【摘要】：背景:隨著慢性阻塞性肺疾病患病率逐年升高,據(jù)世界衛(wèi)生組織報告慢性阻塞性肺疾病已經成為了繼缺血性心臟病、卒中之后的全球第三大死亡原因。2016年在英國倫敦舉行的歐洲呼吸學年會上,鐘南山先生發(fā)表了一項最新的流行病學調查數(shù)據(jù),在我國40歲以上的人群中慢性阻塞性肺疾病的患病率儼然已經上升至14%。慢阻肺不僅是影響患者生活質量的一大因素,更是加重社會醫(yī)療資源的緊缺,慢阻肺急性加重的發(fā)生亦加劇這一情況,而且急性加重的發(fā)生還可能會是加速疾病的進展的因素之一,但目前對于慢阻肺急性加重期的診斷仍只依賴于患者咳嗽、咳痰、呼吸困難等癥狀的加重,原有治療不能有效控制病情,需更改治療方案這些依靠患者或醫(yī)生的主觀判斷,存在一定局限性,容易發(fā)生漏診或誤診,因此探究有助于慢阻肺急性加重期診斷的客觀指標就十分必要。目白的:分析因AECOPD住院患者血生物標志物水平變化,探討單獨及聯(lián)合檢測各項生物標志物的臨床意義。比較各項生物標志物對明確慢性阻塞性肺疾病急性加重期診斷的意義。探討各項指標之間是否具有相關性。方法:選擇2016年1月至2016年12月于遼寧省人民醫(yī)院因AECOPD住院治療患者50例,選取同期緩解期cOPD患者50名作為對照組,分別檢測臨床常用的生物標志物,白細胞計數(shù)、中性粒細胞比例、CRP、PCT、D-dimer、FIB,評價各項指標對AECOPD診斷意義。結果:①AECOPD組患者白細胞計數(shù)、中性粒細胞比例、CRP、PCT、D-dimer、FIB水平分別為9.84±4.482、80.18±10.880、59.40±58.655、0.72±0.818、752.57±454.692、4.29±1.143;SCOPD組分別為5.83±1.632、63.69±12.329、10.08±14.012、0.07±0.133、495.63±203.943、3.21±0.878。②白細胞計數(shù)、中性粒細胞比例、CRP、PCT、D-dimer、FIB組數(shù)據(jù)R0C線下面積分別為 0.835、0.832、0.842、0.799、0.684、0.768。分別以 8.64、71.35、8.50、0.163、726.22、3.55為截斷點,WBC的敏感性、特異性、陽性預測值、陰性預測值分別為60%、96%、94%、71%,中性粒細胞比例分別為78%、74%、75%、77%,CRP 分別為 86%、72%、75%、84%,PCT 分別為 62%、98%、97%、72%,D-二聚體分別為42%、90%、81%、61%,FIB分別為74%、70%、71%、73%。中性粒細胞比例和C-反應蛋白、纖維蛋白原分別聯(lián)合后ROC曲線下面積為0.864、0.855,較單項指標有所升高。③在AECOPD組中,WBC與N%、CPR、PCT、D-dimer、FIB均存在相關性(R=0.530、0.434、0.496、0.377、0.395),N%與 CRP、PCT、D-dimer、FIB 具有一定相關性(R 分別為 0.582、0.453、0.426、0.478),CPR 與 PCT、D-dimer、FIB 均存在一定相關性(分別是 R=0.680、0.214、0.564),PCT 與D-dimer、FIB之間亦有一定相關性(R=0.312、0.506),D-dimer與FIB之間的相關系數(shù)為0.543。穩(wěn)定期患者中,WBC與N%、CRP、PCT、D-dimer、FIB存在相關性(分別是R=0.316、0.460、0.617、0.383、0.330),N%與 CPR、PCT、D-dimer、FIB 存在相關性(分別是 R=0.414、0.367、0.431、0.383);CPR 與 PCT、D-dimer、FIB 之間存在相關性(分別是R=O.782、0.521、0.498),PCT與D-dimer之間存在相關性(分別是R=0.366),D-dimer與FIB之間的相關系數(shù)為0.438。結論:AECOPD組白細胞計數(shù)、中性粒細胞比例、CRP、PCT、D-dimer、FIB水平較SCOPD組均有明顯升高,可為疾病診斷提供依據(jù),其中CRP的ROC曲線下面積最大,診斷價值高于其他組數(shù)據(jù)。分別聯(lián)合檢測中性粒細胞比例和C-反應蛋白、纖維蛋白原能有效提高AECOPD診斷率。部分項生物標志物之間存在直線相關關系,其中CRP與PCT之間相關性最明顯。
[Abstract]:Background: as the prevalence of chronic obstructive pulmonary disease is increasing year by year, according to WHO, chronic obstructive pulmonary disease has become the third major cause of global death following ischemic heart disease, the third major cause of death after stroke. At the European annual conference on respiratory studies in London, London, Mr. Zhong Nanshan published a latest epidemiology. The survey data, the prevalence rate of chronic obstructive pulmonary disease in the population over 40 years old in our country seems to have risen to 14%. slow resistance lung is not only a major factor affecting the quality of life of the patients, but also the aggravation of the social medical resources, the acute exacerbation of the chronic obstructive pulmonary disease also aggravates this situation, and the occurrence of acute exacerbation may be also likely to be It is one of the factors to accelerate the progress of the disease, but the diagnosis of the acute exacerbation of the