李庆旭

【摘要】 目的：研究慢性阻塞性肺疾病（COPD）合并呼吸衰竭患者血清降鈣素原（PCT）、胆碱酯酶（ChE）、糖类抗原125（CA125）、纤维蛋白原（FIB）的表达及其与预后的相关性。方法：选取2018年2月-2019年2月本院收治的90例COPD患者的临床资料进行回顾性分析，将其按照是否合并呼吸衰竭分为呼吸衰竭组（n=51）和无呼吸衰竭组（n=39）。另取同期于医院进行体检的健康志愿者40例作为对照组。检测并比较三组动脉血气分析指标、APACHEⅡ评分及血清PCT、ChE、CA125、FIB表达水平。比较呼吸衰竭组中死亡者和存活者血清PCT、ChE、CA125、FIB表达水平。采用受试者工作特征（ROC）曲线分析血清PCT、ChE、CA125、FIB水平对COPD合并呼吸衰竭患者预后的预测效能。结果：呼吸衰竭组PaO2低于无呼吸衰竭组，无呼吸衰竭组PaO2低于对照组（P<0.05）;呼吸衰竭组PaCO2、APACHEⅡ评分均高于无呼吸衰竭组，无呼吸衰竭组PaCO2、APACHEⅡ评分均高于对照组（P<0.05）。呼吸衰竭组血清PCT、CA125、FIB水平均高于无呼吸衰竭组，无呼吸衰竭组血清PCT、CA125、FIB水平均高于对照组（P<0.05）;呼吸衰竭组血清ChE水平低于无呼吸衰竭组，无呼吸衰竭组血清ChE水平低于对照组（P<0.05）。呼吸衰竭组中死亡者的血清PCT、CA125、FIB表达水平均高于存活者，而血清ChE水平低于存活者（P<0.05）。血清PCT、ChE、CA125、FIB表达水平联合检测预测COPD合并呼吸衰竭患者预后的曲线下面积、敏感度、特异度均高于上述各项指标单独检测。结论：COPD合并呼吸衰竭患者血清PCT、CA125、FIB呈高表达，而血清ChE呈低表达。联合检测上述各项指标水平可有效预测COPD合并呼吸衰竭患者预后。

【关键词】 慢性阻塞性肺疾病 呼吸衰竭 降钙素原 胆碱酯酶 糖类抗原125

[Abstract] Objective： To study the expression of serum procalcitonin （PCT）， cholinesterase （ChE）， carbohydrate antigen 125 （CA125） and fibrinogen （FIB） in patients with chronic obstructive pulmonary disease （COPD） combined with respiratory failure and analyze their correlation with prognosis. Method： Clinical data of 90 COPD patients admitted to our hospital from February 2018 to February 2019 were retrospectively analyzed， and they were divided into respiratory failure group （n=51） and non-respiratory failure group （n=39） according to whether they were complicated with respiratory failure. In addition， 40 healthy volunteers who underwent physical examination in hospital during the same period were taken as the control group. Arterial blood gas index， APACHEⅡ score and the expression levels of PCT， ChE， CA125 and FIB in serum were detected and compared among the three groups. The expression levels of PCT， ChE， CA125 and FIB were compared between dead and alive patients in respiratory failure group. Receiver operating characteristic （ROC） curve was used to analyze the prognostic efficacy of serum PCT， ChE， CA125 and FIB levels in COPD patients with respiratory failure. Result： PaO2 in the respiratory failure group was lower than that in non-respiratory failure group， and PaO2 in non-respiratory failure group was lower than that of control group （P<0.05）; PaCO2 and APACHEⅡ scores in the respiratory failure group were higher than those in the non-respiratory failure group， and those in the non-respiratory failure group were higher than those in the control group （P<0.05）. The levels of serum PCT， CA125 and FIB in respiratory failure group were higher than those in the non-respiratory failure group， and those in the non-respiratory failure group were higher than those in the control group （P<0.05）; serum ChE level in respiratory failure group was lower than that in non-respiratory failure group， and that in non-respiratory failure group was lower than that in control group （P<0.05）. The expression levels of PCT， CA125 and FIB of dead patients in respiratory failure group were higher than those of survivors， while ChE was lower than those in survivors （P<0.05）. The area under the curve， sensitivity and specificity of serum PCT， ChE， CA125 and FIB expression levels combined to predict prognosis of COPD patients with respiratory failure were higher than those of the above indexes alone. Conclusion： PCT， CA125 and FIB are significantly high in patients with COPD combined with respiratory failure， while ChE is abnormally low. Combined detection of the above indicators can effectively predict the prognosis of patients with COPD combined with respiratory failure.

[Key words] Chronic obstructive pulmonary disease Respiratory failure Procalcitonin Cholinesterase Carbohydrate antigen 125

First-author’s address： Tieling Central Hospital， Tieling 112000， China

doi：10.3969/j.issn.1674-4985.2021.25.039

慢性阻塞性肺疾病（COPD）是目前临床上较为常见的呼吸系统疾病之一，主要临床表现特征为气流受限非完全可逆，往往呈进行性发展[1]。……