社区获得性肺炎患儿血浆和肽素水平改变及其意义

The Changes of Plasma Copeptin Levels in Children with Community- acquired Pneumonia and Its Significance

目的通过观察社区获得性肺炎（CAP）患儿体内血浆和肽素（Copeptin）水平的改变，探讨其临床意义。方法入选住院CAP患儿46例，其中普通CAP30例，重症16例；同时选健康儿童30例作为正常对照组。检测CAP患儿入院诊断时和对照组血浆中Copeptin、白细胞（WBC）及中性粒细胞（N）计数、C反应蛋白（CRP）、降钙素原（PCT）及血清钠水平。结果CAP患儿（包括普通和重症病例）血浆Copeptin均显著高于对照组（P〈0．01），同时普通和重症CAP间也有统计学意义（P〈0．05）；而各组间CRP及血清钠水平则无统计学意义差异（P〉0．05），WBC、N及PCT在普通和重症组间无统计学意义差异（P〉0．05）。且血浆中Copeptin水平与WBC、N、CRP及血清钠无显著相关性。受试者工作特征曲线（ROC曲线）分析显示血浆Copeptin水平对诊断重症CAP有一定诊断效能（曲线下面积=0．753，95％CI：0．605～0．902，P=0．005）；以Copeptin〉0．92ng／mL为界点，对诊断重症CAP有50％的敏感度和86．67％的特异度。结论测定CAP患儿体内血浆Copeptin或有助于判断CAP的病情及其严重程度，但仍需更深入的研究。

Objective To investigate clinical significances through observing the changes of plasma copeptin levels in children with community -acquired pneumonia （CAP）. Methods 46 hospitalized children with CAP were selected, in- cluding 30 cases with common pnemnonia （common group） and 16 severe ones （severe group） , meanwhile, 30 healthy chil- dren were enrolled as normal control group. Plasma copetin level, white blood cell （ WBC ） and neutrophil （N） count, plas- ma levels of C - reactive protein （CRP） , procalcitonin （PCT） and serum sodium level were detected in the CAP children and normal children. Results Plasma copeptin levels in the common and severe groups were significantly higher than the control group （P 〈 0. 01 ） and the differences were significant between common and severe cases （P 〈0. 05 ） , and no statistical sig- nificant difference was found in CRP and serum sodium levels （ P 〉 0. 05 ） among the groups. No significant differences were found in WBC, N and PCT between the common and severe groups. There was no significant correlation between plasma co- petin level and other indicators. Receiver operating characteristic （ROC） curve analysis showed that plasma copetin possesses diagnostic value for intensive CAP （ area under curve = 0. 753, 95% CI：0. 605 - 0. 902, P = 0. 005 ）. The sensitivity and specificity of the diagnosis for the severe cases were 50% and 86.67% , respectively when copeptin 〉 0. 92 ng/mL was taken as boundary point. Conclusion Determination of plasma copetin of children with CAP may contribute to the diagnosis and e- valuation of severity of CAP, but further research is still needed.