chronic obstructive pulmonary disease is still dependent on the aggravation of the patient's cough, expectoration, and dyspnea. The original treatment can not effectively control the condition. It is necessary to change the treatment plan by relying on the subjective judgment of the patient or the doctor. There are some limitations, and it is easy to have missed diagnosis or misdiagnosis. Therefore, it is necessary to explore the objective indicators that can help the diagnosis of acute exacerbation of the chronic obstructive pulmonary disease. Methods: 50 cases of AECOPD hospitalized patients in Liaoning people's Hospital from January 2016 to December 2016 were selected and 50 patients in the same period of remission period cOPD were selected as the control group. The clinical biomarkers, leukocyte count, neutrophils ratio, CRP, PCT, D-dime were detected respectively. R, FIB, evaluate the diagnostic significance of each index to AECOPD. Results: (1) the levels of leukocyte count, neutrophils ratio, CRP, PCT, D-dimer, FIB in group AECOPD were 9.84 + 4.482,80.18 + 10.880,59.40 + 58.655,0.72 + 0.818752.57 + 1.143, respectively, and 5.83 +. 203.943,3.21 + 0.878., neutrophils count, neutrophils ratio, CRP, PCT, D-dimer, FIB, the area under the R0C line is 0.835,0.832,0.842,0.799,0.684,0.768., respectively, 8.64,71.35,8.50,0.163726.22,3.55 as a truncation point, WBC sensitivity, specificity, positive predictive values, negative predictive values of 60%, 96%, 94%, 71%, neutrophils, respectively. The proportion of cells were 78%, 74%, 75%, 77%, and CRP were 86%, 72%, 75%, 84%, respectively 62%, 98%, 97%, 72%, respectively, D- two polymers, respectively, FIB respectively, 73%. neutrophils ratio and C- reactive protein, the area under the ROC curve of fibrinogen was 0.864,0.855, higher than the single index. Third, AE In group COPD, there are correlations between WBC and N%, CPR, PCT, D-dimer, FIB, N% and CRP, PCT, D-dimer, there are certain correlations. R=0.312,0.506, the correlation coefficient between D-dimer and FIB is in the 0.543. stable period patients, WBC and N%, CRP, PCT, D-dimer, FIB are correlated (respectively R=0.316,0.460,0.617,0.383,0.330). There was a correlation between PCT and D-dimer (R=0.366), and the correlation coefficient between D-dimer and FIB was 0.438. conclusion: the leukocyte count, the proportion of neutrophils, CRP, PCT, D-dimer, and the FIB level were significantly higher than those of the D-dimer group, which could provide the basis for the diagnosis of disease. The value of diagnosis was higher than that of other groups. The ratio of neutrophils and C- reactive protein were detected, and fibrinogen could effectively improve the diagnostic rate of AECOPD. There was a linear correlation between some biomarkers, among which the correlation between CRP and PCT was the most obvious.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.9

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