【摘要】 目的 分析老年慢性阻塞性肺疾病急性加重（AECOPD）合并Ⅱ型呼吸衰竭（Ⅱ-RF）血清微小RNA-101(miR-101)、微小RNA-223(miR-223)水平联合预测预后的价值。方法 选取2022年7月至2023年12月邯郸市第一医院收治的210例老年AECOPD合并Ⅱ-RF患者，男性134例，女性76例，年龄（69.8±3.4）岁，年龄范围为61～75岁。根据治疗后1年预后情况将患者分为预后不良组（n=60）与预后良好组（n=150），比较两组患者一般资料、治疗前血清miR-101和miR-223水平，采用Logistic回归分析老年AECOPD合并Ⅱ-RF患者预后不良的影响因素，采用限制性立方样条模型分析相关性，采用受试者工作特征（ROC）曲线分析预测价值。结果 Logistic回归分析显示，调整吸烟史、机械通气治疗时间、治疗前急性生理功能和慢性健康状况评分系统Ⅱ评分、治疗前尿酸及治疗前C反应蛋白后，治疗前血清miR-223升高是老年AECOPD合并Ⅱ-RF患者预后不良的独立危险因素（P<0.05）,miR-101升高是老年AECOPD合并Ⅱ-RF患者预后不良的独立保护因素（P<0.05）。限制性立方样条模型分析显示，治疗前血清miR-101与预后不良存在非线性剂量-反应关系（P=0.003）；治疗前血清miR-223与预后不良存在非线性剂量-反应关系（P<0.001）。ROC分析显示，miR-101、miR-223二者联合预测预后不良的曲线下面积大于其单独预测的曲线下面积（P=0.007、P=0.005）。结论 血清微小RNA-101、微小RNA-223在预测老年慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者预后方面具有一定预测效能，二者联合能明显提高预测价值。更多还原

【Abstract】 Objective To analyze the value of combined prediction of serum micro RNA-101 and micro RNA-223 levels for prognosis in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with type Ⅱ respiratory failure（Ⅱ-RF）. Methods A total of 210 elderly patients with acute exacerbation of chronic obstructive pulmonary disease and type Ⅱ respiratory failure from July 2022 to December 2023 were selected from Handan First Hospital,there were 134 males and 76 females,aged(69.8±3.4)years old,ranging from 61 to 75 years old.According to the one-year prognosis after treatment,they were divided into poor prognosis group(n=60) and good prognosis group(n=150). Compare the general information and serum levels of micro RNA-101 and micro RNA-223 between two groups,analyze the influencing factors of poor prognosis,and examine the correlation between pre-treatment serum levels of micro RNA-101 and micro RNA-223 and poor prognosis,as well as their predictive value for poor prognosis. Results Logistic regression analysis revealed that after adjusting for smoking history,duration of mechanical ventilation treatment,acute physiology and chronic health evaluation Ⅱ score before treatment,serum uric acid,and C-reactive protein,elevated serum micro RNA-223 before treatment was identified as an independent risk factor for poor prognosis in elderly patients with AECOPD complicated with Ⅱ-RF(P<0.05),while elevated micro RNA-101 served as an independent protective factor(P<0.05). Restricted cubic spline model analysis indicated a nonlinear dose-response relationship between serum micro RNA-101 and poor prognosis before treatment(P=0.003),as well as between serum micro RNA-223 and poor prognosis before treatment(P<0.001). Receiver operating characteristic analysis demonstrated that the area under the curve for predicting poor prognosis was greater when combining micro RNA-101 and micro RNA-223 compared to each micro RNA alone(P=0.007,P=0.005). Conclusion Serum micro RNA-101 and micro RNA-223 have certain predictive power in predicting the prognosis of elderly patients with AECOPD combined with Ⅱ-RF, the combination of the two can significantly improve the predictive value.更多还原