COPD合并呼吸衰竭患者预后因素分析及SP-A和SP-D检测对其预后的评估价值

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摘要目的探究血清表面活性蛋白A（SP-A）和表面活性蛋白D（SP-D）在慢性阻塞性肺疾病（COPD）患者合并呼吸衰竭中的意义及其对预后的评估价值。方法选取2015年9月～2018年8月青海省人民医院呼吸科住院的COPD患者70例，根据有无合并呼吸衰竭分为COPD组（20例），合并Ⅰ型呼吸衰竭组（25例）和合并Ⅱ型呼吸衰竭组（25例），分析各组实验室指标及血气指标。根据COPD合并呼吸衰竭患者结局指标分为死亡组（13例）和非死亡组（37例），分析预后危险因素。结果合并Ⅰ型、Ⅱ型呼吸衰竭组C-反应蛋白低于COPD组，SP-A和SP-D高于COPD组，差异有统计学意义（P ＜ 0.05）。合并Ⅱ型呼吸衰竭组pH低于COPD组，差异有统计学意义（P ＜ 0.05）。合并Ⅰ型和Ⅱ型呼吸衰竭组氧分压低于COPD组，合并Ⅱ型呼吸衰竭组高于合并Ⅰ型呼吸衰竭组，差异有统计学意义（P ＜ 0.05）。合并Ⅱ型呼吸衰竭组二氧化碳分压高于COPD组和合并Ⅰ型呼吸衰竭组，差异有统计学意义（P ＜ 0.05）。死亡组与非死亡组吸烟、pH、SP-A和SP-D比较，差异有统计学意义（P ＜ 0.05）。logistic回归分析显示，pH是COPD合并呼吸衰竭预后的危险因素（OR ＞ 1，P ＜ 0.05）。结论 COPD合并呼吸衰竭患者SP-A和SP-D增高，但对COPD合并呼吸衰竭患者预后的评估价值不大，而pH对COPD合并呼吸衰竭预后的评估价值较大。

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	顾玉海1 石雪峰1 牛迪2 解友邦3

关键词 ：慢性阻塞性肺病, 呼吸衰竭, 表面活性蛋白A, 预后, 危险因素

Abstract：Objective To explore the significance of serum surfactant protein A (SP-A) and surfactant protein D (SP-D) in patients with chronic obstructive pulmonary disease (COPD) complicated with respiratory failure and their prognostic value. Methods A total of 70 COPD patients hospitalized in the Department of Respiratory Medicine of Qinghai Provincial People′s Hospital from September 2015 to August 2018 were selected. They were divided into COPD group (20 cases), combined with type Ⅰ respiratory failure group (25 cases) and combined with type Ⅱ respiratory failure group (25 cases), according to the presence or absence of respiratory failure. The laboratory indicators and blood gas indicators of each group were analyzed. According to the outcome indexes of COPD patients with respiratory failure, they were divided into death group (13 cases) and non-death group (37 cases), while the prognostic risk factors were analyzed. Results The C-reactive protein of the combined type Ⅰ and type Ⅱ respiratory failure groups were lower than that of the COPD group, while SP-A and SP-D were higher than those of the COPD group, and the differences were statistically significant (P ＜ 0.05). The pH of the combined type Ⅱ respiratory failure group was lower than that of the COPD group, and the difference was statistically significant (P ＜ 0.05). The partial pressure of oxygen in the combined type Ⅰ and type Ⅱ respiratory failure group were lower than that in the COPD group, while combined type Ⅱ respiratory failure group was higher than combined type Ⅰ respiratory failure group, and the differences were statistically significant (P ＜ 0.05). The partial pressure of carbon dioxide in the combined with type Ⅱ respiratory failure group was higher than those in the COPD group and the combined typeⅠrespiratory failure group, and the differences were statistically significant (P ＜ 0.05). There were statistically significant differences between the death group and non-death group in smoking, pH, SP-A and SP-D (P ＜ 0.05). Logistic regression analysis showed that pH was a risk factor for the prognosis of COPD combined with respiratory failure (OR ＞ 1, P ＜ 0.05). Conclusion In COPD patients with respiratory failure, SP-A and SP-D increased, and of little assessed value in the prognosis of COPD combined with respiratory failure, while pH has a greater assessed value of COPD combined with respiratory failure.

Key words： Chronic obstructive pulmonary disease Respiratory failure Surfactant Protein Prognosis Risk factors

基金资助:青海省级临床重点专科建设项目（青财社字[2013]2578-2号）；
青海省科学技术厅青年项目（2017-ZJ-954Q）；
青海省创新平台建设专项项目（2019-SF-L4）；
青海省人民医院院内指导项目（2018-004）。

通讯作者: 解友邦（1980.6-），男，博士，副主任医师，主要从事血液及高原医学基础和临床工作。

作者简介: 顾玉海（1962.7-），男，主任医师，主要从事呼吸系统疾病临床和相关基础研究。

引用本文:

顾玉海1 石雪峰1 牛迪2 解友邦3. COPD合并呼吸衰竭患者预后因素分析及SP-A和SP-D检测对其预后的评估价值[J]. 中国医药导报, 2020, 17(14): 135-139.
GU Yuhai1 SHI Xuefengu1 NIU Di2 XIE Youbang3. Analysis of prognostic risk factors and the prognostic assessed value of SP-A and SP-D in COPD with respiratory failure patients. 中国医药导报, 2020, 17(14): 135-139.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I14/135

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