血清淀粉樣蛋白A及CRP水平與慢性阻塞性肺疾病急性加重期患者臨床指標(biāo)的相關(guān)性探討
發(fā)布時(shí)間：2019-01-11 10:39
【摘要】：目的:探討淀粉樣蛋白A及C反應(yīng)蛋白預(yù)測(cè)COPD急性加重期的意義。探討兩者在預(yù)測(cè)AECOPD合并細(xì)菌與病毒感染中的作用。同時(shí)淀粉樣蛋白A是公認(rèn)的心血管疾病的指標(biāo),進(jìn)一步探索淀粉樣蛋白A與肺源性心臟病及呼吸衰竭之間的關(guān)系。方法:選取COPD急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者45例觀察對(duì)象為AECOPD組,穩(wěn)定期的COPD患者15例為對(duì)照組。AECOPD組于入院時(shí)、出院前1～2天檢測(cè)淀粉樣蛋白及CRP值和血常規(guī)。穩(wěn)定期患者清晨同一時(shí)間點(diǎn)抽血對(duì)照。均測(cè)兩組的CRP和淀粉樣蛋白A及血常規(guī)的值。比較兩組的各項(xiàng)值之間統(tǒng)計(jì)學(xué)意義。計(jì)算受試者工作曲線的曲線下面積及利用Pearson相關(guān)分析分析各指標(biāo)相關(guān)性。同時(shí)將AECOPD組根據(jù)是否感冒樣癥狀分為感冒樣癥狀組及非感冒樣癥狀組;根據(jù)是否黃痰或痰培養(yǎng)陽(yáng)性分為黃痰組與非黃痰組;根據(jù)是否合并肺心病分為肺心病組與非肺心病組;根據(jù)是否呼吸衰竭分為呼吸衰竭組與無(wú)呼吸衰竭組。分別統(tǒng)計(jì)各組間的各指標(biāo)的統(tǒng)計(jì)學(xué)意義。結(jié)果:1.與對(duì)照組和出院時(shí)比較,入院時(shí)AECOPD組的淀粉樣蛋白A及白細(xì)胞明顯升高(P0.05)。AECOPD組CRP水平入院時(shí)與出院前及對(duì)照組比均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05,P=0.05)。AECOPD組的中性粒細(xì)胞水平入院時(shí)較對(duì)照組升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),與出院前比無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.將45例AECOPD患者分為有感冒樣癥狀組和無(wú)感冒樣癥狀組,入院時(shí)感冒樣癥狀組的淀粉樣蛋白A水平高于無(wú)感冒樣癥狀組,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。CRP、中性粒細(xì)胞、白細(xì)胞值在兩組間比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.將45例AECOPD患者分為有膿痰或痰培養(yǎng)陽(yáng)性與無(wú)膿痰并且痰培養(yǎng)陰性組,入院時(shí)有膿痰或痰培養(yǎng)陽(yáng)性組的淀粉樣蛋白A及CRP水平高于無(wú)膿痰并且痰培養(yǎng)陰性組,差異有統(tǒng)計(jì)學(xué)意義(P0.001及0.05)。中性粒細(xì)胞、白細(xì)胞值在兩組間比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.將45例AECOPD患者分為合并肺心病組與無(wú)肺心病組,入院時(shí)的淀粉樣蛋白A、CRP、中性粒細(xì)胞、白細(xì)胞值在兩組間比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5.將45例AECOPD患者分為合并呼吸衰竭組與無(wú)呼吸衰竭組,入院時(shí)的淀粉樣蛋白A、CRP、中性粒細(xì)胞、白細(xì)胞值在兩組間比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。6.淀粉樣蛋白A、CRP、白細(xì)胞、中性粒細(xì)胞診斷AECOPD的ROC曲線的曲線下面積(AUC):淀粉樣蛋白A最大(AUC=0.847),白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞計(jì)數(shù)、CRP的曲線下面積分別為0.728、0.674和0.624。淀粉樣蛋白A、白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞計(jì)數(shù)和CRP的Cutoff值分別為:27.5mg/L、5.8×10^9/L、4.09×1 0^9/L 和 12.9 mg/L。7.淀粉樣蛋白A、CRP、中性粒細(xì)胞及白細(xì)胞在AECOPD患者中的相關(guān)性:淀粉樣蛋白A與CRP之間有較好的相關(guān)性,P0.01;淀粉樣蛋白A與白細(xì)胞及中性粒細(xì)胞之間無(wú)相關(guān)性,P0.05;CRP與白細(xì)胞有相關(guān)性,P0.01;白細(xì)胞與中性粒細(xì)胞之間有較大相關(guān)性,P0.001。結(jié)論:在AECOPD中,淀粉樣蛋白A是較CRP敏感的生物標(biāo)志物,聯(lián)合檢測(cè)對(duì)鑒別細(xì)菌及病毒感染有一定的指導(dǎo)作用�？赡艿矸蹣拥鞍譇能作為AECOPD患者一個(gè)較好的評(píng)價(jià)疾病的一個(gè)生物標(biāo)志物。但急性加重期的SAA及CRP水平可能與肺源性心臟及呼吸衰竭相關(guān)性不大。
[Abstract]:Objective: To study the significance of amyloid A and C-reactive protein in the prediction of acute exacerbation of COPD. To explore the role of both in predicting the combination of bacterial and viral infection in AECOPD. At the same time, amyloid A is a recognized index of cardiovascular disease, and further explores the relationship between amyloid A and pulmonary heart disease and respiratory failure. Methods: 45 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were selected as AECOPD group and 15 patients with stable COPD were control group. In the AECOPD group, amyloid and CRP and blood routine were detected at 1-2 days before discharge. At the same time in the stationary phase, the patient drew blood control at the same time in the morning. The values of CRP and amyloid A and blood routine in both groups were measured. The statistical significance between the values of the two groups was compared. The area under the curve of the subject's working curve was calculated and the correlation was analyzed with Pearson correlation analysis. meanwhile, the AECOPD group is divided into a cold-like symptom group and a non-cold-like symptom group according to whether the common cold-like symptom is divided into a yellow sputum group and a non-yellow sputum group according to whether the symptoms of the yellow sputum or the sputum culture are positive, and the pulmonary heart disease group is divided into a pulmonary heart disease group and a non-yellow sputum group according to whether the combined pulmonary heart disease is divided into a cor pulmonale group and a non-yellow sputum group; The respiratory failure was divided into the respiratory failure group and the non-respiratory failure group. The statistical significance of each index in each group was counted separately. Results: 1. Compared with the control group and the discharge, the amyloid A and the white blood cell of AECOPD group increased significantly (P0.05). The level of CRP in AECOPD group was not significant (P0.05, P = 0.05). The level of neutrophil in AECOPD group was higher than that in the control group at the time of admission (P <0.05), and there was no significant difference with the pre-discharge ratio (P0.05). 