社区获得性肺炎严重程度及预后与肾上腺皮质功能的相关性

Correlation study on severity and prognosis of patients with community-acquired pneumonia to their adrenal function

目的 通过探讨肾上腺皮质功能与社区获得性肺炎的严重程度、预后的相关性,评价其临床病情判断的价值.方法 将2011年4月至2012年5月收住我院并达研究标准的72例社区获得性肺炎患者,按肺炎严重度指数（PSI）分为低危组（n=30例）和高危组（n=42例）.采用化学发光免疫法检测每组患者血清中皮质醇和促肾上腺皮质激素（ACTH）的浓度.分析比较两组血清中皮质醇和ACTH的浓度及二者与PSI和患者病死情况相关性.结果 高危组患者血清中的皮质醇、ACTH浓度和PSI评分均显著高于低危组（P〈0.05）;PSI评分与血清皮质醇、ACTH浓度显著正相关（r分别为0.291和0.281,P＜0.05）;ROC曲线分析表明,住院患者病死情况与血清皮质醇浓度下面积为0.843（95%可性度区间为0.754～0.943）;与血清ACTH浓度曲线下面积为0.707（95%可性度区间为0.551～0.863）.结论 血清皮质醇、ACTH浓度与肺炎的严重程度均有较强的相关性,可作为判断社区获得性肺炎病情严重程度及预后的有效评估指标.

Objective To investigate the correlation of severity and prognosis of patients with community-ac- quired pneumonia （CAP） to their adrenal function. Methods 72 CAP patients were divided into the low risk group （ n = 40） and the high risk group （ n = 32） according to pneumonia severity index （PSI）. The concentration of serum cortisol and ACTH were compared. The correlations among them were investigated as well. Results The concentra- tion of serum cortisol, ACTH and PSI in the high risk group were all significantly higher than those in the low risk group （P 〈 0.05）. The concentration of serum cortisol and ACTH was positively correlated with PSI （r = 0. 291 and 0. 281 respectively, P 〈0. 05）. Analysis indicated that the area under the receiver operating characteristic （ROC） curves was 0. 843 （95% Cl 0.754-0. 943） for serum cortisol and the number of death in hospital, and 0. 707 （95% Cl0. 5514）. 863） for ACTH. Conclusion Serum eortisol and ACTH are closely related to the severity of CAP, which may be the effective parameters in the assessment of the severity and prognosis of CAP.