摘要
目的 探讨血清激活素A(ACTA)联合血管外肺水指数(EVLWI)对老年慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者预后的评估价值。方法 选取笔者所在医院2018年1月至2020年11月收治的197例COPD合并呼吸衰竭患者,根据28 d后生存情况分为死亡组(n=55)和存活组(n=142)。比较两组血清ACTA水平和EVLWI,多因素逐步Logistic回归分析老年COPD合并呼吸衰竭患者预后不良影响因素,受试者工作特征(ROC)曲线分析血清ACTA联合EVLWI对老年COPD合并呼吸衰竭患者预后不良的评估价值。结果 死亡组血清ACTA水平和EVLWI高于存活组(P均<0.05)。多因素逐步Logistic回归分析显示,高氧合指数(OR=0.959,95%CI:0.933~0.986)为老年COPD合并呼吸衰竭患者预后不良独立保护因素,高急性生理和慢性健康评估Ⅱ评分(OR=1.195,95%CI:1.026~1.392)、ACTA水平(OR=1.351,95%CI:1.177~1.550)、EVLWI(OR=2.165,95%CI:1.498~3.129)为其独立危险因素(P均<0.05)。ROC曲线显示,ACTA+EVLWI(AUC=0.918,95%CI:0.871~0.953)评估老年COPD合并呼吸衰竭患者预后不良的AUC大于ACTA(AUC=0.812,95%CI:0.751~0.864)、EVLWI(AUC=0.789,95%CI:0.725~0.844)单独评估(P均<0.05)。结论 高血清ACTA水平和EVLWI为老年COPD合并呼吸衰竭患者预后不良独立危险因素,联合检测可提升预后不良评估价值。
Objective To explore the prognostic value of serum activin A(ACTA)combined with extravascular lung water index(EVLWI)in the prognosis of elderly patients with chronic obstructive pulmonary disease(COPD)and respiratory failure.Methods A total of 197 COPD patients with respiratory failure admitted to our hospital from January 2018 to November 2020 were selected and divided into death group(n=55)and survival group(n=142)according to their survival status after 28 days.The serum levels of ACTA and EVLWI were compared between the two groups.Multivariate stepwise Logistic regression was used to analyze the adverse prognostic factors of elderly COPD patients with respiratory failure.ROC curve analysis was used to analyze the value of serum ACTA combined with EVLWI on poor prognosis of elderly COPD patients with respiratory failure.Results The serum ACTA level and EVLWI in the death group were significantly higher than those in the survival group(P all<0.05).Multivariate stepwise logistic regression analysis showed that hyperoxia index(OR=0.959,95%CI:0.933-0.986)was an independent protective factor for the poor prognosis of elderly COPD patients with respiratory failure,high acute physiology and chronic health as-sessmentⅡscore(OR=1.195,95%CI:1.026-1.392),ACTA level(OR=1.351,95%CI:1.177-1.550),EVLWI(OR=2.165,95%CI:1.498-3.129)were independent risk factors(P all<0.05).The ROC curve showed that the AUC of ACTA+EVLWI(AUC=0.918,95%CI:0.871-0.953)to assess the poor prognosis of elderly COPD pa-tients with respiratory failure was significantly greater than that of ACTA(AUC=0.812,95%CI:0.751-0.864),EVLWI(AUC=0.789,95%CI:0.725-0.844)evaluation(P all<0.05).Conclusion High serum ACTA level and EVLWI are independent risk factors for poor prognosis in elderly COPD patients with respiratory failure.Combined detection can enhance the evaluation value of poor prognosis.
作者
赵晓秋
陶赟臻
严晓妹
柳江红
ZHAO Xiaoqiu;TAO Yunzhen;YAN Xiaomei;LIU Jianghong(First Department of Respiratory and Critical Care,Zhangjiakou First Hospital,Zhangjiakou 075000,China;First Department of Geriatrics,Zhangjiakou First Hospital,Zhangjiakou 075000,China;Department of General Practice,Zhangjiakou First Hospital,Zhangjiakou 075000,China)
出处
《宁夏医科大学学报》
2023年第7期689-693,698,共6页
Journal of Ningxia Medical University
基金
张家口市重点研发计划项目(1921088D)。
关键词
老年
慢性阻塞性肺疾病
呼吸衰竭
激活素A
血管外肺水指数
预后
eldly
chronic obstructive pulmonary disease
respiratory failure
activin A
extravascular lung water index
prognosis
