摘要
目的观察铁稳态失调在介导COPD伴Ⅱ型呼吸衰竭患者贫血发生中的作用机制及贫血对患者预后的影响。方法选择2019年9月—2020年9月海南医学院第二附属医院呼吸内科收治COPD伴Ⅱ型呼吸衰竭患者70例。根据患者是否存在贫血分为贫血组(n=22)和非贫血组(n=48)。比较2组患者入院时临床资料及炎性因子、贫血相关指标及铁稳态指标(铁调素),并分析铁调素与炎性因子之间的相关性。多因素Logistic回归分析影响患者发生贫血的危险因素。随访90 d,分析2组患者慢性阻塞性肺疾病急性发作(AECOPD)及存活情况之间的差异。结果贫血组年龄、病程及血清IL-1、IL-6、TNF-α、铁调节素水平高于非贫血组(t/P=3.881/<0.001、2.221/0.032、2.313/0.026、4.242/<0.001、2.442/0.021、5.746/<0.001),血清Alb水平低于非贫血组(t/P=4.055/<0.001);贫血组患者随访期间AECOPD发生率、发生次数显著高于非贫血组(χ^(2)/P=4.635/0.034,t/P=9.321/<0.001)。IL-6、TNF-α与铁调素呈正相关(r/P=0.309/0.008、0.294/0.011),而IL-1与铁调素之间无显著相关性(r/P=0.026/0.821)。年龄大、高IL-6、高铁调节素是患者发生贫血的独立危险因素[OR(95%CI)=1.401(1.063~1.843)、1.164(1.079~2.976)、1.555(1.089~2.221)],高Alb是患者发生贫血的独立保护因素[OR(95%CI)=0.491(0.276~0.873)]。结论COPD伴Ⅱ型呼吸衰竭合并贫血的患者体内存在铁稳态失调,可能是由炎性因子引起的;贫血可导致COPD伴Ⅱ型呼吸衰竭患者住院90 d内AECOPD风险增加。
Objective To observe the mechanism of iron homeostasis in mediating the occurrence of anemia in COPD patients with typeⅡrespiratory failure and the effect of anemia on the prognosis of patients.Methods From September 2019 to September 2020,70 patients with COPD and type II respiratory failure were admitted to the Department of Respiratory Medicine,Second Affiliated Hospital of Hainan Medical College.According to whether patients have anemia,they are divided into anemia group(n=22)and non-anemia group(n=48).The clinical data and inflammatory factors,anemia-related indicators and iron homeostasis indicators(hepcidin)were compared between the two groups of patients when they were admitted to the hospital,and the correlation between hepcidin and inflammatory factors was analyzed.Multivariate logistic regression analysis of the risk factors of anemia in patients.The difference between the acute onset of chronic obstructive pulmonary disease(AECOPD)and survival during the 90-day follow-up period of the two groups was analyzed.Results The age,course of disease,IL-1,IL-6,TNF-α,and ironmodulin levels in the anemia group were higher than those in the non-anemia group(t/P=3.881/<0.001,2.221/0.032,2.313/0.026,4.242/<0.001,2.442/0.021,5.746/<0.001),the level of Alb is lower than the non-anemia group(t/P=4.055/<0.001).The incidence and frequency of AECOPD during the follow-up period in the anemia group were significantly higher than those in the non-anemia group(χ^(2)/P=4.635/0.034,t/P=9.321/<0.001).IL-6,TNF-αand hepcidin were positively correlated(r/P=0.309/0.008,0.294/0.011),but there was no significant correlation between IL-1 and hepcidin(r/P=0.026/0.821).Old age,high IL6,and methordrin are independent risk factors for anemia in patients[OR(95%CI)=1.401(1.063-1.843),1.164(1.079-2.976),1.555(1.089-2.221)],high Alb is Independent protective factors for anemia in patients[OR(95%CI)=0.491(0.276-0.873)].Conclusion In patients with COPD with typeⅡrespiratory failure and anemia,there is an imbalance of iron homeostasis in
作者
林石宁
王发辉
石慧芳
徐建光
陈山
Lin Shining;Wang Fahui;Shi Huifang;Xu Jianguang;Chen Shan(Department of Respiratory Medicine, Second Affiliated Hospital of Hainan Medical College, Hainan Province,Haikou 570311,China)
出处
《疑难病杂志》
CAS
2021年第10期1012-1016,共5页
Chinese Journal of Difficult and Complicated Cases
基金
海南省卫生健康行业科研项目(20A200310)。
关键词
慢性阻塞性肺疾病
呼吸衰竭
Ⅱ型
贫血
铁调素
炎性反应
Chronic obstructive pulmonary disease
Respiratory failure,typeⅡ
Anemia
Hepcidin
Inflammatory response
