摘要
目的分析炎症反应与慢性阻塞性肺疾病(COPD)伴呼吸衰竭住院患者短期再入院的关系。方法纳入91例COPD伴呼吸衰竭住院患者进行前瞻性队列研究,根据患者在住院期间的并发症发生情况分为发生组(n=17)与未发生组(n=74),根据患者出院后30 d内再入院情况分为再入院组(n=18)与非再入院组(n=73)。另纳入91例单纯COPD患者为对照,比较单纯COPD组与COPD伴呼吸衰竭组、发生组与未发生组患者治疗前炎症指标[白细胞(WBC)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平,使用多因素二元Logistic回归分析COPD伴呼吸衰竭患者30 d再入院的危险因素,绘制受试者操作特征(ROC)曲线,分析相关因素预测COPD或COPD伴呼吸衰竭患者短期再入院的价值。结果治疗后COPD伴呼吸衰竭患者及单纯COPD患者的WBC、CRP、TNF-α水平低于治疗前(P均<0.05)。COPD伴呼吸衰竭患者治疗前WBC、CRP、TNF-α水平高于单纯COPD患者(P均<0.05)。COPD伴Ⅱ型呼吸衰竭患者治疗前WBC、CRP、TNF-α水平高于伴Ⅰ型呼吸衰竭患者(P均<0.05)。发生组患者治疗前CRP、TNF-α水平高于未发生组(P均<0.05)。再入院组患者治疗前CRP、TNF-α水平高于非再入院组(P均<0.05)。多因素二元Logistic回归分析调整混杂因素结果显示,CRP、TNF-α与COPD患者30 d再入院无关(P>0.05),但无论是否调整混杂因素,CRP、TNF-α均为影响COPD伴呼吸衰竭患者30 d再入院的因素(P均<0.05)。治疗前CRP、TNF-α单独及联合检测预测COPD伴呼吸衰竭患者30 d再入院的曲线下面积均超过0.70,具有一定的预测价值。结论CRP、TNF-α在临床预测COPD伴呼吸衰竭患者短期再入院的效能较高,可根据二者水平制定治疗方案以降低患者再入院风险。
Objective To analyze the relationship between inflammatory reaction and the short-term readmission of hospitalized patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods Ninetyone hospitalized patients with COPD complicated with respiratory failure were included in this prospective cohort study.They were divided into the occurrence group(n=17)and the non-occurrence group(n=74)according to the occurrence of complications during hospitalization.They were also divided into the readmission group(n=18)and the non-readmission group(n=73)according to the 30-d readmission situation.Another 91 patients with COPD alone were assigned into the control group.The pre-treatment inflammation indicators(white blood cell(WBC),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α))were compared between patients with COPD alone and COPD complicated with respiratory failure and different prognosis.The risk factors of 30-d readmission of COPD complicated with respiratory failure were identified by multivariate binary Logistic regression analysis.The receiver operating characteristic(ROC)curve was delineated to analyze the diagnostic values of these risk factors for the short-term readmission of COPD patients complicated with respiratory failure.Results After treatment,the levels of WBC,CRP,and TNF-αin COPD patients with respiratory failure and simple COPD were significantly lower than those before treatment(all P<0.05).The levels of WBC,CRP and TNF-αin patients with COPD complicated with respiratory failure before treatment were significantly higher than those in patients with COPD alone(all P<0.05).The levels of WBC,CRP and TNF-αin COPD patients complicated with typeⅡrespiratory failure before treatment were significantly higher than those in patients complicated with typeⅠrespiratory failure(all P<0.05).The levels of CRP and TNF-αin the occurrence group before treatment were significantly higher than those in the non-occurrence group(both P<0.05).The levels of CRP and TNF-αin
作者
郑雨霖
金雪文
陈坤伦
严利华
ZHENG Yulin;JIN Xuewen;CHEN Kunlun;YAN Lihua(Department of Respiratory and Critical Care,Yuhuan People’s Hospital and Yuhuan Branch,the First Affiliated Hospital of Wenzhou Medical University,Yuhuan 317600,China)
出处
《新医学》
CAS
2024年第8期631-640,共10页
Journal of New Medicine
基金
台州市社会发展科技计划项目(21ywb133)。
关键词
慢性阻塞性肺疾病
呼吸衰竭
炎症反应
C-反应蛋白
白细胞
肿瘤坏死因子-Α
再入院
Chronic obstructive pulmonary disease
Respiratory failure
Inflammatory reaction
C-reactive protein
White blood cell
Tumor necrosis factor-α
Readmission
