摘要
目的探讨copeptin与重症肺炎患者应激性高血糖、病情严重程度以及预后的关系。方法采用前瞻性观察研究,入选45例重症肺炎患者。入院时采集静脉血标本检测copeptin。记录入ICU时血气分析、CRP、血糖、APACHEⅡ值等基本资料;对血糖≥10.0mmol/L给予胰岛素治疗,记录24h短效胰岛素总量;随访患者28d后的生存情况。结果患者入院时copeptin和APACHEⅡ正相关(r=0.481,P=0.001);死亡组较存活组copeptin水平(pmol/L)明显升高(75.18±30.42郴.52.78±22.82,P=0.007);入院时copeptin和血糖呈正相关(r=0.417,P=0.004);需要胰岛素治疗者,入院时copeptin和24h胰岛素总量正相关(r=0.556,P=0.009);多因素COX回归分析示copeptin是28d死亡独立危险因素(P=0.005,OR=1.022,95%CI:1.00—1.044);ROC曲线下面积为0.7409(P=0.006)。结论重症肺炎患者copeptin和APACHEⅡ、应激性高血糖呈正相关,反映病情严重程度、应激性高血糖控制的难易程度,可以预测患者预后。
Objective To study the changes of plasma copeptin level in pneumonia patients and to explore the correlation between copeptin and disease severity, outcome as well as stress hyperglycemia. Methods A total of 45 patients with severe pneumonia were included in a prosPective observation. The plasma levels of copeptin, CRP and blood glucose were measured after admission, and the APACHE Ⅱ scores were recorded within 24 hours. The patients were given insulin therapy by intravenous micro-dosage pump, and the total doses of insulin were recorded. All the patients with 28-day survival were followed up. Results The plasma levels of copeptin of severe pneumonia patients after admission were positively correlated with APACHE Ⅱ ( r = 0. 481, P = 0. 001 ) and blood glucose ( r = 0. 417, P = 0. 004), and were also correlated with the total insulin doses in patients under insulin therapy ( blood glucose≥ 10. 0 mmol/L). The plasma levels of copeptin of the survival group were significanatly higher than the non- survival group, COX regression multivariate analysis showed that copeptin was an independent risk factor of death in severe pneumonia patients ( P = 0. 005, OR = 1. 022, 95% CI: 1.00 - 1. 044), and the area under the ROC curve was 0. 740 9 ( P = 0. 006 ). Conclusion The plasma levels in all patients with copeptin of severe pneumonia after admission is positively correlated with APACHEⅡ and stresshyperglycemia, suggesting a useful approach to the judgment of disease severity, outcome and glucose control.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2016年第3期338-342,共5页
Chinese Journal of Emergency Medicine