hs-CRP与白蛋白比值对呼吸衰竭COPD患者撤机失败的预测价值

徐晓敏; 余鸿艳; 徐茂华; 韩利峰

doi:10.16766/j.cnki.issn.1674-4152.003864

hs-CRP与白蛋白比值对呼吸衰竭COPD患者撤机失败的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.003864

1.
浙江省人民医院淳安分院急诊医学科, 浙江杭州 311700
2.
浙江省人民医院淳安分院呼吸内科

基金项目:

浙江省医药卫生科技计划项目 2023XY015

详细信息

通讯作者:
徐晓敏，E-mail：kukiimi@163.com

中图分类号: R563 R563.8
计量
- 文章访问数: 8
- HTML全文浏览量: 3
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-08-29
- 网络出版日期: 2025-03-27

Predictive value of hs-CRP to albumin ratio for weaning failure in COPD patients with respiratory failure

1.
Department of Emergency Medicine, Chun' an Branch of Zhejiang Provincial People' s Hospital, Hangzhou, Zhejiang 311700, China

摘要

摘要: 目的通过探讨超敏C反应蛋白(hs-CRP)与白蛋白(Alb)与呼吸衰竭慢性阻塞性肺疾病(COPD)患者撤机失败的关系, 分析其对该类患者撤机失败的预测价值。方法选取2022年10月—2023年10月浙江省人民医院淳安分院收治的242例呼吸衰竭COPD患者, 根据撤机结果将患者分为2组: 撤机成功组(180例)与撤机失败组(62例)。采用单因素分析比较2组患者的一般资料, 采用多因素logistic回归分析法分析呼吸衰竭COPD患者撤机失败的影响因素, 绘制ROC曲线分析hs-CRP与Alb比值对呼吸衰竭COPD患者撤机失败的预测价值。结果撤机成功组患者年龄、急性生理与慢性健康评分(APACHE Ⅱ)、hs-CRP、hs-CRP与Alb比值、胃肠功能受损发生率较撤机失败组低, 机械通气时间较撤机失败组短, Alb水平较撤机失败组高(P < 0. 05);logistic回归分析结果显示, 年龄较大、APACHEⅡ评分高、hs-CRP与Alb比值较高均为呼吸衰竭COPD患者撤机失败的危险因素; ROC曲线结果显示, 年龄、APACHE Ⅱ、hs-CRP与Alb比值预测呼吸衰竭COPD患者撤机失败的AUC为0. 735、0. 716、0. 927, 其中hs-CRP与Alb比值的预测价值最高。结论呼吸衰竭COPD患者撤机失败的发生与hs-CRP与Alb比值的上升有关, 其可以作为撤机失败发生的预测因子。
- 慢性阻塞性肺疾病 /
- 超敏C反应蛋白 /
- 白蛋白 /
- 呼吸衰竭 /
- 撤机
Abstract: Objective By analyzing the relationship between high-sensitivity C-reactive protein (hs-CRP) and albumin (Alb) and the failure of weaning in patients with respiratory failure and chronic obstructive pulmonary disease (COPD), the predictive value of weaning failure in this disease is analyzed. Methods A retrospective analysis was conducted on 242 patients with respiratory failure COPD at Chun ' an Branch of Zhejiang Provincial People ' s Hospital from October 2022 to October 2023. The cases were were divided into a successful weaning group (180 cases) and a failed weaning group (62 cases) based on the weaning outcome. Univariate analysis was used to analyze the general information of two groups of patients, and multiple logistic regression analysis was used to analyze the influencing factors of weaning failure in COPD patients with respiratory failure. ROC curves were plotted to analyze the predictive value of hsCRP to Alb ratio for weaning failure in COPD patients with respiratory failure. Results The age, acute physiology and chronic health score (APACHE Ⅱ), hs-CRP, hs-CRP to Alb ratio, incidence of gastrointestinal dysfunction, mechanical ventilation time, and Alb level of patients in the successful weaning group were lower than those in the failed weaning group (P < 0. 05), the duration of mechanical ventilation was shorter than that of the failed weaning group and the Alb levels were higher than that of the failed weaning group (P < 0. 05). Older age, high APACHE Ⅱ score, and high hs-CRP to Alb ratio are all risk factors for failed weaning in COPD patients with respiratory failure. The ROC curve results showed that age, APACHE Ⅱ, hs-CRP to Alb ratio had AUC values of 0. 735, 0. 716, and 0. 927 for the failure of weaning in COPD patients with respiratory failure, among them, the hs-CRP to Alb ratio had the highest predictive value. Conclusion The occurrence of weaning failure in COPD patients with respiratory failure is related to the increase in the ratio of hsCRP to Alb, which can serve as an early predictor of weaning failure.
- Chronic obstructive pulmonary disease /
- Hypersensitive C-reactive protein /
- Albumin /
- Respiratory failure /
- Weaning

