血清白蛋白在慢性阻塞性肺疾病急性加重期患者中的临床意义

目的 探讨血清白蛋白(ALB)在慢性阻塞性肺疾病急性加重期(AECOPD)患者中的临床意义.方法 选取141例AE-COPD住院患者(AECOPD组)、56例慢性阻塞性肺疾病稳定期门诊患者(COPD组)、42例同期健康体检者(健康对照组),比较三组ALB、总蛋白(TP)、前白蛋白(PAB)水平;将AECOPD患者肺功能按照慢性阻塞性肺疾病全球倡议(GOLD)分级分为GOLDⅠ级、GOLDⅡ级、GOLDⅢ级、GOLDⅣ级,同时根据ALB水平分为营养状况良好组、轻度营养不良组、中重度营养不良组,统计各组患者肺功能GOLD分级情况,分析AECOPD肺功能分级与ALB的相关性;将AECOPD患者按转归分为好转组及死亡组,采用多因素logistic回归分析AECOPD患者年龄、体质量指数、吸烟指数、TP、ALB与疾病转归的相关性,同时分析好转组抗菌素使用时间、住院总费用与ALB的相关性.结果 AECOPD组中ALB为(36.9±5.1)g·L-1,TP为(63.9±6.2)-1,PAB为(233±56)mg·L-1、COPD组中ALB为(41.6±5.0)g·L-1,TP为(67.5±4.9)g·L-1,PAB为(242±54)-1,健康对照组中ALB为(48.5±3.8)g·L-1,TP为(73.9±4.8)g·L-1,PAB为(251±41)mg·L-1,三组间ALB、TP水平差异有统计学意义(P<0.05),PAB水平差异无统计学意义(P>0.05);AECOPD肺功能分级与ALB具有相关性(r=0.653,P<0.05);ALB降低是AECOPD患者死亡的独立危险因素(OR=0.542,95%CI:0.370~0.795,P<0.05),ALB水平与好转组抗菌素使用时间、住院总费用呈负相关(r=-0.796,P<0.05;r=-0.816,P<0.05).结论 ALB可用于评估AECOPD患者病情严重程度及预后,对临床治疗具有重要指导意义.

Clinical significance of serum albumin in patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To explore the clinical significance of serum albumin (ALB) in patients with acute exacerbation of chronic ob -structive pulmonary disease (AECOPD).Methods One hundred and forty-one cases of hospitalized patients with AECOPD (AECO-PD group),56 outpatients with chronic obstructive pulmonary disease at stabilization phase (COPD group) and 42 persons with healthy physical examination data at the same time (healthy control group) were selected.ALB,total protein (TP) and prealbumin (PAB) a-mong three groups were compared .AECOPD patients were assigned into GOLD Ⅰ,GOLD Ⅱ,GOLD Ⅲ,GOLD Ⅳ grade according to the global initiative for chronic obstructive pulmonary disease (GOLD) classification.The patients were assigned into good nutritional status group,mild malnutrition group and severe malnutrition group according to ALB level .Statistics was made of pulmonary function GOLD classification of each group of patients ,and the correlation between AECOPD pulmonary function classification and ALB was ana -lyzed.AECOPD patients were classified into improved group and death group .The multi-factor Logistic regression was used to analyze the correlation between AECOPD patients 'age,body mass index,smoking index,TP,ALB and the prognosis of disease .The association between antimicrobial use time,the total hospitalization expense and ALB was analyzed .Results In the AECOPD group,the value of ALB was (36.9 ±5.1) g· L -1 ,the value of TP was (63.9 ±6.2) g· L -1 ,the value of PAB was (233 ±56) mg· L -1 .In the COPD group,the value of ALB was (41.6 ±5.0) g· L-1 ,the value of TP was (67.5 ±4.9) g· L-1 ,the value of PAB was (242 ±54) mg-1 .In the healthy controls group ,the value of ALB was (48.5 ±3.8) g· L-1 ,the value of TP was (73.9 ±4.8) g· L-1 ,the val-ue of PAB was (251 ±41) mg· L-1 .The difference in ALB and TP levels inamong the three groups was statistically significant (P <0.05),but difference in PAB level among the three groups was not statistically significant (P >0.05).AECOPD pulmonary function grading was correlated with ALB (r =0.653,P <0.05).The reduction of ALB was the independent risk factor of death in patients with AECOPD (OR =0.542,95%CI:0.370 ~0.795,P <0.05).ALB level was negatively correlated with antimicrobial use time and the · L total hospitalization expense (r =-0.796,P <0.05;r =-0.816,P <0.05).Conclusions ALB can be used to evaluate the severity and prognosis of patients with AECOPD ,and it also has important instruction significance for clinical treatment .