血清胆固醇联合C反应蛋白对慢性阻塞性肺疾病急性加重患者住院病死率的早期评估

目的：探讨早期评估慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstruc-tive pulmonary disease AECOPD）患者住院期间死亡的相关因素,重点讨论血清胆固醇对COPD预后的影响。方法：依据慢性阻塞性肺疾病全球倡议（GOLD）指南,回顾性分析同仁医院2008年1月至2009年12月间诊断为AECOPD的住院患者338例。所有患者均在发病72h内收入住院,将患者按照死亡与否分为死亡组与存活组,且两组资料具有可比性,所有患者入院后24h内均抽静脉血进行血常规、血生化分析,并对这些因素进行单因素分析。结果：经分析,与血清总胆固醇（Totalcholesterol,TC）浓度≤3.67mmoL/L相比,TC浓度3.67-4.37mmoL/L,OR=0.672,P=0.442,TC浓度4.37-5.23mmoL/L,OR=0.145,P=0.006,TC≥5.23mmoL/L,OR=1.012,P=0.018,血CRP浓度随着TC浓度的上升而下降。C反应蛋白（C-reactiveprotein,CRP）≥170mg/L时,OR=7.074.P=0.029.结论：CRP、TC均可早期预测COPD患者住院病死率,血TC3.67-4.37mmoL/L为降低死亡优势的保护性因素,TC〈3.67mmoL/L或TC〉5.23mmoL/L为增加死亡优势的危险因素,高CRP为增加死亡优势的危险因素,血胆固醇增加可以对抗炎症反应,提高住院患者存活率,进而降低住院病死率。

Effect of Total Cholesterol and C-reactive Protein on In-hospital Mortality and Early Assessment of Patients with Acute of Exacerbation of Chronic Obstructive Pulmonary Disease

Objective：To analyze the factors of prediction for the in-hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）,especially the effect of total cholesterol and C-reactive protein on the prognosis of COPD.Method：Factors for predicting in-hospital mortality were evaluated retrospesctively from the clinical data collected from 338 AECOPD patients of Tongren Hospital between January 2008 and December 2009 according to the GOLD.The patients were treated with blood routine examination,blood biochemical test with 24 hours after admission.The patients were divided as per outcome into decreased and survivor group.All patients were admitted within 72 hours after the onset of symptoms.The Chi-square test was used for univariate analysis.Results：Compared with TC≤3.67mmol/L,when the TC was between 3.67-4.37 mmol/L,OR was 0.672（ P=0.442）,while TC was between 4.37-5.23mmol/L,OR was 0.145（ P=0.006）.The OR was 1.012（P=0.018） when TC was ≥5.23mmol/L.The variation of serumTC levels was accompanied with the changes of C-reactiveprotein（CRP）.When the CRP was ≥170mg/l,OR was 7.074（P=0.031）.Conclusion：The CRP and TC can be used for early predicting for the in-hospital mortality of AECOPD patients.TC is a protective factor when it was between 4.37 mmol/L and 5.23 mmol/L,while it is a risk factor when ≥5.23mmol/L or ≤3.67mmol/L.CRP ≥170mg/L increases the probabilty of fatal outcome.Moderate elevation of TC level seems to increase the resistance to inflammation and hence improving the survival rate of patients with AECOPD and reducing the in-hospital mortality.