pro-AVP和pro-ADM对社区获得性肺炎严重度及预后的预测价值

The Value of Pro-AVP and Pro-ADM for Severity Assessment and Outcome Prediction in Patients with Community Acquired Pneumonia

目的评价血管加压素原(pro-AVP/CPP)和肾上腺髓质素原(pro-ADM)水平对社区获得性肺炎(CAP)患者严重程度评估和预后预测的价值。方法采用前瞻性分析方法,203例CAP患者的临床资料及基础病史,利用肺炎严重指数(PSI)进行肺炎严重度评价,同时收集其血浆,采用酶联免疫吸附测定(ELISA)对pro-AVP、pro-ADM及降钙素原(PCT),同时检测C反应蛋白(CRP),根据不同的PSI评分分组,比较各组pro-AVP及pro-ADM浓度和PCT、CRP水平变化。结果患者血浆pro-AVP、pro-ADM及PCT水平随着患者PSI分级水平升高而升高,而CRP水平随患者PSI分级水平升高而升高的趋势不明显;研究结束时共有168例患者存活,死亡35例(17.2%),死亡病例患者血浆pro-AVP、pro-ADM、PCT及CRP水平均升高,差异有统计学意义(P<0.05);各级CAP患者的PSI评分均与pro-AVP、pro-ADM水平呈显著的正相关(P<0.05)。结论 pro-AVP和pro-ADM可以作为CAP患者严重程度分层和预后的生物标志物。

Objective To evaluate the value of pro-vasopressin （pro-AVP） and pro-adrenomedullin （pro-ADM） for severity assessment and outcome prediction in patients with community acquired pneumonia （CAP）. Methods 203 patients with CAP were enrolled for this prospective study.Levels of pro-AVP, pro-ADM, procalcitonin （PCT） and C- reactive protein（CRP） were detected by enzyme-linked immuno-sorbent assay （ELISA）. All clinical variables and the pneumonia severity index （PSI） were recorded.Data was analyzed based on different groups which were divided by PSI score. Results Levels of pro-AVP, pro-ADM and PCT were positively correlated with PSI score while there was no such correlation between CRP levels and PSI score. At the end of the study there were totally 168 patients survived while there were 35 cases of death （17.2%）. In patients who didn＇t survive,levels of pro-AVP,pro-ADM,PCT and CRP were significantly higher than those of survivors （P〈0.05）. All CAP patients＇ PSI score showed significant positive correlation with plasma pro-AVP and pro-ADM levels （P〈0.05）. Conclusion Levels of pro-AVP and pro-ADM could be considered as a valuable marker for the severity assessment and outcome prediction for patients with CAP.