目的: 探究血清高迁移率蛋白B1（high mobility group box 1,HMGB1）、α1-抗胰蛋白酶（alpha-1 antitrypsin,α1-AT）与慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）合并呼吸衰竭（respiratory failure,RF）及其预后的相关性。方法: 选取2020年7月—2023年7月我院收治的80例AECOPD合并RF患者作为观察组,另外选取同期单纯AECOPD患者50例为对照组,比较两组血清HMGB1、α1-AT水平。根据观察组病情转归分为预后良好组与预后不良组,探究AECOPD合并RF患者预后水平的影响因素,并采用受试者工作特征（ROC）曲线分析血清HMGB1、α1-AT对AECOPD合并RF患者预后的预测价值。结果: 观察组患者血清HMGB1、α1-AT水平高于对照组。本研究80例AECOPD合并RF患者中预后不良患者共22例（27.50%）,预后不良组患者病程、CAT评分、血清HMGB1、α1-AT水平均高于预后良好组,且CAT评分、血清HMGB1、α1-AT水平是AECOPD合并RF患者预后的独立影响因素。Pearson相关性分析结果显示,AECOPD合并RF患者CAT评分与血清HMGB1、α1-AT水平均呈正相关。ROC特征曲线结果显示,血清HMGB1、α1-AT预测AECOPD合并RF患者预后的最佳截断值分别为179.925 μg/L、14.710 mg/L,且指标联合预测AECOPD合并RF患者预后的AUC为0.869,特异性为96.60%,高于单一指标。结论: 与单纯AECOPD患者比较,AECOPD合并RF患者血清HMGB1、α1-AT水平上调,其中HMGB1、α1-AT均为AECOPD合并RF患者预后水平的独立影响因素,且HMGB1联合α1-AT对AECOPD合并RF患者预后具有较高的预测价值。
Abstract
Objective To explore the correlation between serum high mobility group box 1(HMGB1), alpha-1 antitrypsin (alpha1-AT) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure (RF) and the prognosis. Methods A total of 80 patients with AECOPD and RF who were admitted to the hospital from July 2020 to July 2023 were selected as the observation group. Meanwhile, 50 patients with simple AECOPD were selected as the control group. Serum HMGB1 and alpha1-AT levels of the two groups were compared. Patients in the observation group were divided into good prognosis group and poor prognosis group. The prognostic factors in patients with AECOPD and RF were explored. The prognostic value of serum HMGB1 and alpha1-AT in patients with AECOPD and RF was analyzed using the receiver operating characteristic (ROC) curves. Results Serum HMGB1 and alpha1-AT levels in the observation group were higher than those in the control group. In this study, 22(27.50%) of 80 patients with AECOPD and RF had poor prognosis. Course of disease, CAT score, and serum HMGB1 and alpha1-AT levels in the poor prognosis group were higher than those in the good prognosis group. CAT score, serum HMGB1 and alpha1-AT levels were independent prognostic factors in patients with AECOPD and RF. Pearson correlation analysis results showed that CAT score of patients with AECOPD and RF was positively correlated with serum HMGB1 and alpha1-AT levels. ROC curves indicated that the optimal cutoff values of serum HMGB1 and alpha1-AT levels for predicting the prognosis of patients with AECOPD and RF were 179.925 μg/L and 14.710 mg/L, respectively. The AUC and specificity of combined prediction were 0.869 and 96.60%, both of which were higher than those of prediction using a single indicator. Conclusion Compared to patients with simple AECOPD, patients with AECOPD and RF have higher serum levels of HMGB1 and alpha1-AT. HMGB1 and alpha1-AT are independent prognostic factors in patients with AECOPD and RF, and HMGB1 combined with alpha1-AT is of high value in the prognosis of AECOPD with RF.
关键词
高迁移率蛋白B1 /
α1-抗胰蛋白酶 /
慢性阻塞性肺疾病 /
急性加重期 /
呼吸衰竭 /
预后
Key words
high mobility group box 1 /
alpha-1 antitrypsin /
chronic obstructive pulmonary disease /
acute exacerbation /
respiratory failure /
prognosis
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基金
安徽省医学会急诊医学分会2021年急诊临床研究计划项目（Ky2021008）
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