老年COPD伴呼吸衰竭病人血清CHE、白蛋白、β2-MG、Cys C水平及意义

摘要

Objective To investigate the level and significance of serum cholinesterase (CHE), albumin, β2-microglobulin (β2-MG) and cystatin C (Cys C) in the patients with chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Methods From January 2016 to October 2017, a total of 168 patients with COPD in our hospital were selected, including 59 cases of patients with COPD and respiratory failure (COPD with respiratory failure group), 109 cases of patients with COPD (COPD group), and another 100 healthy volunteers were selected as the control group. The serum levels of CHE, albumin, β2-MG, Cys C, and bloodgas were measured, and the acute physiological and chronic health status score Ⅱ (APACHE Ⅱ) was used to evaluate the degree of the disease. Results The levels of CHE, albumin and PaO2 in COPD with respiratory failure group were (3041.46±942.55) U/L, (29.84±2.88) g/L and (50.47±9.11) mm Hg respectively, which were significantly lower than those in the control group and COPD group (P＜0.05), while the levels of Cys C, β2-MG, APACHE score and PaCO2 were (151.10 ± 30.11) ng/m L, (2.91 ± 0.30) mg/L, (26.25 ±5.16) and (60.01 ± 4.39) mm Hg respectively, which were significantly higher than those of COPD group (P＜0.05); During the period of treatment, 16 cases died, 43 cases survived in COPD with respiratory failure group; The levels of CHE, albumin and PaO2 in death group were (2554.41±670.24) U/L, (25.46±2.46) g/L and (43.20±5.29) mm Hg, which were significantly lower than those in the survival group (P＜0.05), while the levels of Cys C, β2-MG, APACHE score and PaCO2 were (169.33±30.32) ng/m L, (3.04±0.61) mg/L, (31.38±5) and (55.22±3.10) mm Hg, which were significantly higher than those in the survival group (P＜0.05); The serum levels of CHE, albumin and PaO2 in the patients with COPD and respiratory failure were negatively correlated with APACHE Ⅱ score (r=-0.564, -0.521 and-0.411, P＜0.05), Cys C, β2-MG and PaCO2 were positively with APACHE II score (r=0.301, 0.331 and 0.320, P＜0.05). Conclusions The level of serum CHE and albumin in the elderly patients with COPD complicated with respiratory failure are significantly decreased, which are related to the degree of disease and prognosis of the patients.%目的 探讨老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)伴呼吸衰竭病人血清胆碱酯酶(cholinesterase,CHE)、白蛋白、β2微球蛋白(β2-microglobulin,β2-MG)及胱抑素C(cystatin C,Cys C)的水平及意义.方法 选取2016年1月至2017年10月在我院治疗的COPD病人168例,其中COPD伴呼吸衰竭病人59例(COPD伴呼衰组),单纯COPD病人109例(COPD组),同时选取健康志愿者100例作为对照组,检测各组血清CHE、白蛋白、β2-MG和Cys C水平以及血气分析,同时采用急性生理和慢性健康状态评分Ⅱ(acute physiological and chronic health status scoreⅡ,APACHEⅡ)进行病情严重程度评估.结果COPD伴呼衰组CHE、白蛋白和动脉血氧分压(PaO2)分别为(3041.46±942.55)U/L、(29.84±2.88)g/L和(50.47±9.11)mm Hg,明显低于对照组和COPD组(P＜0.05),而Cys C、β2-MG、APACHEⅡ评分和动脉血二氧化碳分压(PaCO2)分别为(151.10±30.11)ng/m L、(2.91±0.30)mg/L、(26.25±5.16)分和(60.01±4.39)mm Hg,明显高于COPD组(P＜0.05).治疗期间COPD伴呼衰组死亡16例,存活43例;COPD伴呼衰组死亡病人CHE、白蛋白和PaCO2分别为(2554.41±670.24)U/L、(25.46±2.46)g/L和(43.20±5.29)mm Hg,明显低于存活病人(P＜0.05),而Cys C、β2-MG、APACHEⅡ评分和PaCO2分别为(169.33±30.32)ng/m L、(3.04±0.61)mg/L、(31.38±5.00)分和(55.22±3.10)mm Hg,明显高于存活病人(P＜0.05).COPD伴呼衰病人血清CHE、白蛋白、PaO2与APACHEⅡ评分呈负相关(r=-0.564、-0.521和-0.411,P＜0.05);Cys C、β2-MG和PaCO2与APACHEⅡ评分呈正相关(r=0.301、0.331和0.320,P＜0.05).结论 老年COPD伴呼吸衰竭病人血清CHE和白蛋白水平明显降低,与病人病情程度及预后有一定关系.