【摘要】 目的 分析血清间接胆红素（IBIL）水平、急性生理和慢性健康状况Ⅱ（APACHEⅡ）评分与晚期肺癌合并呼吸衰竭患者预后的相关性。方法 选取2021年7月至2024年4月北京丰台医院收治的83例晚期肺癌合并呼吸衰竭患者为研究对象，根据入院后30 d的预后不同将研究对象分为生存组（入院后30 d存活，58例）和死亡组（入院后30 d死亡，25例）。比较分析两组患者的临床资料、血气分析指标[动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）]、血清IBIL水平、APACHEⅡ评分。采用多因素Cox回归模型分析晚期肺癌合并呼吸衰竭患者入院后30 d预后不良的独立影响因素。采用受试者操作特征（ROC）曲线分析血清IBIL水平、APACHEⅡ评分对晚期肺癌合并呼吸衰竭患者入院后30 d预后不良的预测价值。结果 两组患者的临床资料比较差异无统计学意义（P>0.05）；死亡组患者的PaO₂低于生存组，PaCO₂、血清IBIL水平、APACHEⅡ评分均高于生存组，差异均有统计学意义（P<0.05）。多因素Cox回归分析结果显示，PaO₂是晚期肺癌合并呼吸衰竭患者入院后30 d预后不良的独立保护因素（P<0.05）,PaCO₂、血清IBIL水平、APACHEⅡ评分是晚期肺癌合并呼吸衰竭患者入院后30 d预后不良的独立危险因素（P<0.05）。ROC曲线分析结果显示，血清IBIL、APACHEⅡ评分两者联合预测晚期肺癌合并呼吸衰竭患者入院后30 d预后不良的曲线下面积为0.877，大于血清IBIL（曲线下面积为0.780）、APACHEⅡ评分（曲线下面积为0.793）单一指标，差异有统计学意义（P<0.001）。结论 血清IBIL水平、APACHEⅡ评分与晚期肺癌合并呼吸衰竭患者入院后30 d的预后不良显著相关，且血清IBIL水平、APACHEⅡ评分两者联合对晚期肺癌合并呼吸衰竭患者入院后30 d的预后不良具有较好预测价值。更多还原

【Abstract】 Objective To analyze the correlation between serum indirect bilirubin（IBIL） level,acute physiological and chronic health statusⅡ（APACHEⅡ） scores and prognosis in patients with advanced lung cancer complicated with respiratory failure.Method A total of 83 patients with advanced lung cancer complicated with respiratory failure admitted to Beijing Fengtai Hospital from July 2021 to April 2024 were selected as the study subjects.According to the different prognosis 30 days after admission,they were divided into survival group（survived 30 days after admission,58 cases） and death group（died 30 days after admission,25 cases）.The clinical data,blood gas analysis indexes（PaO₂,PaCO₂）,serum IBIL level and APACHEⅡscore in the two groups were compared and analyzed.Multivariate Cox regression model was used to analyze the independent influencing factors of poor prognosis in patients with advanced lung cancer complicated with respiratory failure 30 days after admission.ROC curve was used to analyze the predictive value of serum IBIL level and APACHEⅡscore on the poor prognosis in patients with advanced lung cancer complicated with respiratory failure 30 days after admission.Result There was no significant difference in clinical data between the two groups（P>0.05）.The PaO₂ in death group was lower than that in survival group,and the PaCO₂,serum IBIL level,APACHEⅡscore were higher than those in survival group,with statistical signifi cance（P<0.05）.Multivariate Cox regression analysis showed that PaO₂ was an independent protective factor for poor prognosis 30 days after admission in patients with advanced lung cancer complicated with respiratory failure（P<0.05）,and PaCO₂,IBIL and APACHEⅡscores were independent risk factors for poor prognosis 30 days after admission in patients with advanced lung cancer complicated with respiratory failure（P<0.05）.ROC curve analysis results showed that the area under the curve of the combined serum IBIL and APACHEⅡscores predicted the poor prognosis in patients with advanced lung cancer complicated with respiratory failure 30 days after admission was 0.877,which was higher than serum IBIL（with area under curve of 0.780） and APACHEⅡscore（with area under curve of 0.793）,and the difference was statistically significant（P<0.001）.Conclusion Serum IBIL level and APACHEⅡscore were signifi cantly correlated with the poor prognosis 30 days after admission in patients with advanced lung cancer complicated with respiratory failure,and the combination of serum IBIL level and APACHEⅡscore had a good predictive value for the poor prognosis 30 days after admission in patients with advanced lung cancer complicated with respiratory failure.更多还原