【作者】 周毅；

【导师】 沈华浩；

【作者基本信息】 浙江大学 ， 内科学（呼吸系病）， 2017， 硕士

【摘要】 目的:探讨淀粉样蛋白A及C反应蛋白预测COPD急性加重期的意义。探讨两者在预测AECOPD合并细菌与病毒感染中的作用。同时淀粉样蛋白A是公认的心血管疾病的指标,进一步探索淀粉样蛋白A与肺源性心脏病及呼吸衰竭之间的关系。方法:选取COPD急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者45例观察对象为AECOPD组,稳定期的COPD患者15例为对照组。AECOPD组于入院时、出院前1～2天检测淀粉样蛋白及CRP值和血常规。稳定期患者清晨同一时间点抽血对照。均测两组的CRP和淀粉样蛋白A及血常规的值。比较两组的各项值之间统计学意义。计算受试者工作曲线的曲线下面积及利用Pearson相关分析分析各指标相关性。同时将AECOPD组根据是否感冒样症状分为感冒样症状组及非感冒样症状组;根据是否黄痰或痰培养阳性分为黄痰组与非黄痰组;根据是否合并肺心病分为肺心病组与非肺心病组;根据是否呼吸衰竭分为呼吸衰竭组与无呼吸衰竭组。分别统计各组间的各指标的统计学意义。结果:1.与对照组和出院时比较,入院时AECOPD组的淀粉样蛋白A及白细胞明显升高(P<0.05)。AECOPD组CRP水平入院时与出院前及对照组比均无统计学意义(P>0.05,P=0.05)。AECOPD组的中性粒细胞水平入院时较对照组升高,差异有统计学意义(P<0.05),与出院前比无统计学意义(P>0.05)。2.将45例AECOPD患者分为有感冒样症状组和无感冒样症状组,入院时感冒样症状组的淀粉样蛋白A水平高于无感冒样症状组,差异有统计学意义(P<0.001)。CRP、中性粒细胞、白细胞值在两组间比较无统计学意义(P>0.05)。3.将45例AECOPD患者分为有脓痰或痰培养阳性与无脓痰并且痰培养阴性组,入院时有脓痰或痰培养阳性组的淀粉样蛋白A及CRP水平高于无脓痰并且痰培养阴性组,差异有统计学意义(P<0.001及0.05)。中性粒细胞、白细胞值在两组间比较无统计学意义(P>0.05)。4.将45例AECOPD患者分为合并肺心病组与无肺心病组,入院时的淀粉样蛋白A、CRP、中性粒细胞、白细胞值在两组间比较无统计学意义(P>0.05)。5.将45例AECOPD患者分为合并呼吸衰竭组与无呼吸衰竭组,入院时的淀粉样蛋白A、CRP、中性粒细胞、白细胞值在两组间比较无统计学意义(P>0.05)。6.淀粉样蛋白A、CRP、白细胞、中性粒细胞诊断AECOPD的ROC曲线的曲线下面积(AUC):淀粉样蛋白A最大(AUC=0.847),白细胞计数、中性粒细胞计数、CRP的曲线下面积分别为0.728、0.674和0.624。淀粉样蛋白A、白细胞计数、中性粒细胞计数和CRP的Cutoff值分别为:27.5mg/L、5.8×10^9/L、4.09×1 0^9/L 和 12.9 mg/L。7.淀粉样蛋白A、CRP、中性粒细胞及白细胞在AECOPD患者中的相关性:淀粉样蛋白A与CRP之间有较好的相关性,P<0.01;淀粉样蛋白A与白细胞及中性粒细胞之间无相关性,P>0.05;CRP与白细胞有相关性,P<0.01;白细胞与中性粒细胞之间有较大相关性,P<0.001。结论:在AECOPD中,淀粉样蛋白A是较CRP敏感的生物标志物,联合检测对鉴别细菌及病毒感染有一定的指导作用。可能淀粉样蛋白A能作为AECOPD患者一个较好的评价疾病的一个生物标志物。但急性加重期的SAA及CRP水平可能与肺源性心脏及呼吸衰竭相关性不大。更多还原

