血清Copeptin、hs-CRP及IL-6水平在老年慢性肺源性心脏病患者中的表达及其临床意义

Expression and clinical significance of serum Copeptin, hs-CRP and IL-6 levels in elderly patients with chronic pulmonary heart disease

目的探讨血清和肽素(Copeptin)、超敏C反应蛋白(hs-CRP)及白细胞介素-6(IL-6)水平在老年慢性肺源性心脏病(CPHD)患者中的表达及预后评估价值。方法选取2013年1月至2016年9月海南省第三人民医院收治的老年CPHD患者168例作为CPHD组,同时期健康体检者150例作为对照组,根据患者住院期间及出院24 h内是否死亡,将其分为死亡组31例和存活组137例。比较死亡组和存活组患者第0天、第3天、第7天血清Copeptin、hs-CRP及IL-6水平的动态变化,应用单因素及多因素Logistic回归分析影响老年CPHD患者死亡的危险因素。绘制ROC曲线评估各指标预测老年CPHD患者死亡的效能,相关性分析采用Pearson相关分析。结果 CPHD组患者第0天、第3天、第7天血清Copeptin、hs-CRP及IL-6水平均明显高于对照组,差异均有显著统计学意义(P<0.01),且CPHD组患者第7天的血清Copeptin、hs-CRP及IL-6水平均明显高于第0天和第3天,差异均有统计学意义(P<0.05);死亡组患者第0天、第3天、第7天的血清Copeptin、hs-CRP及IL-6水平均明显高于存活组,且随着住院时间的延长,存活组各指标水平逐渐下降,死亡组各指标水平逐渐升高,差异均有统计学意义(P<0.05);多元Logistic回归分析显示,Copeptin、hs-CRP及IL-6是老年CPHD患者死亡的独立危险因素。ROC曲线显示,第0天血清Copeptin、hs-CRP及IL-6水平及三项联合预测老年CPHD患者死亡的AUC及95%CI分别为0.824(0.761~0.893)、0.805(0.738~0.862)、0.773(0.702~0.839)、0.872(0.793~0.942),其中三项联合对预测老年CPHD患者死亡的敏感度和特异度最好,分别为90.2%和82.4%。相关性分析显示,死亡患者第0天、第3天、第7天血清Copeptin与hs-CRP及IL-6水平均呈正相关(P<0.05)。结论血清Copeptin、hs-CRP及IL-6水平在老年CPHD患者中明显升高,三项联合检测对预测老年CPHD患者的预后具有较好的价值。

Objective To investigate the expression and prognostic value of serum Copeptin, high sensitivity C reactive protein（hs-CRP） and interleukin-6（IL-6） in elderly patients with chronic pulmonary heart disease（CPHD）.Methods A total of 168 elderly patients with CPHD in the Third People＇s Hospital of Hainan Province from January2013 to September 2016 were selected as CPHD group, and 150 healthy subjects were taken as control group. The CPHD patients were divided into death group（31 cases） and survival group（137 cases） according to their death during hospitalization and within 24 hours after discharge. The dynamic changes of serum Copeptin, hs-CRP and IL-6 levels of patients at day 0, day 3, day 7 in two groups were compared. Univariate and multivariate logistic regression analysis were used to analyze the risk factors of death in elderly patients with CPHD. ROC curve was used to evaluate the effectiveness of each index to predict the mortality of elderly patients with CPHD, and the correlation analysis was performed by Pearson correlation analysis. Results The serum Copeptin, hs-CRP and IL-6 levels at day 0, day 3, day 7 in CPHD group were significantly higher than those of the control group（P〈0.01）. The serum Copeptin, hs-CRP and IL-6 levels at day 7 in CPHD group were significantly higher than those at day 0, day 3（P〈0.05）. The serum Copeptin, hs-CRP and IL-6 levels at day0, day 3, day 7 in death group were significantly higher than those in survival group, and with the prolonging of hospitalization duration, the indexes levels decreased in survival group and increased gradually in death group（P〈0.05）. Univariate and multivariate logistic regression analysis showed that Copeptin, hs-CRP and IL-6 were independent risk factors for death in elderly patients with CPHD. The ROC curve showed that the area under the curve（AUC） and 95%CI of serum Copeptin, hs-CRP, IL-6, and joint detection for prediction of mortality in elderly patients with CPHD at day 0 were respectively 0.824（0.761-0.893）, 0.805（0.738-0.862）, 0.773（0.702-0.839）, 0.872（0.793-0.942）. Joint detection had the highest sensitivity and specificity, which were 90.2% and 82.4%. Correlation analysis showed that serum Copeptin were positively correlated with hs-CRP and IL-6 levels at day 0, day 3, day 7（P〈0.05）. Conclusion The levels of serum Copeptin, hs-CRP and IL-6 are significantly increased in elderly patients with CPHD, and the combined detection of the three indexes has good value in predicting the prognosis of elderly patients with CPHD.