者院内死亡率的相应增加,DECAF评分及CURB-65评分在4分以上,院内死亡率分别为48%及50%。BAP-65评分在4分以上院内死亡率为80%。5、在预测院内死亡率上CURB-65评分和BAP-65评分曲线下面积在0.80以上,DECAF评分曲线下面积为约为0.95。三个评分的AUROC面积分别两两Z检验,结果示CURB-65评分与BAP-65评分比较,差异无统计学意义(P0.05),DECAF评分分别与CURB-65评分与BAP-65评分比较,差异有统计学意义(P0.05)。结论:1、AECOPD死亡相关危险因素有严重的呼吸困难、意识障碍、C反应蛋白水平增高、嗜酸性粒细胞数减低、酸中毒及合并肺实变、房颤,综合参考上述指标评价患者预后。2、入院时进行CURB-65评分、BAP-65评分及DECAF评分,这三种评分对于预测慢性阻塞性肺疾病急性加重院内死亡率均有一定价值,DECAF评分在三个评分中对AECOPD患者预后预测准确度最高,值得临床推广使用。
[Abstract]:Objective: to analyze the risk factors related to death in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and to explore the value of CURB-65 score BAP-65 and DECAF in the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). From January 2014 to January 2016, 302 inpatients with acute exacerbation of chronic obstructive pulmonary disease (COPD) were diagnosed by the Department of Respiratory Medicine, second Hospital of Tianjin Medical University. Clinical data and laboratory data were collected after 24 hours of admission. According to the survival condition, the patients were divided into survival group and death group. The clinical data of survival group and death group were compared, the risk factors of death were analyzed, and the CURB-65 score, BAP-65 score and DECAF score were used to calculate the mortality of patients with different scores. ROC curve was constructed to analyze the prognostic value of CURB-65 score BAP-65 score and DECAF score in hospital mortality of AECOPD patients. Results: 1. Univariate analysis showed that the death group of AECOPD patients was complicated with pulmonary consolidation, atrial fibrillation and severe dyspnea. The mean values of eosinophils, PH in arterial blood, FEV1% of albumin in survival group were lower than those in survival group. The average percentage of neutrophils was higher than that of the survival group (P 0.05). Age, white blood cell value, hemoglobin, fibrinogen D-dimer, arterial oxygen partial pressure were measured in the dead group and the survival group. There was no significant difference in carbon dioxide partial pressure, creatinine, blood urea nitrogen, smoking history (P 0.05). Multivariate analysis showed that patients had severe dyspnea, disturbance of consciousness, complicated with pulmonary consolidation, atrial fibrillation, and low albumin. Decrease of PH value of eosinophilic granulocytes and elevation of CRP in patients with nosocomial death. 3 the CURB-65 score of death group and BAP-65 score and DECAF score were higher than those of survival group, and the difference was statistically significant (P < 0.05). With the increase of three kinds of scores, the mortality in hospital increased correspondingly. The scores of DECAF and CURB-65 were above 4. Hospital mortality was 48% and 50.BAP-65 scores were above 4. Hospital mortality rate was 80. 5. In predicting hospital mortality, the area under CURB-65 score and BAP-65 score curve was 0. 80 or above. The area under the score curve was about 0. 95. The area under the AUROC score was about 0. 95. A pair of Z test, The results showed that there was no significant difference between the CURB-65 score and the BAP-65 score. There was no significant difference between the CURB-65 score and the CURB-65 score and the BAP-65 score. The level of C-reactive protein increased, the number of eosinophils decreased, acidosis and complicated pulmonary consolidation, atrial fibrillation. The prognosis of patients was evaluated by referring to the above indexes. The CURB-65 score and BAP-65 and DECAF score were evaluated on admission. These three kinds of scores have certain value in predicting the hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). DECAF score has the highest accuracy in predicting the prognosis of patients with AECOPD among the three scores, and it is worth popularizing in clinic.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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