45 patients with AECOPD were divided into common cold-like symptom group and no-cold-like symptom group, and the level of amyloid A in common cold-like symptom group was higher than that of common cold-like symptom group, and the difference was statistically significant (P0.01). CRP, neutrophils and white blood cell values were not statistically significant between the two groups (P0.05). 45 cases of AECOPD were divided into the positive and the non-purulent sputum and the negative group of the sputum culture, and the level of the amyloid A and CRP in the positive group with the purulent sputum or the sputum culture at the time of admission was higher than that of the negative group without purulent sputum and the sputum culture negative group (P 0.001 and 0.05). Neutrophil and white blood cell values were not statistically significant between the two groups (P0.05). 45 cases of AECOPD were divided into the group of pulmonary heart disease and the non-pulmonary heart disease group, and the amyloid A, CRP, neutrophils and white blood cells were not statistically significant between the two groups (P0.05). 45 cases of AECOPD were divided into two groups: the combined respiratory failure group and the non-respiratory failure group, the amyloid A, CRP, the neutrophils and the white blood cells were not statistically significant between the two groups (P0.05). The area under the curve of the ROC curve of amyloid A, CRP, white blood cells, and neutrophils (AUC): the maximum (AUC = 0.847), the white blood cell count, the neutrophil count, and the CRP curve under the curve of the amyloid A (AUC = 0.847), the white blood cell count, the neutrophil count, and the CRP were 0.728, 0.674 and 0.624, respectively. The Coutoff values of amyloid A, white blood cell count, neutrophil count and CRP were: 275.5mg/ L, 5.08/ 10/ 9/ L, 4.09/ 100/ 9/ L and 12.9mg/ L. The correlation of amyloid A, CRP, neutrophils and white blood cells in the patients with AECOPD: there was a good correlation between amyloid A and CRP, P0.01, the correlation between amyloid A and white blood cells and neutrophils, P0.05, and the correlation of CRP with white blood cells, P0.01; There was a large correlation between the white blood cells and the neutrophils, but P. 001. Conclusion: In AECOPD, amyloid A is a CRP-sensitive biomarker, and the combined detection has a guiding role in the identification of bacteria and viral infection. The possible amyloid A can be a biomarker for a better evaluation of the disease as an AECOPD patient. However, the level of SAA and CRP in the acute exacerbation may not be related to the pulmonary source and respiratory failure.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9
[Abstract]:Objective: To study the significance of amyloid A and C-reactive protein in the prediction of acute exacerbation of COPD. To explore the role of both in predicting the combination of bacterial and viral infection in AECOPD. At the same time, amyloid A is a recognized index of cardiovascular disease, and further explores the relationship between amyloid A and pulmonary heart disease and respiratory failure. Methods: 45 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) were selected as AECOPD group and 15 patients with stable COPD were control group. In the AECOPD group, amyloid and CRP and blood routine were detected at 1-2 days before discharge. At the same time in the stationary phase, the patient drew blood control at the same time in the morning. The values of CRP and amyloid A and blood routine in both groups were measured. The