合并AECOPD 髋关节置换患者围手术期PCT、CRP 的相关性研究

Regression analysis of PCT and CRP in hip-joint replacement surgery of patients with AECOPD

摘要:

目的 探讨检测合并慢性阻塞性肺疾病急性加重期（AECOPD）的髋关节置换患者围手术期血清降钙素原（PCT）和C 反应蛋白（CRP）动态变化，并分析其临床意义。方法 选择本院收治的107 例合并AECOPD 的髋关节置换患者，在入院第1、3、5、7 及9 天抽取静脉血，动态地检测所有患者的血清CRP及PCT 水平，并对结果取对数（LN）后进行线性回归分析。同时根据是否合并肺炎，进行多元线性回归的亚组分析。结果 患者LN（PCT）的值与天数（day）相关，差异有统计学意义（P <0.05），并得到回归方程：LN（PCT）=1.97-0.42day。同时LN（CRP）的值与天数（day）相关，差异有统计学意义（P <0.05），并得到回归方程：LN（CRP）=4.93-0.28day。方程代入正常值可知，患者PCT 恢复至正常值较CRP 恢复至正常值早3.84 d。同时对是否合并肺炎进行亚组分析，统计得出LN（PCT）及LN（CRP）的数值分别与天数（day）及合并肺炎与否（pneu）两个变量相关（P <0.05）。PCT 的方程为：LN（PCT）=1.80-0.42day+0.34pneu，CRP 的方程为：LN（CRP）=4.79-0.28day+0.26pneu。将正常值带入方程可知合并肺炎组（A 组）比不合并肺炎组（B 组）患者PCT 指标恢复到正常值早0.810 d，CRP 指标恢复到正常值早0.928 d。结论 髋关节置换术前，合并肺炎的AECOPD 患者，血清PCT、CRP 恢复时间更长。同时，血清PCT 在AECOPD 患者的恢复过程中，较CRP 更为灵敏，动态监测PCT 能有助于更早的明确感染控制情况，尽早的进行髋关节置换手术。

Abstract:

Objective To explore the dynamic changes of perioperative serum procalcitonin (PCT) and C-reactive protein (CRP) in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) receiving hip-joint replacement surgery and to analyze its clinical significance. Methods Totally 107 patients with AECOPD who received hip-joint replacement surgery were selected from our hospital. Venous blood was drawn on the 1st, 3rd, 5th, 7th and 9th day after admission. Serum CRP and PCT levels of all patients were dynamically detected. Linear regression analysis was performed on logarithms (LN) of the results. At the same time, multiple linear regression analysis of the subgroups accompanied with pneumonia or not was carried out. Results The patients’ LN (PCT) was associated with time (day) with statistical significance (P < 0.05), and the regression equation was: LN(PCT) = 1.97 -0.42day. At the same time LN(CRP) was associated with time (day) (P < 0.05), the regression equation was: LN(CRP) = 4.93 - 0.28day. When the normal values were substituted into the equations, it was obtained that the time for PCT to recovery to normal value in the AECOPD patients was 3.84 days earlier than that of CRP. And subgroup analysis was carried out according to whether the patients were accompanied with pneumonia, it was obtained that LN (PCT) and LN (CRP) were associated with the time (day) and whether accompanied with pneumonia (pneu),respectively (P < 0.05). The equation of PCT was: LN(PCT) = 1.80 - 0.42day + 0.34pneu, while the equation of CRP was: LN(CRP) = 4.79 - 0.28day + 0.26pneu. When the normal values were substituted into the equations, it was obtained that the time for PCT to recovery to normal value in the group A (accompanied with pneumonia) was 0.810 day earlier than that of the group B (not accompanied with pneumonia). And that of CRP was earlier by 0.928 day. Conclusions For AECOPD patients accompanied with pneumonia before hip-joint replacement surgery, the recovery time of serum PCT and CRP is longer. At the same time, in the recovery process of AECOPD patients serum PCT is more sensitive than CRP. Dynamic monitoring of PCT can help to earlier clarify the situation of infection control and carry out hip replacement surgery as early as possible.