老年慢性心力衰竭患者肺部感染后血清胆碱酯酶和胱抑素C及炎症因子分析

Relationship between serum cholinesterase,cystatin C,inflammation and prognosis in elderly patients with chronic heart failure accompanying pulmonary infection

目的探讨老年慢性心力衰竭伴肺部感染患者血清胆碱酯酶(CHE)、胱抑素C(Cys C)、炎症因子与预后的关系。方法选取2017年1-8月医院收治的慢性心力衰竭伴肺部感染患者100例设为感染组,选取100例单纯慢性心力衰竭患者为无感染组,入院后检测血清CHE、Cys C和C-反应蛋白(CRP)、B型脑钠肽(BNP)水平,观察患者住院期间及随访出院后3个月内不良心脏事件(Major Adverse Cardiovascular Events,MACE)发生情况。结果感染组患者Cys C、PCT、CRP、BNP分别为(1.98±1.62)mg/dl、(1.71±0.72)mg/ml、(34.89±11.27)、mg/L、(6 731.60±2 348.55)ng/L均高于无感染组,血清CHE为(3 833.81±2 155.23)U/L低于无感染组(P <0.001);感染组预后不良率为36.00%(36/100)高于无感染组(P=0.019);感染组预后良好患者Cys C、PCT、CRP、BNP分别为(1.32±1.03)mg/dl、(1.45±0.67)mg/ml、(24.62±10.41)mg/L、(5 742.57±2 056.14)ng/L低于预后不良患者,血清CHE为(5 234.33±2 345.67)高于预后不良患者(P<0.05);无感染组预后良好患者Cys C、PCT、CRP、BNP分别为(1.01±0.58)mg/dl、(0.35±0.17)mg/ml、(8.34±5.21)mg/L、(1 878.44±1 634.83)ng/L低于预后不良患者,血清CHE为(6 224.33±2 215.47)U/L高于预后不良患者(P<0.05)。结论老年慢性心力衰竭伴肺部感染患者血清CHE降低,Cys C与炎症指标升高,预后不良患者各指标变化更为明显,具有一定的临床价值。

OBJECTIVE To explore the relationship between serum cholinesterase(CHE),cystatin C(Cys C),inflammatory factors and prognosis in elderly patients with chronic heart failure accompanying pulmonary infection.METHODS We included 100 cases of elderly patients with chronic heart failure accompanying pulmonary infection admitted to the hospital from Jan.2017 to Aug.2017 as the infected group,and 100 cases of elderly patients with chronic heart failure as the uninfected group.The CHE,Cys C,procalcitonin(PCT),C-reactive protein(CRP),and B-type natriuretic peptide(BNP)levels were measured at admission in both groups.The incidence of major adverse cardiac events(MACE)occurred during hospital stay and within 3 months after discharge was observed in both groups.RESULTS Cys C,PCT,CRP and BNP of the infected group were(1.98±1.62)mg/dl,(1.71±0.72)mg/ml,(34.89±11.27)mg/L,and(6 731.60±2 348.55)ng/L,higher than those of the uninfected group.CHE of the infected group was(3 833.81±2 155.23)U/L,significantly lower than that of the uninfected group(P <0.001).There were 36 patients with poor prognosis in the infected group(36.00%),the incidence was significantly higher than that of the uninfected group(P=0.019).Cys C was(1.32±1.03)mg/dl,PCT was(1.45±0.67)mg/ml,CRP was(24.62±10.41)mg/L,BNP was(5 742.57±2 056.14)ng/L in the patients with good prognosis of the infected group,significantly lower than those in the patients with poor prognosis,whereas the serum CHE of(5 234.33±2 345.67)U/L in infected patients with good prognosis was significantly higher than that in the infected patients with poor prognosis(P<0.05).Cys C was(1.01±0.58)mg/dl,PCT was(0.35±0.17)mg/ml,CRP was(8.34±5.21)mg/L,BNP was(1 878.44±1 634.83)ng/L in patients with good prognosis of the uninfected group,significantly lower than those in the patients with poor prognosis(P<0.05),whereas the serum CHE of(6 224.33±2 215.47)U/L in uninfected patients with good prognosis was significantly higher than that in the uninfected patients with poor prognosis(P<0.05).CONCLUSION The serum CHE level obviously decreases in elderly patients with chronic heart failure accompanying pulmonary infection,Cys C and inflammatory cytokines significantly increase,and the changes of the above indicators are more obvious in patients with poor prognosis,indicating a certain value of these indicators.