急性肺损伤患者血清及肺泡灌洗液和肽素水平变化的临床分析

Clinical analysis on changes of copeptin 1evels in serum and bronchoalveolar lavage fluid in patients with acute lung injury

目的观察血清及支气管肺泡灌洗液(BALF)和肽素的变化与急性肺损伤(ALI)患者病情及预后的关系。方法采用ELISA法,测定57例ALI患者血清及BALF的和肽素水平,选择健康体检者32名作为血清对照组(A组),14名BALF检查无异常的就诊者作为BALF对照组(B组);ALI患者分为直接和间接肺损伤亚组、轻中度和重度肺损伤亚组、多器官功能障碍综合征(MODS)亚组和非MODS亚组、28d存活亚组和死亡亚组,同时将其和肽素表达水平与急性病生理学和长期健康评价(APACHE)Ⅱ评分、肺损伤评分(LIS)、氧合指数(PaO2/FiO2)进行相关性分析;监测ALI患者确诊第1、3、5、7天血清和肽素水平及第1、7天的BALF和肽素水平。结果 ALI患者血清及BALF的和肽素水平明显高于A、B组(P均<0.01),直接肺损伤亚组血清和肽素水平与间接肺损伤组无统计学差异(P>0.05),直接肺损伤亚组的BALF和肽素水平明显高于间接肺损伤亚组(P<0.01);重度肺损伤亚组和MODS亚组的血清和BALF的和肽素水平明显高于轻中度肺损伤亚组和非MODS亚组(P<0.01),死亡亚组血清第l、3、5、7天和肽素水平及第1、7天的BALF和肽素水平明显高于存活亚组(P<0.01);血清和肽素变化与BALF和肽素水平、LIS评分、PaO2/FiO2呈正相关(r=0.712,P<0.01;r=0.305,P<0.05;r=0.435,P<0.01),与起始APACHEⅡ评分无相关性(r=0.007,P>0.05)。结论血清及BALF和肽素水平与肺损伤严重程度具有相关性,可有效评价ALI患者病情及预后。

Objective To study the changes of copeptin levels in serum and bronchoalveolar lavage fluid （BALF） in patients with acute lung injury （ALl）, and explore their correlation with the severity of ALl and its prognosis. Methods The levels of copeptin in serum and BALF were detected in 57 patients with ALI by enzyme-linked immunosorbent assay. Thirty-two healthy volunteers were enrolled as serum control group （group A） and 14 patients with normal BALF findings as BALF control group （group B）. All the 57 ALl patients were divided into direct ALl and indirect ALl subgroups, mild-to-moderate lung injury and severe lung injury subgroups in accordance with different scoring standards. They were further classified into multiple organ dysfunction syndrome （MODS） and non-MODS subgroups, and were followed up for 28 days and then assigned to survival and non-survival subgroups. The correlations of copeptin expression with acute physiology and chronic health evaluation （APACHE） Ⅱ score, lung injury score （LIS）, and oxygenation index （PaO2/FiO2） were also analyzed. All the patients were measured serum copeptin levels on 1st, 3rd, 5th and 7th d and copeptin levels in BALF on the 1st and 7th d. Results The levels of copeptin in serum and BALF in all the patients were significantly higher than the group A and B （all P〈0.01）. In the direct ALI subgroup, no significant difference was found in the serum copeptin levels as compared to the indirect ALI subgroup （P〉0.05）, while the BALF copeptin levels were much higher （P〈0.01）. The copeptin levels in serum and BALF in the severe lung injury and MODS subgroups were significantly higher than the mild-to-moderate lung injury and non-MODS subgroups （all P〈0.01）. In the non-survival subgroup, the serum copeptin levels on the 1st, 3rd, 5th and 7th d and the BALF copeptin levels on the 1st and 7th d were significantly increased as compared to the survival subgroup （all P〈0.01）. Serum copeptin levels were positively correlated with the BALF copeptin levels, LIS, and PaO2/FiO2 （r=0.712, P〈0.01; r=0.305, P〈0.05; r=0.435, P〈0.01, respectively）. However, the serum copeptin levels bore no relation to APACHE Ⅱ score at the onset of ALI in all the ALI patients （r=0.007, P〉0.05）. Conclusion The levels of copeptin in serum and BALF are associated with the severity of lung injury, and they can effectively evaluate pathogenesis and prognosis of patients with ALl.