CAJ | 학술논문

目的：探讨血清蛋白（前白蛋白、白蛋白）水平对重症慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）预后的预测价值。方法选取107例重症 COPD 患者，测定入住重症医学科初始及72 h血清蛋白水平、按初始白蛋白水平，将患者分为白蛋白＜30 g／L组和白蛋白≥30 g／L组，比较白蛋白＜30 g／L组和白蛋白≥30 g／L组急性生理功能和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluation Ⅱ， APACHEⅡ）评分、初始前白蛋白水平、机械通气时间及28 d病死率。按28 d转归分为死亡组和存活组，观察死亡组和存活组血清蛋白水平的动态变化。结果白蛋白≥30 g／L 组 APACHEⅡ评分、机械通气时间与28 d 病死率明显低于白蛋白＜30 g／L组（P ＜0．01），初始前白蛋白水平明显高于白蛋白＜30 g／L组（P ＜0．01）。存活组0 h和72 h前白蛋白水平及白蛋白水平均高于死亡组（P ＜0．01）。存活组72 h前白蛋白水平高于0 h水平（P ＜0．01），存活组72 h 白蛋白水平与0 h比较差异无统计学意义（P ＞0．05），死亡组72 h前白蛋白和白蛋白水平与0 h比较差异无统计学意义（P ＞0．05）。结论血清蛋白水平是重症 COPD 患者严重程度及预后的重要预测指标。
목적：탐토혈청단백（전백단백、백단백）수평대중증만성조새성폐질병（chronic obstructive pulmonary disease，COPD）예후적예측개치。방법선취107례중증 COPD 환자，측정입주중증의학과초시급72 h혈청단백수평、안초시백단백수평，장환자분위백단백＜30 g／L조화백단백≥30 g／L조，비교백단백＜30 g／L조화백단백≥30 g／L조급성생리공능화만성건강상황평분계통Ⅱ（acute physiology and chronic health evaluation Ⅱ， APACHEⅡ）평분、초시전백단백수평、궤계통기시간급28 d병사솔。안28 d전귀분위사망조화존활조，관찰사망조화존활조혈청단백수평적동태변화。결과백단백≥30 g／L 조 APACHEⅡ평분、궤계통기시간여28 d 병사솔명현저우백단백＜30 g／L조（P ＜0．01），초시전백단백수평명현고우백단백＜30 g／L조（P ＜0．01）。존활조0 h화72 h전백단백수평급백단백수평균고우사망조（P ＜0．01）。존활조72 h전백단백수평고우0 h수평（P ＜0．01），존활조72 h 백단백수평여0 h비교차이무통계학의의（P ＞0．05），사망조72 h전백단백화백단백수평여0 h비교차이무통계학의의（P ＞0．05）。결론혈청단백수평시중증 COPD 환자엄중정도급예후적중요예측지표。
Objective To study the predictive value of prealbumin(PA)and albumin level for prognosis of patients with severe chronic obstructive pulmonary disease(COPD).Methods The study selected 107 patients with severe COPD,the serum protein of initial and 72 hours in intensive care unit was detected.According to the initial albumin levels,the patients were divided into albumin < 30 g/L group and albumin ≥ 30 g/L group,comparison was made in acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,initial albumin level,the time of mechanical ventilation,and the case fatality rate of 28 days of two groups.After 28 days,outcome was divided into death group and alive group,observation was performed on the dynamic change of serum protein level.Results The APACHE Ⅱ score,mechanical ventilation time and case fatality rate of 28 days in albumin ≥ 30 g/L group were significantly lower than those in albumin <30 g/L group(P <0.01).Initial PA level of albumin ≥30 g/L group was significantly higher than that of albumin <30 g/L group(P <0.01).PA level of survival group was higher than that of death group at 0 h and 72 h(P <0.01).PA level of survival group at 72 h was above the 0 h(P < 0.01).The albumin level of survival group at 72 h showed no significant difference as compared with that of 0 h(P >0.05).PA and albumin level of death group at 72 h also showed no significant difference as compared with those of 0 h(P >0.05).Conclusion Serum protein level is an important predictor of severity and prognosis for severe COPD patients.