慢性阻塞性肺疾病患者C反应蛋白测定及其临床意义

目的 探讨慢性阻塞性肺疾病(COPD)患者不同分期及不同分级血中C反应蛋白(CRP)浓度变化的临床意义,肺功能损害程度与CRP浓度变化的关系.方法 选择COPD急性加重期患者42例,入院时及经治疗病情好转进入缓解期出院前均进行肺功能第1秒用力呼气容量(FEV1)和1秒率(FEV1/FVC)测定；动脉血气分析:包括氧分压(PaO2)、二氧化碳分压(PaCO2)的测定；采集患者清晨空腹静脉血,采用ELISA法检测CRP浓度.同时,选择10名健康者作为对照组进行CRP测定.结果 急性加重期COPD患者血清CRP浓度较健康对照者明显增高[(6.283 ±3.168)mg/L与(0.134±0.040)mg/L,t=4.12,(P＜0.05)],COPD急性加重期Ⅳ级患者增高最明显,但各级之间差异无统计学意义(P＞0.05).COPD患者急性加重期比缓解期明显升高,差异有统计学意义[(6.283±3.168)mg/L与(4.104±1.013)mg/L;t =4.35,P＜0.05].COPD患者肺功能FEV1变化与血CRP浓度变化呈负相关(r=-0.618,P＜0.05),FEV1/FVC变化与血CRP浓度变化呈负相关(r=-0.629,P＜0.05).PaO2与血CRP浓度变化呈负相关(r=-0.605,P＜0.05),PaCO2与血CRP浓度变化呈正相关(r=0.613,P＜0.05).结论 CRP浓度的增高可能与呼吸困难程度及肺功能损害程度有关,但是CRP作为COPD患者病情进展和预后的独立指标还有待进一步研究.

The clinical significance of C-reactive protein levels in patients with chronic obstructive pulmonary disease

Objective To study the significance of changes in the blood C-reactive protein(CRP)concentration in patients with chronic obstructive pulmonary disease(COPD)at different stages and different classification and further analyze the relationship between the degree of impairment of pulmonary function and CRP concentrations.Methods Fouty-two cases of COPD patients were enrolled,forced expiratory volume in one second(FEV1),the forced expiratory volume in one second/forced vital capacity(FEV1/FVC),a second rate were tested in these patients at admission and discharged from hospital after recovery.Arterial blood gas including PaO2,PaCO2 were analyzed.The CRP level was measured by ELISA from venous blood collected in the early morning.At the same time,10 healthy people were selected as control group.Results The CRP level in COPD group was significantly higher than that of the control group(P ＜ 0.05).It displayed highest in the Ⅳ grade of COPD patients,but there was no statistically significant differences among the levels(P ＞ 0.05).The CRP level in COPD patients at acute exacerbations was significantly higher than that in COPD patients at remission and differences was statistically significant([6.283 ± 3.168]mg/L vs[4.104 ± 1.013]mg/L,P ＜0.05).The changes of serum CRP levels was correlated negatively with FEV1(r =-0.618,P ＜ 0.05),with FEV1/FVC(r =-0.629,P ＜ 0.05)and with PaO2(r =-0.605,P ＜ 0.05).The changes of serum CRP levels was correlated positively with PaCO2(r =0.613,P ＜ 0.05).Conclusion The increase of CRP level may be associated with the damage of lung function and the degree of dyspnea in COPD patients.But CRP as a independent predictor of COPD outcomes and prognosis remains to be further studied.