HTML全文

图 1 各指标预测呼吸衰竭COPD患者撤机结局的ROC曲线

Figure 1. ROC Curve for predicting weaning outcomes in COPD Patients with respiratory failure based on various indicators

下载: 全尺寸图片幻灯片

表 1 2组呼吸衰竭COPD患者临床资料比较

Table 1. Comparison of clinical data between two groups of COPD patients with respiratory failure

项目	撤机成功组(n=180)	撤机失败组(n=62)	统计量	P值
性别[例(%)]			0.516^a	0.472
男性	125(69.44)	40(64.52)
女性	55(30.56)	22(35.48)
年龄(x±s，岁)	58.64±4.33	62.11±3.66	5.652^b	< 0.001
BMI(x±s)	22.05±1.36	21.89±1.20	0.822^b	0.412
吸烟[例(%)]	78(43.33)	20(32.26)	2.348^a	0.125
饮酒[例(%)]	62(34.44)	14(22.58)	3.013^a	0.083
合并糖尿病[例(%)]	51(28.33)	14(22.58)	0.777^a	0.378
合并高血压[例(%)]	36(20.00)	7(11.29)	2.394^a	0.122
合并高脂血症[例(%)]	21(11.67)	9(14.52)	0.345^a	0.557
血pH值(x±s)	7.28±1.33	7.32±1.84	0.184^b	0.854
呼吸次数(x±s，次)	20.77±4.36	21.10±3.52	0.538^b	0.591
ICU住院时间(x±s，d)	17.21±4.11	17.59±3.25	0.660^b	0.510
撤机方式[例(%)]			0.607^a	0.436
自主呼吸试验	68(37.78)	20(32.26)
智能化撤机	112(62.22)	42(67.74)
平均动脉压(x±s，mmHg)	105.25±3.33	104.82±3.41	0.872^b	0.384
APACHE Ⅱ评分(x±s，分)	15.28±6.58	19.95±5.30	5.055^b	< 0.001
血清Alb(x±s，g/L)	24.91±4.62	22.57±3.71	2.081^b	0.039
hs-CRP(x±s，mg/L)	39.33±12.69	55.58±14.03	3.609^b	< 0.001
hs-CRP与Alb比值(x±s)	1.58±0.39	2.35±0.35	13.658^b	< 0.001
机械通气时间(x±s，d)	5.02±1.22	5.32±1.20	3.577^b	< 0.001
胃肠功能受损[例(%)]			5.024^a	0.025
是	20(11.11)	14(22.58)
否	160(88.89)	48(77.42)
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 各变量赋值情况

Table 2. Variable assignment

变量	赋值方法
年龄	连续变量，以实际值赋值
APACHE Ⅱ评分	连续变量，以实际值赋值
Alb	连续变量，以实际值赋值
hs-CRP	连续变量，以实际值赋值
hs-CRP与Alb比值	连续变量，以实际值赋值
胃肠道功能受损	是=1，否=0
机械通气时间	连续变量，以实际值赋值
撤机结局	失败=1，成功=0

下载: 导出CSV

表 3 呼吸衰竭COPD患者撤机结局的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of weaning outcomes in COPD patients with respiratory failure

