慢性阻塞性肺疾病急性加重期患者并发肾功能受损的相关因素分析OA

Background Chronic obstructive pulmonary disease(COPD)is one of the major diseases that severely jeopardize the health of the Chinese population.The kidneys are extremely sensitive to low oxygen levels due to their sensitivity,patients with COPD are susceptible to renal impairment.Nevertheless,there is a paucity of research on the factors associated with COPD and renal impairment both domestically and internationally.Objective Analyze the clinical characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease complicated by renal dysfunction,identify relevant factors,and provide theoretical basis for the prevention and treatment of renal dysfunction in clinical AECOPD patients.Methods A total of 100 patients with acute exacerbation of chronic obstructive pulmonary disease complicated by renal dysfunction who were hospitalized in the Respiratory Department of the First Affiliated Hospital of Jinzhou Medical University from December 2020 to July 2023 were selected.At the same time,92 patients with AECOPD who were admitted and had complete examination data during the same period were collected,totaling 192 cases.According to the glomerular filtration rate(eGFR)of patients,they were divided into a normal renal function group(92 cases),a mild impairment group(66 cases),and a severe impairment group(34 cases).Collect general data of the subjects and laboratory data:white blood cell(WBC),hemoglobin(Hb),C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),albumin(ALB),brain natriuretic peptide(BNP),troponin I(CTnI),glucose(GLU),pH Arterial oxygen partial pressure(PaO2),arterial carbon dioxide partial pressure(PaCO2),lactate(cLac),creatinine(Cr),Cystatin C(Cys C),β2-Microglobulin(β2-MG),Urea,uric acid(UA),percentage of forced expiratory volume per second(FEV1%),and percentage of forced vital capacity per second(FEV1/FVC).Multivariate Logistic regression analysis of predictive factors for renal dysfunction in AECOPD patients;Pearson correlation analysis shows the correlation between eGFR,Cys C,and other indicators;Draw ROC curves and evaluate the predictive value of various factors on renal function damage in AECOPD patients.Results Three inter group analysis,age,hypertension,coronary heart disease,Hb,CRP,ALB,BNP,CTnI,IL-6,Cr,UA,Urea,Cys C,β2-MG,FEV1%and PaO2 were statistically significant(P<0.05);Cys C is negatively correlated with PaO2 and FEV1%(r=-0.379,-0.254,P<0.01),and positively correlated with IL-6(r=0.641,P<0.01).eGFR is positively correlated with PaO2 and FEV1%(r=0.470,0.286,P<0.01),and negatively correlated with IL-6(r=-0.456,P<0.01).Multivariate Logistic regression analysis showed that age,hypertension,PaO2,IL-6,UA,β2-MG and Cys C were predictive factors for renal dysfunction in patients with acute exacerbation of COPD(P<0.05).Further ROC curve analysis showed that UA(AUC=0.646,95%CI=0.569-0.724),Cys C(AUC=0.895,95%CI=0.852-0.939),β2-MG(AUC=0.822,95%CI=0.764-0.879),IL-6(AUC=0.743,95%CI=0.674-0.812),and PaO2(AUC=0.676,95%CI=0.601-0.751)had certain predictive value for renal function damage in AECOPD patients(P<0.05).In terms of concurrent renal dysfunction in AECOPD patients,the sensitivity,specificity,accuracy,and area under the ROC curve of Cys C were all higher than those of β2-MG,IL-6,and PaO2,with statistically significant differences(P<0.05).Conclusion Age,hypertension,PaO2,IL-6,UA,β2-MG and Cys C are related predictive factors for renal dysfunction in patients with acute exacerbation of chronic obstructive pulmonary disease.Cys C has a high diagnostic value in predicting renal function impairment in AECOPD patients,and is an indicator for predicting the risk of renal injury in AECOPD patients.