2022 年第 9 期 第 17 卷

血清胱抑素C对老年慢性阻塞性肺疾病患者预后的预测价值

Prognostic value of serum cystatin C in outcomes of elderly patients with chronic obstructive pulmonary disease

作者：张净陈颖谭春婷王珊石赟

英文作者：Zhang Jing Chen Ying Tan Chunting Wang Shan Shi Yun

单位：首都医科大学附属北京友谊医院老年医学科，北京100050

英文单位：Department of Geriatrics Beijing Friendship Hospital Capital Medical University Beijing 100050 China

关键词：慢性阻塞性肺疾病；胱抑素C；呼吸衰竭

英文关键词：Chronicobstructivepulmonarydisease;CystatinC;Respiratoryfailure

• 摘要：

• 目的 探讨血清胱抑素C对老年慢性阻塞性肺疾病（COPD）患者预后的预测价值。方法  选取2018年4月至2021年4月首都医科大学附属北京友谊医院收治的114例COPD患者，按临床预后情况分为好转组66例，死亡组48例。另选取71例老年健康志愿者为对照组。比较3组受试者的血清胱抑素C、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）水平和好转组及死亡组的急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。采用受试者工作特征（ROC）曲线分析血清胱抑素C对COPD患者预后的预测价值。采用多因素Logistic回归方法分析老年COPD患者预后的危险因素。结果  死亡组血清胱抑素C水平高于对照组和好转组［（1.47±0.18）mg/L比（0.87±0.22）、（1.02±0.11）mg/L］，PaO2水平低于好转组，PaCO2水平和APACHEⅡ评分高于好转组，差异均有统计学意义（均P＜0.05）。ROC曲线结果显示，截断值为1.23 mg/L时，血清胱抑素C区分COPD患者死亡与存活的曲线下面积为0.658（95%置信区间：0.547~0.823），敏感度为0.771，特异度为0.696。多因素Logistic回归分析结果显示，胱抑素C、呼吸衰竭、APACHEⅡ评分是影响老年COPD患者预后的独立危险因素（均P＜0.05）。结论 胱抑素C、呼吸衰竭、APACHEⅡ评分是影响老年COPD患者预后的独立危险因素。血清胱抑素C水平可作为提示患者预后的重要生物学指标，可考虑用于指导临床治疗。

• Objective  To investigate the prognostic value of serum cystatin C in outcomes of elderly patients with chronic obstructive pulmonary disease (COPD). Methods  Totally 114 patients with COPD admitted to Beijing Friendship Hospital, Capital Medical University from April 2018 to April 2021 were enrolled. Patients were divided into the improvement group (66 cases) and death group (48 cases) according to the clinical outcomes. Another 71 elderly healthy volunteers were selected as the control group. The levels of serum cystatin C, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) were compared among the three groups. The acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score was compared between improvement group and death group. The prognostic value of serum cystatin C in outcomes of patients with COPD was analyzed by receiver operating characteristic (ROC) curve. Multivariate Logistic regression model was used to analyze the prognostic risk factors of elderly patients with COPD. Results  The level of serum cystatin C in the death group were higher than those in the control group and the improvement group［（1.47±0.18）mg/L vs （0.87±0.22）,（1.02±0.11）mg/L］, the level of PaO2 was lower than that in the improvement group, and the level of PaCO2 and APACHEⅡ score were higher than those in the improvement group (all P＜0.05). The ROC curve showed that when the cut-off value was 1.23 mg/L, the area under the curve of serum cystatin C to distinguish the death and survival of patients with COPD was 0.658 (95% confidence interval: 0.547-0.823), the sensitivity was 0.771 and the specificity was 0.696. Multivariate Logistic regression analysis showed that cystatin C, respiratory failure and APACHEⅡ score were independent risk factors affecting the outcomes of elderly patients with COPD (all P＜0.05). Conclusions  Cystatin C, respiratory failure and APACHEⅡ score are independent risk factors affecting the prognosis of elderly patients with COPD. Serum cystatin C level can be used as an important biological index to indicate the prognosis of patients and to guide treatment.