社区获得性肺炎老年患者血清合肽素测定的意义

Clinical significance of serum copeptin in elderly patients with community-acquired pneumonia

目的 探讨社区获得性肺炎(CAP)老年患者血清合肽素的临床意义.方法 收集河南省人民医院呼吸科病房2009年1月至12月入院的68例年龄>65岁的CAP患者,男36例,女32例,平均年龄(70±5)岁;对照组为年龄>65岁的30名健康体检者,男15名,女15名,平均年龄(68±3)岁.68例CAP患者诊断依据及入院治疗标准符合中华医学会呼吸病学分会制定的'社区获得性肺炎诊断和治疗指南'.按肺炎严重指数(PSI)将患者分为:Ⅰ～Ⅲ级组25例,Ⅳ级组23例,Ⅴ级组20例.测定肺炎患者治疗前后及对照组的血清合肽素、血常规、血清超敏C反应蛋白、动脉血氧饱和度(PaO2)及氧合指数(PaO2/FiO2),比较四组相关数值的差异.组间比较采用q检验,治疗前后的比较采用组内配对t检验.结果 治疗前V级肺炎患者血清合肽素为(1.25±0.18)μg/L,明显高于Ⅳ级肺炎患者的(0.76±0.16)μg/L;Ⅰ～Ⅲ级肺炎患者的(0.38±0.08)μg/L及对照组的(0.12±0.02)μg/L;治疗后V级、Ⅳ级、Ⅰ～Ⅲ级肺炎患者血清合肽素分别为(0.18±0.06)μg/L、(0.11±0.05)μg/L和(0.08±0.02)μg/L,均较治疗前显著降低.治疗前肺炎患者血清超敏C反应蛋白、白细胞总数均明显高于对照组,治疗后明显下降.治疗前V级肺炎患者PaO2、PaO2/FiO2均明显低于Ⅳ级、Ⅰ～Ⅲ级肺炎患者及对照组,治疗后明显升高.结论 血清合肽素可作为判断社区获得性肺炎老年患者治疗疗效的一项指标.

Objective To study the clinical significance of serum copeptin in elderly patients with community-acquired pneumonia (CAP). Methods Sixty-eight cases of hospitalized CAP including 36 males and 32 females with a mean age of (70±5) years were recruited from the respiratory wards in the Henan province hospital from January 2009 to December 2009.Thirty healthy volunteers including 15 males and 15 females with a mean age of (68±3) years served as the control.The CAP patients were divided into 3 groups: grade Ⅰ-Ⅲ(n=25),grade Ⅳ(n=23) and grade Ⅴ(n=20) according to pneumonia severity index (PIS). Results Serum copeptin concentration of the grade Ⅴ patients [(1.25±0.18)μg/L] was significantly higher than those of the grade Ⅳ patients [(0.76±0.16) μg/L], grade Ⅰ-Ⅲ patients [(0.38±0.08) μg/L] and the control group[(0.12±0.02) μg/L] before the treatment.Serum copeptin concentration of the grade Ⅴ patients [(0.18±0.06) μg/L],grade Ⅳ patients [(0.11±0.05) μg/L],and grade Ⅰ-Ⅲ patients [(0.08±0.02) μg/L] after the treatment were significantly lower than those before the treatment.Serum high-sensitivity C-reactive protein and the total number of while blood cells of the patients with CAP were significantly higher than those of the control group before the treatment. Serum high-sensitivity C-reactive protein and total number of while blood cells of the patients with CAP were significantly decreased after the treatment.PaO2/FiO2 of the grade Ⅴ patients were significantly lower than of the grade Ⅳpatients, grade Ⅰ-Ⅲ patients and the control group before the treatment, and were significantly increased after the treatment. Conclusions Serum copeptin could be used as an inflammatory marker for judging the treatment efficacy in elderly patients with CAP.