肺炎合并全身炎性反应综合征患者CRP、NT-proBNP水平变化研究

Research on changes of CRP and NT-proBNP levels in patients with pneumonia complicating systemic inflammatory response

目的观察肺炎合并与未合并全身炎性反应综合征(SIRS)患者C反应蛋白(CRP)、N-末端脑钠肽前体(NT-proBNP)水平变化情况及临床意义。方法选取2012年9月至2014年2月该院呼吸科收治的肺炎患者60例以及本院同期健康体检者30例,按照是否合并SIRS,分为SIRS组30例,非SIRS组30例以及健康体检组(对照组)30例。全部患者均于入院时抽取静脉血,采用酶联免疫吸附法(ELISA)测定2组患者的血清CRP、NT-proBNP水平,并行肺炎严重指数评分,以住院最后1d资料判断多系统器官功能衰竭(MSOF)。结果入院24h血糖、CRP以及NT-proBNP水平比较,SIRS组明显高于非SIRS组与对照组(P<0.01),而非SIRS组与对照组比较差异无统计学意义(P>0.05),CRP水平明显高于对照组(P<0.01);肺炎患者NT-proBNP水平与患者体温、心率、CO2分压、中性粒细胞分数、肺炎严重度指数(PSI)评分密切相关。结论患者血糖和CRP水平与肺炎严重程度密切相关,临床上联合应用CRP和血糖这2项指标对于判断肺炎的转归和疗效具有一定的意义;合并有SIRS的患者NTproBNP水平明显超过普通肺炎患者和健康者,可依据NT-proBNP的水平对肺炎是否合并有SIRS加以区分,临床意义重大。

Objective To observe the changes of C-reactive protein（CRP） and N terminal pro-brain natriuretic peptide（NT-proBNP） levels and their clinical significance in the patients with pneumonia complicating systemic in flammatory response（SIRS）. Methods 60 cases of pneumonia in the respiration department of our hospital were se lected and divided into the pneumonia complicating systemic inflammatory response group（SIRS group,30 cases） and the non-complicating systemic inflammatory response group（non-SIRS group, 30 cases） according to whether compli- cating systemic inflammatory response. Contemporaneous 30 individuals undergoing the physical health examination were selected as the control group. The venous blood sample was collected at admission in all the patients and the ser um CRP and NT-proBNP levels were detected by using enzyme-linked immunosorbent assay （ELISA）, the pneumoni a severity index score was evaluated and the multiple systemic organ failure（MSOF） was judged according to the data on last day of hospitalization. Results The blood glucose within 24 h after admission,CRP and NT-proBNP levels in the SIRS group were significantly higher than those in the nowSIRS group and the control group （P〈0.01）, while which had no statistical differences between the non-SIRS group and the control group （P〉0.05） ;the CRP level in the SIRS group was significantly higher than that in the control group （P〈0.01） ;the NT-proBNP level in the pa- tients with pneumonia was closely related with the body temperature,heart rate, CO2 partial pressure, neutrophil frac- tion and PSI score. Conclusion The blood glucose and CRP levels in the patients with pneumonia are closely associ- ated with the pneumonia severity,the clinical combined application of CRP and blood glucose has certain significance for judging the pneumonia outcome and curative effect; the NT-proBNP level in the patienrs, with complicating SIRS is significantly higher than that in the patients with ordinary pneumonia and healthy people. Therefore, pneumonia whether complicating SIRS could be distinguished according to the NT proBNP level, which showing important sig- nificance.