摘要
目的:探讨慢性阻塞性肺疾病(COPD)急性加重期伴呼吸衰竭患者氧化应激水平在其预后早期评估中的临床价值。方法:选取2012年1月-2014年8月本院收治的COPD急性加重期伴呼吸衰竭患者85例为研究组,另选取30例COPD稳定期患者为对照组。检测两组治疗前、治疗3 d和1周的血清8-isoprostane、超氧化物歧化酶(SOD)、丙二醛(MDA)和总抗氧化能力(T-AOC)等氧化应激指标,采用Kaplan-Meier生存曲线分析两组随访1年的预后情况,比较不同预后情况COPD急性加重期伴呼吸衰竭患者治疗前后的氧化应激指标水平并采用Spearman无条件相关分析法和Logistic多元回归分析法分析其氧化应激指标水平与预后的关系。结果:与对照组比较,研究组治疗前后的血清SOD、T-AOC水平均降低(P<0.01),同期血清8-isoprostane和MDA水平均升高(P<0.01);与治疗前比较,研究组治疗3 d和1周的血清SOD、T-AOC水平均升高(P<0.01),同期血清8-isoprostane和MDA水平均降低(P<0.01)。研究组和对照组1年生存率分别为78.82%和96.67%,研究组1年生存率低于对照组(P<0.05)。且研究组死亡患者治疗前后的血清SOD、T-AOC水平均较存活患者降低,同期血清8-isoprostane和MDA水平均升高(P<0.05)。Spearman无条件相关分析结果显示,COPD急性加重期伴呼吸衰竭患者血清SOD、T-AOC水平与其1年生存率均呈正相关(r=0.748、0.766,P<0.05),其血清8-isoprostane和MDA水平与其1年生存率则呈负相关(r=-0.753、-0.768,P<0.05)。Logistic多元回归分析结果亦显示,COPD急性加重期伴呼吸衰竭患者血清SOD、T-AOC、8-isoprostane和MDA水平与其1年生存率均密切相关(P<0.01)。结论:COPD急性加重期伴呼吸衰竭患者氧化应激水平升高而抗氧化能力降低且其氧化应激水平与其预后密切相关,这可能与氧化应激促进细胞损伤和血管内皮功能损伤相关,COPD急性加重期伴呼吸衰竭患者氧化应激水平可能作为其预后的早期评估的参考指标。
Objective： To investigate the clinical value of oxidation stress level in early assessing the prognosis of chronic obstructive pulmonary disease （ COPD ） patients with respiratory failure in acute exacerbation period.Method： 85 COPD patients with respiratory failure in acute exacerbation period in our hospital from January 2012 to August 2014 were selected as the research group, and 30 patients with COPD in stabilization period were selected as the control group.Before treatment and after treated with 3 d and 1 week serum 8-isoprostane, superoxide dismutase （ SOD ）, malondialdehyde （ MDA ） and total antioxidant capacity （ T-AOC ） and other oxidative stress indicators level of the research group and control group were tested.Kaplan Meier survival curve was applied in analysis of the prognosis of two groups in 1 year followed up and the oxidative stress indexes level of patients with different prognosis in COPD patients with respiratory failure in acute exacerbation period before and after treatment were compared.Spearman unconditionally correlation analysis and Logistic multivariate regression analysis method were applied to analyze the relationship between serum oxidative stress index level with the prognosis.Result： Compared with the control group, serum SOD and T-AOC level of the research group before and after treatment were reduced （ P〈0.01 ）, while serum 8-isoprostane and MDA level were higher （ P〈0.01 ） ; compared with before treatment, serum SOD and T-AOC level of the exacerbation group after treated with 3 d and 1 week were elevated while serum 8-isoprostane and serum MDA levels at the same time were lower （ P〈0.01 ） .1 yearsurvival rates of research group and the control group were 78.82% and 96.67% respectively, 1 year survival rate of research group was lower than that of the control group （ P〈0.05 ） .Compared with the survival patients, serum SOD and T-AOC level of death patients in experimental group before and after treatment were lower while serum 8-isoprostane and MDA levels in the same time were elevated （ P〈O.05 ） .Unconditional Spearman correlation analysis results showed that serum SOD and T-AOC level of COPD patients with respiratory failure in acute aggravating period were positively correlated with 1 year survival rates （ r=0.748, 0.766, P〈0.05 ）, while the serum 8-isoprostate and MDA level and the 1 year survival rate were negatively correlated with （ r=-0.753, -0.768, P〈0.05 ） .Logistic multivariate regression analysis results also showed that serum SOD, T-AOC, 8-isoprostane and MDA level of COPD patients with respiratory failure in acute aggravating period and 1 year survival rate were closely related （P〈0.01） .Conclusion： Oxidative stress levels of COPD patients with respiratory failure acute exacerbation period increase and antioxidant capacity decrease and the oxidative stress level and its prognosis are closely related, this may be related to oxidative stress promoting cell injury,and vascular endothelial function injury, therefore oxidative stress levels of COPD patients with respiratory failure in acute exacerbation period may be the reference index in early evaluation of the prognosis.
作者
陈泳祥
CHEN Yong-xiang(The Second People＇s Hospital of Nanhai District in Foshan, Foshan 528200,Chin)
出处
《中国医学创新》
CAS
2017年第6期1-5,共5页
Medical Innovation of China
基金
佛山市自筹经费类科技计划项目(2015AB000692)
关键词
COPD
急性加重期
呼吸衰竭
氧化应激水平
预后
早期评估
COPD
Acute exacerbation period
. Respiratory failure
Oxidative stress level
Prognosis
Early assessment