【Abstract】 Objective:To discuss the predictive value of amyloid A and CRP in acute exacerbation of chronic obstructive pulmonary patients.To discuss whether amyloid A and CRP could predict the vivus and bacteria or not.Furthermore.SAA is accepted as a biomarker of angiocardiopathy,so we discuss the relationship between SAA and cor pulmonale or respiratory failure.Methods:45 cases of patients with acute exacerbation of chronic obstructive pulmonary disease were selected as the AECOPD group,15 cases of patients with stable chronic obstructive pulmonary disease were selected as the control group.The level of amyloid A、CRP、white blood cell and neutrothil count was tested among 45 AECOPD,on the 1st day at admission and the last two days before discharged,All the indexes were also tested among the control group.Firstly,we analyzed all the data between the two groups,calculated the area under the receiver operating characteristic curve(AUC)and the correlation with Pearson.Secondly,the AECOPD group was divided into two groups according to if they were under the situation of influenza,the result of the sputum smear and cluture,if accompanied with cor pulmonale and respiratory failure,then we analyzed all the data between the two groups respectively.Results:1.The levels of AECOPD group of amyloid A and white blood cell count on the 1st day were significantly higher than the levels before discharged from the hospital and the control group(P<0.05).There was no significant difference in AECOPD group on the 1st day at admission and the last two days before discharged of CRP(P>0.05);and there was also no significant difference in AECOPD group on the 1st day at admission between the control group(P=0.05).The level of AECOPD group of neutrothil count on the 1st day at admission was significantly higher than the control group(P<0.05);There was no significant difference between the 1st day at admission and the last two days before discharg(P>0.05).2.The AECOPD group was divided into two groups according to if the paitents were infected with influenza.The level of amyliod A on the 1st day at admission was higher when the patients has an influenza(P<0.001),while there were no differences of the level of CRP、white blood cell count and neutrothil count between the two groups(P>0.05).3.The AECOPD group was divided into two groups according to the results of sputum smear and cluture.The level of amyliod A and CRP on the 1st day at admission was higher when the sputum was purulent or bacteria was founded in it(P<0.001 and 0.05).while there were no significant differences of the level of white blood cell count and neutrothil count between the two groups(P>0.05).4.The AECOPD group was divided into two groups according to if they were accompanied with cor pulmonale.There were no significant differences of the level of amyliod A、CRP、white blood cell count and neutrothil count on the 1st day at admission between the two groups(P>0.05).5.The AECOPD group was divided into two groups according to if they were accompanied with respiratory failure.There were no significant differences of the level of amyliod A、CRP、white cell count and neutrothil count on the 1st day at admission between the two groups(P>0.05).6.The AUC of amyloid A、white blood cell count、neutrothil count and CRP were 0.847、0.728、0.674 and 0.624 repectively.The amyloid A is the most significant one.The cutoff of amyloid A、white cell count、neutrothil count and CRP was 27.5mg/L、5.8×10^9/L、4.09×10^9/L、12.9mg/L.7.The level of amyliod A was correlated with the level of CRP(P<0.01).The level of amyliod A wasn’t correlated with the level of white blood cell and neutrothil count(P>0.05).The level of white blood cell count was correlated with the level of CRP(P<0.01).The level of white cell count was significantly correlated with the level of neutrothil count(P<0.001).Conclusion:The serum amyloid A is a more sensitive biomarker than CRP in AECOPD.The combined detection of amyliod A and CRP might beneficial for distinguishing the vivus and bacteria.The serum amyloid A maybe a good biomarker of AECOPD.But SAA and CRP of AECOPD maybe have little relevant to respiratory failure and cor pulmonale.更多还原