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血清淀粉样蛋白A及CRP水平与慢性阻塞性肺疾病急性加重期患者临床指标的相关性探讨

发布时间:2019-01-11 10:39
【摘要】:目的:探讨淀粉样蛋白A及C反应蛋白预测COPD急性加重期的意义。探讨两者在预测AECOPD合并细菌与病毒感染中的作用。同时淀粉样蛋白A是公认的心血管疾病的指标,进一步探索淀粉样蛋白A与肺源性心脏病及呼吸衰竭之间的关系。方法:选取COPD急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者45例观察对象为AECOPD组,稳定期的COPD患者15例为对照组。AECOPD组于入院时、出院前1~2天检测淀粉样蛋白及CRP值和血常规。稳定期患者清晨同一时间点抽血对照。均测两组的CRP和淀粉样蛋白A及血常规的值。比较两组的各项值之间统计学意义。计算受试者工作曲线的曲线下面积及利用Pearson相关分析分析各指标相关性。同时将AECOPD组根据是否感冒样症状分为感冒样症状组及非感冒样症状组;根据是否黄痰或痰培养阳性分为黄痰组与非黄痰组;根据是否合并肺心病分为肺心病组与非肺心病组;根据是否呼吸衰竭分为呼吸衰竭组与无呼吸衰竭组。分别统计各组间的各指标的统计学意义。结果:1.与对照组和出院时比较,入院时AECOPD组的淀粉样蛋白A及白细胞明显升高(P0.05)。AECOPD组CRP水平入院时与出院前及对照组比均无统计学意义(P0.05,P=0.05)。AECOPD组的中性粒细胞水平入院时较对照组升高,差异有统计学意义(P0.05),与出院前比无统计学意义(P0.05)。2.将45例AECOPD患者分为有感冒样症状组和无感冒样症状组,入院时感冒样症状组的淀粉样蛋白A水平高于无感冒样症状组,差异有统计学意义(P0.001)。CRP、中性粒细胞、白细胞值在两组间比较无统计学意义(P0.05)。3.将45例AECOPD患者分为有脓痰或痰培养阳性与无脓痰并且痰培养阴性组,入院时有脓痰或痰培养阳性组的淀粉样蛋白A及CRP水平高于无脓痰并且痰培养阴性组,差异有统计学意义(P0.001及0.05)。中性粒细胞、白细胞值在两组间比较无统计学意义(P0.05)。4.将45例AECOPD患者分为合并肺心病组与无肺心病组,入院时的淀粉样蛋白A、CRP、中性粒细胞、白细胞值在两组间比较无统计学意义(P0.05)。5.将45例AECOPD患者分为合并呼吸衰竭组与无呼吸衰竭组,入院时的淀粉样蛋白A、CRP、中性粒细胞、白细胞值在两组间比较无统计学意义(P0.05)。6.淀粉样蛋白A、CRP、白细胞、中性粒细胞诊断AECOPD的ROC曲线的曲线下面积(AUC):淀粉样蛋白A最大(AUC=0.847),白细胞计数、中性粒细胞计数、CRP的曲线下面积分别为0.728、0.674和0.624。淀粉样蛋白A、白细胞计数、中性粒细胞计数和CRP的Cutoff值分别为:27.5mg/L、5.8×10^9/L、4.09×1 0^9/L 和 12.9 mg/L。7.淀粉样蛋白A、CRP、中性粒细胞及白细胞在AECOPD患者中的相关性:淀粉样蛋白A与CRP之间有较好的相关性,P0.01;淀粉样蛋白A与白细胞及中性粒细胞之间无相关性,P0.05;CRP与白细胞有相关性,P0.01;白细胞与中性粒细胞之间有较大相关性,P0.001。结论:在AECOPD中,淀粉样蛋白A是较CRP敏感的生物标志物,联合检测对鉴别细菌及病毒感染有一定的指导作用。可能淀粉样蛋白A能作为AECOPD患者一个较好的评价疾病的一个生物标志物。但急性加重期的SAA及CRP水平可能与肺源性心脏及呼吸衰竭相关性不大。
[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.
【学位授予单位】:浙江大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R563.9

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