标题：老年AECOPD患者血尿酸、胆红素、纤维蛋白原水平与病情严重程度的关系及预测预后的价值

      作者：鹿敏，王艳杰，孙如坤，胡祥坤，潘春香    鹿敏，王艳杰，孙如坤，胡祥坤，潘春香周口市中心医院呼吸与危重症医学科，河南 周口 466000

      卷次： 2023年34卷23期

      【摘要】 目的 探究血尿酸(SUA)、总胆红素(TBIL)、纤维蛋白原(Fib)与老年(≥60岁)慢性阻塞性肺疾病急性加重(AECOPD)患者病情严重程度的相关性及预测预后的价值。方法 前瞻性选取2020年3月至2021年3月周口市中心医院呼吸与危重症医学科收治的180例老年AECOPD患者为研究对象，根据患者的病情严重程度分为轻度组(n=67)、中度组(n=61)和重度组(n=52)，比较三组患者的外周血SUA、TBIL、Fib水平，通过Spearman相关系数分析外周血SUA、TBIL、Fib水平与患者病情严重程度的相关性；所有患者均随访1年，统计预后情况，比较不同预后患者临床资料、外周血SUA、TBIL、Fib水平，通过多因素Logistic回归分析老年AECOPD预后的影响因素，采用受试者工作特征曲线(ROC)分析外周血TBIL、SUA、Fib预测预后的价值。结果 重度组患者入院时外周血SUA、Fib水平高于中度组、轻度组，中度组高于轻度组，重度组外周血TBIL水平低于中度组、轻度组，中度组低于轻度组，差异均有统计学意义(P<0.05)；老年AECOPD患者外周血 SUA、Fib水平与病情严重程度呈正相关(r=0.469、0.447，P<0.05)，TBIL水平与病情严重程度呈负相关(r=-0.512，P<0.05)；经多因素Logistic回归分析结果显示，年龄、吸烟、病情严重程度、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、急性加重次数、外周血SUA、Fib均为老年AECOPD患者预后不良的独立危险因素(P<0.05)，TBIL为保护因素(P<0.05)；经ROC分析结果显示，外周血SUA、TBIL、Fib预测老年AECOPD患者预后不良的曲线下面积(AUC)分别为 0.744 (95%CI：0.673~0.807)、0.765(95%CI：0.695~0.826)、0.757 (95%CI：0.687~0.819)。结论 外周血SUA、TBIL、Fib水平与老年AECOPD患者病情严重程度密切相关，且能辅助临床预测患者预后。
      【关键词】 慢性阻塞性肺疾病急性加重；血尿酸；胆红素；纤维蛋白原；病情；预后；相关性
      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2023）23—3433—05

Relationship between serum uric acid, bilirubin, fibrinogen levels and severity of acute exacerbation of chronicobstructive pulmonary disease in elderly patients and their prognostic value.
LU Min, WANG Yan-jie, SUN Ru-kun,HU Xiang-kun, PAN Chun-xiang. Department of Respiratory and Critical Care Medicine, Zhoukou Central Hospital,Zhoukou 466000, Henan, CHINA
【Abstract】 Objective To explore the correlation between serum uric acid (SUA), total bilirubin (TBIL), fibrin-ogen (FIB) and the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in elderly pa-tients (≥60 years old) and their prognostic value. Methods A total of 180 elderly AECOPD patients admitted to theDepartment of Respiratory and Critical Care Medicine, Zhoukou Central Hospital from March 2020 to March 2021 wereprospectively selected as the research objects. According to the severity of the disease, the patients were divided intomild group (n=67), moderate group (n=61), and severe group (n=52). The levels of SUA, TBIL, and Fib in peripheralblood of the three groups were compared among the three groups. Spearman correlation coefficient was used to analyzethe levels of SUA, TBIL, FIB in peripheral blood. All the patients were followed up for 1 year, and the prognosis was an-alyzed. Clinical data, peripheral blood SUA, TBIL, and FIB levels were compared among patients with different progno-sis. The influencing factors for the prognosis of elderly AECOPD were analyzed through multivariate logistic regression,and the value of peripheral blood TBIL, SUA, and FIB in predicting prognosis was analyzed using receiver operatingcharacteristic curve (ROC). Results The levels of SUA and Fib were significantly higher in the severe group than inthe moderate group and the mild group at admission, and also in moderate group and in the mild group; the level ofTBIL was significantly lower in the severe group than in the moderate group and the mild group, and also in the moder-ate group than in the mild group; the differences were statistically significant (P<0.05). The levels of SUA and Fib in pe-ripheral blood of elderly patients with AECOPD were positively correlated with the severity of the disease (r=0.469,0.447, P<0.05), while the level of TBIL was negatively correlated with the severity of the disease (r=-0.512, P<0.05).Multivariate logistic regression analysis showed that age, smoking, disease severity, APACHEⅡ score, times of acute ex-acerbation, SUA and Fib in peripheral blood were independent risk factors for poor prognosis in elderly patients with AE-COPD (P<0.05), and TBIL was the protective factor (P<0.05). ROC analysis showed that the area under the curve(AUC) of peripheral blood SUA, TBIL, and Fib in predicting poor prognosis of elderly patients with AECOPDwere 0.744 (95% CI: 0.673-0.807), 0.765 (95% CI: 0.695-0.826), and 0.757 (95% CI: 0.687-0.819), respectively.Conclusion The levels of SUA, TBIL, and Fib in peripheral blood are closely related to the severity of AECOPD inelderly patients, and can help predict the prognosis of patients.
      【Key words】 Acute exacerbation of chronic obstructive pulmonary disease; Blood uric acid; Bilirubin; Fibrino-gen; Illness; Prognosis; Relationship