血清合肽素、降钙素原对COPD急性加重患者临床风险预测的价值

摘要

目的:评估血清合肽素、降钙素原对慢性阻塞性肺疾病急性加重(AECOPD)患者临床风险预测的价值.方法:选择159例住院治疗的AECOPD患者,在入组时、入组第14天、第6个月末分别留取血清标本,采用酶联免疫吸附法测定血清合肽素水平,电化学发光法测定降钙素原水平.采用单因素和多因素分析血清合肽素、降钙素原水平对AECOPD患者临床风险预测的价值.结果:与入组第14天和第6个月末相比,AECOPD患者入组时血清合肽素、降钙素原水平显著升高(均P<0.05).在6个月随访过程中单因素分析显示:入组时血清合肽素水平较高的患者死亡率较高(P<0.05),而降钙素原水平较高的患者死亡率无明显升高(P＞0.05);多因素分析显示:血清合肽素水平是AECOPD患者6个月内死亡事件发生的唯一预测因子(P<0.05);血清合肽素水平预测6个月内死亡事件的受试者工作特征曲线下面积为0.74(0.61～0.87,P<0.05).结论:血清合肽素水平可以作为AECOPD患者临床风险预测指标.%Objective:To estimate the prognostic value of serumal copeptin and procalcitonin in patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD). Methods:We enrolled 159 hospitalized AECOPD patients. Venous blood samples were collected for measurement of serumal copeptin and procalcitonin at baseline, 14 days and 6 months after including. The prognostic value of serumal copeptin and procalcitonin in patients with AECOPD were analyzed with univariate and multivariate analysis. Results:Comparing with the 14 days and 6 months after including, serumal levels of copeptin and procalcitonin were elevated at baseline ( all P < 0. 05 ) . Serumal copeptin levels were higher in patients with a death endpoint compared to survivors, but there was no difference of serumal procalcitonin level between the dead and survivors. In a multivariable Cox proportional hazards model only copeptin was predictive for mortality ( P < 0. 05 ) . For the prediction of death, receiver operating characteristic ( ROC ) curve analysis revealed an area under the curve for copeptin of 0. 74 ( 0. 61 -0. 87 , P < 0. 05 ).Conclusion:Serumal copeptin is a promising marker to predict the outcome in patients with AECOPD.