The Predictive Value Of Serum Calcitonin In The Application Of Noninvasive Ventilator In Axute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective: The cutoff value of AECOPD in the serum of patients with AECOPD was obtained by monitoring the serum level of PCT in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD). To further improve the application of noninvasive ventilation indications.Methods: AECOPD patients in the Department of respiration of General Hospital of 95 patients with were selected(2014.3-2015.1). The patients’ age,gender, smoking index, body mass index, blood gas analysis, conscious state,respiratory rate, oxygenation index were analyzed. In the before treatment blood test in the patients blood, erythrocyte sedimentation rate(ESR),C-reactive protein, serum calcitonin fibrinogen, blood gas analysis, a parallel pulmonary function tests. In the choice of antibiotics, the use of noninvasive respiratory units and the use of non respiratory units were selected with the same level of antibiotics, excluding the application of antibiotics before entering the group, 33 cases were treated with noninvasive ventilator assisted ventilation group and 47 cases in non invasive ventilator treatment group. In the course of treatment is 5 cases because of the aggravation of the condition to tracheal intubation with a ventilation and exclusion experiments, 4 cases by an application of noninvasive ventilation in the treatment group into the application of non-invasive breathing machine, this time again review of serum calcitonin hormone, blood, erythrocyte sedimentation rate(ESR),Creactive protein, blood gas analysis and make a record, finally get the NPPV group(n=32), without the use of NPPV group of 43 people. The correlation between PCT and inflammatory factors and blood gas analysis was analyzed.Logistic regression analysis showed that PCT was the independent risk factor of noninvasive ventilator, and the cutoff value of PCT was obtained by ROCcurve. The patients were divided into 3 groups according to Anthonisen symptom scoring system, and the level of PCT in 3 groups was analyzed.Results: By the patients with NPPV group were older, PCT, ESR,P<0.001, CRP, WBC,, the proportion of neutrophils, pulmonary function index and blood gas analysis were worse. PCT was slightly positively correlated with the proportion of neutrophils and CRP, and had no significant correlation with other indexes. Logistic regression analysis showed that PCT,CRP and PaCO2 were the independent risk factors for AECOPD patients with(P values were less than 0.05). The cutoff values of PCT, CRP and PaCO2 were analyzed by using the area under the curve(ROC) of the subjects. The sensitivity of PCT was the highest in the three, and the specificity was not the best. The cutoff value of PCT was 0.1 ng/ml with the ROC curve. According to the Anthonisen score, the PCT values of the groups were significantly higher than those in the 1 groups, and the 2 groups were significantly higher than those in group 3.Conclusion: It was confirmed by this experiment that serum calcitonin was an independent risk factor for the application of noninvasive ventilator in AECOPD patients, and it could be used as a reference index for noninvasive ventilator. In clinical practice, the PCT is more than 0.1ng/ml and it is a reminder that we have no invasive ventilator as soon as possible.