血清pro-BNP hs-CRP FIB水平对AECOPD合并呼吸衰竭的诊断及预后评估研究

doi:10.3969/j.issn.1006-6233.2023.05.030

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Abstract Objective: To explore the levels of serum pro-brain natriuretic peptide (pro-BNP), high-sensitivity C-reactive protein (hs-CRP), and plasma fibrinogen (FIB) in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure and the evaluation of prognosis. Methods: A total of 72 patients with AECOPD complicated with respiratory failure who were admitted to the hospital from January 2017 to December 2021 were selected as group A, 71 patients with AECOPD without respiratory failure were selected as group B, and 71 patients with stable COPD who underwent reexamination were included in group C. The first second expiratory volume (FEV1) and peak expiratory flow rate (PEF) before treatment in the three groups of patients were detected, blood and separate serum for pro-BNP, hs-CRP and FIB were collected, the differences of the above indexes in patients with AECOPD combined with respiratory failure, simple AECOPD and stable COPD patients were analyzed, and the relationship between pro-BNP, hs-CRP and FIB and FEV1 and PEF in patients with AECOPD combined with respiratory failure were studied. The relationship between pro-BNP, hs-CRP and FIB with FEV1 and PEF was investigated among patients with AECOPD and respiratory failure, and the value of pro-BNP, hs-CRP and FIB in guiding the diagnosis of AECOPD with respiratory failure was explored. According to the survival status, the patients were divided into survival group and death group, and the laboratory indicators detected after admission were classified and recorded to explore the value of pro-BNP, hs-CRP and FIB on guiding the prognosis prediction of AECOPD with respiratory failure. Results: FEV1/FVC and PEF were lower in groups A and B than those in group C (P<0.05), and were lower in group A than in group B (P<0.05). The levels of pro-BNP, hs-CRP and FIB were higher in group A and group B than in group C (P<0.05), and higher in group A than in group B (P<0.05). The maximum pro-BNP Yordon index corresponds to a cut-off of 299.95 ng/L and an AUC of 0.878 for the diagnosis of AECOPD combined with respiratory failure, with diagnostic sensitivity and specificity of 86.36% and 86.21%; the maximum hs-CRP Yordon index corresponds to a cut-off of 12.01 mg/L and an AUC of 0.838, with predictive sensitivity and specificity of 70.00% and 88.89%, respectively; the maximum FIB Yordon index corresponds to a cut-off of 4.89 g/L and an AUC of 0.772. The sensitivity and specificity were 70.00% and 88.89%, respectively; the maximum FIB Yordon index corresponded to a cut-off of 4.89 g/L and an AUC of 0.772, with a diagnostic sensitivity and specificity of 75.21% and 75.93%. Predictive prognostic efficacy: pro-BNP, hs-CRP and FIB were higher in the death group than in the survival group (P<0.05), and pro-BNP predicted poor prognosis of AECOPD combined with respiratory failure with a maximum Yordon index corresponding to a cut-off of 367.03 ng/L and an AUC of 0.854, with diagnostic sensitivity and specificity of 88.24% and The maximum hs-CRP Yordon index corresponded to a cut-off of 17.69 mg/L and an AUC of 0.795, with a predictive sensitivity and specificity of 76.47% and 86.67%, respectively; the maximum FIB Yordon index corresponded to a cut-off of 5.99 g/L and an AUC of 0.781, with a diagnostic sensitivity and specificity of 82.35% and 82.22%, respectively.Conclusion: The abnormally elevated levels of serum pro-BNP, hs-CRP and FIB in patients with AECOPD complicated with respiratory failure are related to the pulmonary function indicators of FEV1/FVC and PEF, and serum pro-BNP, hs-CRP and FIB have high value in the diagnosis and prognosis evaluation of AECOPD with respiratory failure.

Key words： Acute exacerbation of chronic obstructive pulmonary disease Respiratory failure Serum pro-brain natriuretic peptide High-sensitivity C-reactive protein Plasma fibrinogen

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2023.05.030 OR http://www.hbyxzzs.cn/EN/Y2023/V29/I5/849