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.156	0.060	6.623	0.011	1.168	1.037~1.317
APACHE Ⅱ评分	0.103	0.043	5.686	0.016	1.109	1.020~1.205
Alb	-0.083	0.071	1.382	0.244	0.920	0.801~1.058
hs-CRP	-0.055	0.037	2.200	0.134	0.947	0.881~1.017
hs-CRP与Alb比值	3.548	0.674	26.731	< 0.001	32.986	8.707~124.213
胃肠道功能受损	0.548	0.623	0.791	0.390	1.729	0.496~6.026
机械通气时间	0.015	0.200	0.005	0.941	1.015	0.686~1.501

下载: 导出CSV

表 4 各指标对呼吸衰竭COPD患者撤机结局的预测价值分析

Table 4. Analysis of the predictive value of various indicators for weaning outcomes in COPD patients with respiratory failure

项目	截断值	灵敏度	特异度	AUC	95% CI	约登指数
年龄	>58岁	85.50	52.20	0.735	0.675~0.790	0.377
APACHE Ⅱ评分	>16分	82.30	57.80	0.716	0.654~0.772	0.400
hs-CRP与Alb比值的截断值>1.9		87.10	83.90	0.927	0.887~0.957	0.710

下载: 导出CSV

参考文献(20)

[1]	杨露露, 时明慧, 何佳泽, 等. DOSE指数对社区稳定期慢性阻塞性肺疾病患者运动耐力受损的评估价值[J]. 中华全科医学, 2024, 22(2): 273-276. doi: 10.16766/j.cnki.issn.1674-4152.003382 YANG L L, SHI M H, HE J Z, et al. Assessment value of DOSE index in evaluating exercise tolerance impairment in patients with stable chronic obstructive pulmonary disease in the community[J]. Chinese Journal of General Practice, 2024, 22(2): 273-276. doi: 10.16766/j.cnki.issn.1674-4152.003382
[2]	SUN J Y, LI Y J, LING B Y, et al. High flow nasal cannula oxygen therapy versus non-invasive ventilation for chronic obstructive pulmonary disease with acute-moderate hypercapnic respiratory failure: an observational cohort study[J]. Int J Chron Obstruct Pulmon Dis, 2019, 14(22): 1229-1237.
[3]	刘浩, 董钊彤, 杨阳, 等. 经鼻高流量氧疗对比无创机械通气对有创机械通气序贯疗效的meta分析[J]. 中国呼吸与危重监护杂志, 2022, 21(11): 773-781. LIU H, DONG Z T, YANG Y, et al. Meta-analysis of sequential effects of nasal high-flow oxygen therapy versus non-invasive mechanical ventilation after invasive mechanical ventilation[J]. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(11): 773-781.
[4]	张帅, 张虹霞, 林蕊艳. NT-proBNP联合浅快呼吸指数对AECOPD伴呼吸衰竭机械通气患者撤机效果的预测价值[J]. 新疆医科大学学报, 2023, 46(7): 920-925. doi: 10.3969/j.issn.1009-5551.2023.07.011 ZHANG S, ZHANG H X, LIN R Y. Predictive value of NT-proBNP combined with rapid shallow breathing index for weaning outcome in patients with AECOPD complicated by respiratory failure undergoing mechanical ventilation[J]. Journal of Xinjiang Medical University, 2023, 46(7): 920-925. doi: 10.3969/j.issn.1009-5551.2023.07.011
[5]	吕媛, 陈天君, 孙忠民, 等. 吸入布地奈德对慢性阻塞性肺疾病急性加重期患者呼吸机撤机的影响[J]. 中国医院用药评价与分析, 2022, 22(12): 1451-1454. LYU Y, CHEN T J, SUN Z M, et al. Effect of inhaled budesonide on ventilator weaning in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Hospital Pharmacy, 2022, 22(12): 1451-1454.
[6]	罗彩琴, 王东磊, 何小花, 等. 床旁超声监测膈肌功能对COPD机械通气患者撤机结果的预测价值[J]. 上海医药, 2023, 44(3): 40-43. doi: 10.3969/j.issn.1006-1533.2023.03.012 LUO C Q, WANG D L, HE X H, et al. Predictive value of bedside ultrasound monitoring of diaphragmatic function for weaning outcome in COPD patients undergoing mechanical ventilation[J]. Shanghai Medical & Pharmaceutical Journal, 2023, 44(3): 40-43. doi: 10.3969/j.issn.1006-1533.2023.03.012