statistical significance between the values of the two groups was compared. The area under the curve of the subject's working curve was calculated and the correlation was analyzed with Pearson correlation analysis. meanwhile, the AECOPD group is divided into a cold-like symptom group and a non-cold-like symptom group according to whether the common cold-like symptom is divided into a yellow sputum group and a non-yellow sputum group according to whether the symptoms of the yellow sputum or the sputum culture are positive, and the pulmonary heart disease group is divided into a pulmonary heart disease group and a non-yellow sputum group according to whether the combined pulmonary heart disease is divided into a cor pulmonale group and a non-yellow sputum group; The respiratory failure was divided into the respiratory failure group and the non-respiratory failure group. The statistical significance of each index in each group was counted separately. Results: 1. Compared with the control group and the discharge, the amyloid A and the white blood cell of AECOPD group increased significantly (P0.05). The level of CRP in AECOPD group was not significant (P0.05, P = 0.05). The level of neutrophil in AECOPD group was higher than that in the control group at the time of admission (P <0.05), and there was no significant difference with the pre-discharge ratio (P0.05). 45 patients with AECOPD were divided into common cold-like symptom group and no-cold-like symptom group, and the level of amyloid A in common cold-like symptom group was higher than that of common cold-like symptom group, and the difference was statistically significant (P0.01). CRP, neutrophils and white blood cell values were not statistically significant between the two groups (P0.05). 45 cases of AECOPD were divided into the positive and the non-purulent sputum and the negative group of the sputum culture, and the level of the amyloid A and CRP in the positive group with the purulent sputum or the sputum culture at the time of admission was higher than that of the negative group without purulent sputum and the sputum culture negative group (P 0.001 and 0.05). Neutrophil and white blood cell values were not statistically significant between the two groups (P0.05). 45 cases of AECOPD were divided into the group of pulmonary heart disease and the non-pulmonary heart disease group, and the amyloid A, CRP, neutrophils and white blood cells were not statistically significant between the two groups (P0.05). 45 cases of AECOPD were divided into two groups: the combined respiratory failure group and the non-respiratory failure group, the amyloid A, CRP, the neutrophils and the white blood cells were not statistically significant between the two groups (P0.05). The area under the curve of the ROC curve of amyloid A, CRP, white blood cells, and neutrophils (AUC): the maximum (AUC = 0.847), the white blood cell count, the neutrophil count, and the CRP curve under the curve of the amyloid A (AUC = 0.847), the white blood cell count, the neutrophil count, and the CRP were 0.728, 0.674 and 0.624, respectively. The Coutoff values of amyloid A, white blood cell count, neutrophil count and CRP were: 275.5mg/ L, 5.08/ 10/ 9/ L, 4.09/ 100/ 9/ L and 12.9mg/ L. The correlation of amyloid A, CRP, neutrophils and white blood cells in the patients with AECOPD: there was a good correlation between amyloid A and CRP, P0.01, the correlation between amyloid A and white blood cells and neutrophils, P0.05, and the correlation of CRP with white blood cells, P0.01; There was a large correlation between the white blood cells and the neutrophils, but P. 001. Conclusion: In AECOPD, amyloid A is a CRP-sensitive biomarker, and the combined detection has a guiding role in the identification of bacteria and viral infection. The possible amyloid A can be a biomarker for a better evaluation of the disease as an AECOPD patient. However, the level of SAA and CRP in the acute exacerbation may not be related to the pulmonary source and respiratory failure.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.9
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