下呼吸道感染患者血浆和肽素和降钙素原水平变化及其临床意义研究

Changes and Clinical Significances of Plasma Levels of Copeptin and Procalcition in Patients with Lower Respiratory Tract Infections

目的探讨下呼吸道感染(LRTI)患者血浆和肽素和降钙素原(PCT)水平变化及其临床意义。方法选取2007年12月—2008年8月于中国医科大学附属第一医院呼吸内科住院的LRTI患者45例作为LRTI组,门诊确诊的稳定期慢性阻塞性肺疾病(COPD)患者16例作为COPD组,体检中心体检健康者14例作为健康对照组。采用酶联免疫吸附试验(ELISA)检测3组受试者血浆和肽素和PCT水平,比较各组受试者血浆和肽素和PCT水平,分析LRTI患者血浆和肽素和PCT水平与CURB-65评分及痰培养结果的关系。结果 LRTI组和COPD组患者血浆和肽素水平高于健康对照组,LRTI组高于COPD组(P<0.01)。LRTI组患者血浆PCT水平高于健康对照组和COPD组(P<0.01)。慢性阻塞性肺疾病急性加重(AECOPD)患者血浆和肽素、PCT水平高于COPD患者(P<0.05)。直线相关分析结果显示,血浆和肽素和PCT水平与CURB-65评分均呈正相关(r值分别为0.425、0.631,P<0.05)。根据痰培养结果将LRTI患者分为痰培养阳性组14例和痰培养阴性组31例,痰培养阳性组患者血浆PCT水平高于痰培养阴性组(P<0.0l);但两亚组患者血浆和肽素水平比较,差异无统计学意义(P>0.05)。不同血浆PCT水平患者痰培养阳性率比较,差异有统计学意义(P<0.001)。结论 LRTI患者血浆和肽素和PCT水平明显升高,检测血浆和肽素和PCT水平有助于评估LRTI严重程度,血浆PCT水平可作为LRTI细菌感染的辅助诊断指标。

Objective To explore the changes and clinical significances of plasma levels of copeptin and procalcition of patients with lower respiratory tract infections. Methods From December 2007 to August 2008 in the First Affiliated Hospital of China Medical University,45 in-patients with lower respiratory tract infections were selected as A group in the Department of Respiratory Medicine,16 COPD patients were selected as B group in the Department of Outpatient Clinic,14 healthy cases were selected as control group in the Physical Examination Center. ELISA was used to detect the plasma levels of copeptin and procalcition,and their correlations with CURB-65 score and sputum culture results were analyzed. Results Plasma copeptin level of groups A and B was statistically significantly higher than that of control group,respectively,and that of A group was statistically significantly higher than that of B group （ P ﹤ 0. 01 ）. Plasma procalcition level of A group was statistically significantly higher than that of B group and control group,respectively（P﹤0. 01）. Plasma levels of copeptin and procalcition of patients with AECOPD were statistically significantly higher than those of patients with COPD（P﹤0. 05）. Linear correlation analysis showed that,plasma levels of copeptin and procalcition were positively correlated with CURB-65 score（ r=0. 425,0. 631,P﹤0. 05）. Of the 45 patients with lower respiratory tract infections,14 cases occurred positive culture results（ A subgroup）,31 cases did not（ B subgroup）,plasma procalcition level of A subgroup was statistically significantly higher than that of B subgroup（P﹤0. 05）,but no statistically significant differences of plasma copeptin levels was found between the two subgroups（P﹥0. 05）. There was statistically significantly difference of sputum culture positive rate in patients with different plasma procalcition levels （ P ﹤ 0. 001 ）. Conclusion Plasma levels of copeptin and procalcition of patients with lower respiratory tract infections are significantly increased,and the detection of them is helpful to judge the severity of lower respiratory tract infections;plasma procalcition level can be used as an assistant diagnosis index for bacterial infection in patients with lower respiratory tract infections.