[7]	金敏敏, 潘慧斌, 嵇朝晖, 等. mNUTRIC评分与NRS2002评分对ICU内慢性阻塞性肺疾病呼吸衰竭患者机械通气时长的预测能力比较[J]. 浙江医学, 2023, 45(21): 2316-2319, 2322. doi: 10.12056/j.issn.1006-2785.2023.42.21.2022-2638 JIN M M, PAN H B, JI Z H, et al. Comparison of predictive abilities of mNUTRIC score and NRS2002 score for mechanical ventilation duration in ICU patients with chronic obstructive pulmonary disease and respiratory failure[J]. Zhejiang Medical Journal, 2023, 45(21): 2316-2319, 2322. doi: 10.12056/j.issn.1006-2785.2023.42.21.2022-2638
[8]	杨敏, 王利凡, 欧峻松, 等. CRP联合RSBI对COPD急性加重期并呼吸衰竭机械通气撤机的指导价值分析[J]. 国际呼吸杂志, 2022, 42(4): 262-266. doi: 10.3760/cma.j.cn131368-20210916-00692 YANG M, WANG L F, OU J S, et al. Analysis of the guiding value of CRP combined with RSBI for ventilator weaning in patients with acute exacerbation of COPD complicated by respiratory failure[J]. International Journal of Respiration, 2022, 42(4): 262-266. doi: 10.3760/cma.j.cn131368-20210916-00692
[9]	张婷, 史菲, 酆孟洁. 超敏C反应蛋白/白蛋白比值对无创通气治疗AECOPD合并呼吸衰竭患者的预后评估价值[J]. 广东医学, 2018, 39(4): 533-536. doi: 10.3969/j.issn.1001-9448.2018.04.011 ZHANG T, SHI F, FENG M J. Prognostic value of the hypersensitive C-reactive protein/albumin ratio in patients with acute exacerbation of chronic obstructive pulmonary disease complicated by respiratory failure undergoing non-invasive ventilation[J]. Guangdong Medical Journal, 2018, 39(4): 533-536. doi: 10.3969/j.issn.1001-9448.2018.04.011
[10]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2007年修订版)[J]. 中华结核和呼吸杂志, 2007, 30(1): 8-17. doi: 10.3760/j:issn:1001-0939.2007.01.004 Chinese Thoracic Society, Respiratory Disease Branch, Chronic Obstructive Pulmonary Disease Group. Guidelines for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease (Revised Edition, 2007)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2007, 30(1): 8-17. doi: 10.3760/j:issn:1001-0939.2007.01.004
[11]	刘幼硕, 蹇在金, 杨悦. 老年人呼吸衰竭的诊断及治疗要点[J]. 中华老年医学杂志, 2004, 23(12): 899-900. doi: 10.3760/j:issn:0254-9026.2004.12.020 LIU Y S, JIAN Z J, YANG Y. Key Points in diagnosis and treatment of respiratory failure in elderly patients[J]. Chinese Journal of Gerontology, 2004, 23(12): 899-900. doi: 10.3760/j:issn:0254-9026.2004.12.020
[12]	张芬, 朱彩侠, 刘玉凤, 等. 稳定期慢性阻塞性肺疾病合并肺动脉高压危险因素的回顾性分析[J]. 中华全科医学, 2024, 22(2): 247-251. doi: 10.16766/j.cnki.issn.1674-4152.003376 ZHANG F, ZHU C X, LIU Y F, et al. Retrospective analysis of risk factors for pulmonary hypertension in patients with stable chronic obstructive pulmonary disease[J]. Chinese Journal of General Practice, 2024, 22(2): 247-251. doi: 10.16766/j.cnki.issn.1674-4152.003376
[13]	JUDITH E, JUDITH M V, ANOUSCHKA V D P, et al. Clinical practice of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease[J]. Respir Res, 2023, 24(1): 208. doi: 10.1186/s12931-023-02507-1
