【摘要】 目的：分析血清白细胞介素-1β(interleukin-1β,IL-1β)、肝素结合蛋白（heparin-binding protein,HBP）与慢性阻塞性肺疾病急性加重期（acute exacerbation phase of chronic obstructive pulmonary disease,AECOPD）合并呼吸衰竭患者无创正压通气（non-invasive positive pressure ventilation,NIPPV）治疗预后的关系。方法：AECOPD合并呼吸衰竭患者122例行NIPPV治疗，比较撤机成功组与撤机失败组临床特征，Logistic回归分析影响NIPPV治疗预后的因素，受试者工作特征（receiver operating characteristic,ROC）曲线分析血清IL-1β、HBP预测NIPPV治疗预后的效能，决策曲线分析血清IL-1β、HBP预测AECOPD合并呼吸衰竭患者NIPPV治疗预后的净收益率。结果：首次撤机成功95例（77.87%），撤机失败27例（22.13%）。相较于撤机成功组，撤机失败组慢阻肺全球倡议分级（global initiative for chronic obstructive lung disease,GOLD）3级、4级比例高，呼吸浅快指数（rapid shallow breathing index,RSBI）、血清IL-1β、HBP水平高，氧合指数低（均P<0.05）。Logistic回归分析显示，AECOPD合并呼吸衰竭患者NIPPV治疗撤机失败与GOLD 3～4级、氧合指数降低，RSBI、血清IL-1β及HBP增高有关（P<0.05）。ROC曲线分析显示，血清IL-1β、HBP预测NIPPV治疗撤机结局的曲线下面积（area under curve,AUC）分别为0.790、0.783，两者联合预测的AUC为0.884，均有一定预测价值。决策曲线分析显示，血清IL-1β、HBP联合能提高预测NIPPV治疗撤机结局效能，联合血清IL-1β、HBP、GOLD分级、RSBI、氧合指数可显著提高预测NIPPV撤机结局的净收益率。结论：AECOPD合并呼吸衰竭患者NIPPV撤机失败与血清IL-1β、HBP表达增高有关，联合血清IL-1β、HBP有助于预测撤机结局。更多还原

【Abstract】 Objective: To analyze the relationship between serum interleukin-1β(IL-1β), heparin-binding protein(HBP) and the prognosis of non-invasive positive pressure ventilation(NIPPV) in patients with acute exacerbation phase of chronic obstructive pulmonary disease(AECOPD) accompanied by respiratory failure. Methods: One hundred and twentytwo patients with AECOPD accompanied by respiratory failure underwent NIPPV treatment. The clinical characteristics of patients in the successful weaning group and the failed weaning group were compared, and Logistic regression analysis was conducted to analyze the factors influencing the prognosis of NIPPV treatment. The receiver operating characteristic(ROC)curve was used to analyze the efficacy of serum IL-1β and HBP in predicting the prognosis of NIPPV treatment. The decision curve was used to analyze the net income ratio of serum IL-1β and HBP in predicting the prognosis of NIPPV treatment in patients with AECOPD accompanied by respiratory failure. Results: Ninety-five cases(77.87%) were successfully dismantled for the first time, while 27 cases(22.13%) failed. Compared with the successful dismantling group, the proportion of patients with Global Initiative for Chronic Obstructive Pulmonary Disease(GOLD) grades 3 and 4 was higher,the respiratory shallow fast index(RSBI), serum IL-1β and HBP levels were higher, and oxygenation index was lower in the failed dismantling group(P<0.05). Logistic regression analysis showed that the failure of NIPPV treatment dismantling in AECOPD patients with respiratory failure was associated with GOLD grade 3 ～4, decreased oxygenation index, and increased RSBI, serum IL-1β,HBP expression(P<0.05). ROC curve analysis showed that the area under curve(AUC) of serum IL-1β and HBP for predicting the dismantling outcome of NIPPV treatment was 0.790 and 0.783 respectively, and the AUC of the combined prediction was 0.884, both of which had certain predictive value. The decision curve analysis showed that the combination of serum IL-1β and HBP can improve the efficacy in predicting the dismantling outcome of NIPPV treatment. The combination of serum IL-1β, HBP, GOLD classification, RSBI and oxygenation index can significantly increase the net income ratio for predicting the dismantling outcome of NIPPV. Conclusion: The failure of NIPPV dismantling in AECOPD patients accompanied by respiratory failure is related to the increased expression of serum IL-1β and HBP, and the combination of serum IL-1β and HBP is helpful for predicting the dismantling outcome.更多还原