【摘要】 目的分析老年慢性阻塞性肺疾病（COPD）患者血清学和肾功能指标。方法选取2014年1¹2月北京海淀医院收治的70例COPD患者为研究对象（COPD组）,另选取同期来医院进行健康体检的35例老年人作为对照组。测定研究对象血清中中性粒细胞、血红蛋白、白蛋白、总胆固醇、肌酐、白细胞、血尿素氮、估算的肾小球滤过率（e GFR）以及β₂微球蛋白（β₂-MG）水平,比较病程>10年组（26例）、病程≤10年组（44例）,总胆固醇≥3.5 mmol/L组（43例）、总胆固醇<3.5 mmol/L组（27例）,贫血组（23例）、非贫血组（47例）,白蛋白≥35 g/L组（48例）、白蛋白<35 g/L组（22例）COPD患者肌酐、e GFR、β₂-MG与胱抑素C水平,分析COPD患者的病程、总胆固醇、血红蛋白、白蛋白、β₂-MG及胱抑素C与e GFR的相关性。结果 COPD组患者的总胆固醇、血红蛋白、白蛋白及e GFR水平显著低于对照组,而β₂-MG与胱抑素C水平显著高于对照组,差异均有统计学意义（P<0.05）;而中性粒细胞百分比（NE）、白细胞计数、血尿素氮及肌酐水平与对照组比较差异无统计学意义（P>0.05）。病程>10年组COPD患者β₂-MG与胱抑素C水平显著高于病程≤10年者[（3.0±0.4）mg/L比（2.1±0.5）mg/L、（150.1±28.1）μg/L比（115.8±27.6）μg/L];而e GFR显著低于病程≤10年组[（82.4±1.5）m L/（min·1.73 m2）比（97.1±1.5）m L/（min·1.73 m2）],差异均有统计学意义（P<0.01）;两组患者的肌酐水平比较,差异无统计学意义（P>0.05）;总胆固醇≥3.5 mmol/L组β₂-MG及胱抑素C水平均低于总胆固醇<3.5 mmol/L组[（3.0±0.9）mg/L比（2.1±0.5）mg/L,（142.9±34.7）μg/L比（118.9±28.1）μg/L],差异均有统计学意义（P<0.01）;贫血组患者β₂-MG与胱抑素C水平高于非贫血组[（3.1±0.7）mg/L比（2.3±0.6）mg/L,（137.9±34.5）μg/L比（112.9±34.2）μg/L],差异均有统计学意义（P<0.05）;白蛋白≥35 g/L组β₂-MG与胱抑素C水平低于白蛋白<35 g/L组[（2.4±0.5）mg/L比（3.2±0.4）mg/L,（111.7±18.8）μg/L比（139.1±30.7）μg/L],差异均有统计学意义（P<0.05）。COPD患者的病程、β₂-MG及胱抑素C与e GFR至负相关（r=-0.709,r=-0.491,r=-0.497,P=0.000）;血红蛋白及白蛋白与e GFR具有正相关（r=0.798,r=0.701,P=0.000）;与总胆固醇无明显相关性（r=0.210,P=0.081）。结论对于血红蛋白及白蛋白水平低,病程长,β₂-MG及胱抑素C水平高的COPD患者要密切注意,并给予及时治疗。更多还原

【Abstract】 Objective To explore the influential factors of serum and renal function indexes in aged patients with chronic obstructive pulmonary disease（ COPD）. Methods Total of 70 elderly patients with COPD admitted to Beijing Haidian Hospital from Jan. to Dec. 2014 as were included as COPD group and 35 healthy individuals during the same period were included as a control group. And neutrophilic granulocyte,hemoglobin（ Hb）,albumin（ ALB）,total cholesterol（ TC）,creatinine,white blood cells（ WBC）,blood urea nitrogen（ BUN）,estimated glomerular filtration rate（ e GFR）,β₂-microglobulin（ β₂-MG） were detected. The duration > 10 years group（ 26 cases）,duration ≤10 years group（ 44 cases）,total cholesterol ≥3. 5 mmol / L group（ 43 cases）,total choles-terol < 3. 5mmol / L group（ 27 cases）,anemia group（ 23 cases）,non-anemic group（ 47 cases）,albumin ≥35 g / L group（ 48 cases）,albumin < 35 g/L group（ 22 cases） were compared with creatinine,e GFR,β₂-MG and cystatin C level,and the correlation between the disease course,TG,Hb,ALB,β₂-MG and Cys C with e GFR was analyzed.Results The levels of NE%,WBC,BUN and SCr in the two groups had no statistically significant difference（ P >0. 05）. The β₂-MG and Cys C levels of the COPD group were significantly higher than the control group（ P <0. 05）,but the TC,Hb,ALB and e GFR levels were significantly lower than the control group（ P < 0. 05）. The e GFR level of > 10 years course group was significant lower than the ≤10 years group [（ 82. 4 ± 1. 5） m L /（ min·1. 73 m2） vs（ 97. 1 ± 1. 5） m L/（ min·1. 73 m2） ]（ P < 0. 05）,β₂-MG[（ 3. 0 ± 0. 4） mg / L vs（ 2. 1 ±0. 5） mg / L] and Cys C levels [（ 150. 1 ± 28. 1） μg / L vs（ 115. 8 ± 27. 6） μg / L] were significantly higher than ≤10 years course subgroup（ P < 0. 01）,but there was no significant difference in SCr level（ P > 0. 01）.β₂-MGand Cys C levels of TC≥3. 5 mmol / L group were lower than the TC < 3. 5 mmol / L group[（ 3. 0 ± 0. 9） mg / L vs（ 2. 1 ± 0. 5） mg / L,（ 142. 9 ± 34. 7） μg / L vs（ 118. 9 ± 28. 1） μg / L],the differences were statistically significant（ P < 0. 05）. β₂-MG and Cys C levels of the anemic group were higher than the non-anemic group [（ 3. 1 ±0. 7） mg / L vs（ 2. 3 ± 0. 6） mg / L,（ 137. 9 ± 34. 5） μg / L vs（ 112. 9 ± 34. 2） μg / L],the differences were statistically significant（ P < 0. 05）. β₂-MG and Cys C levels of the ALB≥35 g / L group were lower than the ALB < 35 g / L group[（ 2. 4 ± 0. 5） mg / Lvs（ 3. 2 ± 0. 4） mg / L,（ 111. 7 ± 18. 8） μg / L vs（ 139. 1 ± 30. 7） μg / L],the differences were statistically significant（ P < 0. 01）. The course of COPD（ r =- 0. 709,P = 0. 000）,β₂-MG（ r =- 0. 491,P = 0. 000） and Cys C（ r =- 0. 497,P = 0. 000） were negatively correlated with e GFR; Hb（ r = 0. 798,P = 0. 000） and ALB（ r = 0. 701,P = 0. 000） were positively correlated with e GFR,there was no observable correlation between TC and e GFR（ r = 0. 210,P = 0. 081）. Conclusion Great attention and timely treatment to the COPD patients with low Hb,ALB and long course,high β₂-MG and Cys C should be given.更多还原