[14]	张冬冬, 吴晓飞, 郭兰. 老年机械通气患者胃肠道功能及营养状态与撤机失败相关性研究[J]. 陕西医学杂志, 2023, 52(11): 1550-1553. doi: 10.3969/j.issn.1000-7377.2023.11.021 ZHANG D D, WU X F, GUO L. Relationship of gastrointestinal function and nutritional status with weaning failure in elderly patients with mechanical ventilation[J]. Shaanxi Medical Journal, 2023, 52(11): 1550-1553. doi: 10.3969/j.issn.1000-7377.2023.11.021
[15]	赵青, 李宏庆. 有创机械通气治疗AECOPD合并呼吸衰竭患者撤机失败的影响因素分析[J]. 广州医科大学学报, 2024, 52(3): 25-30. ZHAO Q, LI H Q. Influencing factors of weaning failure in AECOPD patients with respiratory failure treated by invasive mechanical ventilation[J]. Academic Journal of Guangzhou Medical University, 2024, 52(3): 25-30.
[16]	李娜, 晏木云, 胡赛, 等. COPD合并Ⅱ型呼吸衰竭患者血清磷、降钙素原、25-羟维生素D₃水平与机械通气撤机结局的关系研究[J]. 现代生物医学进展, 2022, 22(10): 1937-1941, 1985. LI N, YAN M Y, HU S, et al. Relationship between serum phosphorus, procalcitonin, 25-Hydroxyvitamin D₃ Levels, and the outcome of mechanical ventilation weaning in patients with COPD complicated by type Ⅱ respiratory failure[J]. Progress in Modern Biomedicine, 2022, 22(10): 1937-1941, 1985.
[17]	李嘉. 老年慢性阻塞性肺疾病急性加重期并呼吸衰竭患者机械通气脱机失败的多因素分析[J]. 中国临床医生杂志, 2020, 48(1): 57-60. LI J. Multifactorial Analysis of failure in mechanical ventilation weaning in elderly patients with acute exacerbation of chronic obstructive pulmonary disease complicated by respiratory failure[J]. Chinese Journal of Clinicians, 2020, 48(1): 57-60.
[18]	周金红, 付左骏, 刘丹, 等. 膈肌超声联合25(OH)D_(3)和NT-proBNP检测在老年COPD机械通气撤机结局中的预测价值[J]. 医药前沿, 2024, 14(16): 53-57. ZHOU J H, FU Z J, LIU D, et al. Predictive value of diaphragm ultrasound combined with 25(OH)D3 and NT-proBNP Levels in determining the outcome of mechanical ventilation weaning in elderly patients with COPD[J]. Frontier Medicine, 2024, 14(16): 53-57.
[19]	丁瑞阳, 张谷香, 杨文柱, 等. 血清超敏C反应蛋白与前白蛋白比值对慢性阻塞性肺疾病急性加重期患者30日再入院的预测价值[J]. 临床内科杂志, 2022, 39(7): 468-472. doi: 10.3969/j.issn.1001-9057.2022.07.009 DING R Y, ZHANG G X, YANG W Z, et al. Predictive Value of the Ratio of Serum High-Sensitivity C-Reactive Protein to Prealbumin for 30-Day Rehospitalization in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease[J]. Journal of Clinical Internal Medicine, 2022, 39(7): 468-472. doi: 10.3969/j.issn.1001-9057.2022.07.009
[20]	王鹏, 白冲, 李星晶, 等. 血Lac、hs-CRP/Alb比值联合HIF-1α水平对AECOPD患者预后的评估价值[J]. 临床肺科杂志, 2021, 26(5): 653-657. doi: 10.3969/j.issn.1009-6663.2021.05.002 WANG P, BAI C, LI X J, et al. Evaluation of the prognostic value of combined blood lactate (Lac), High-Sensitivity C-Reactive protein to Albumin Ratio (hs-CRP/Alb), and Hypoxia-Inducible Factor-1α (HIF-1α) Levels in patients with acute exacerbation of chronic obstructive pulmonary Disease (AECOPD)[J]. Journal of Clinical Pulmonary Medicine, 2021, 26(5): 653-657. doi: 10.3969/j.issn.1009-6663.2021.05.002