重症肺炎患者copeptin与病情严重性、预后及应激性高血糖的关系

Correlation between copeptin and the disease severity, outcome and stress hyperglycemia in severe pneumonia patients

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.