血浆和肽素与重症肺炎患儿病情严重性及预后相关性
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摘要
目的探讨血浆和肽素与重症肺炎患儿病情严重性及预后相关性。方法选取2015年1月～2016年1月我院收治的肺炎患儿225例,分为重症肺炎组(103例)和普通肺炎组(122例),重症肺炎患儿中死亡10例(死亡组),存活93例(存活组),选取同期80例正常体检儿童为对照组,回顾性分析所有纳入者的临床资料,记录并比较纳入者一般资料和血浆和肽素、C-反应蛋白(CRP)及降钙素原(PCT)等临床指标水平,分析不同临床指标评估重症肺炎患儿病情和预后的灵敏度和特异度。结果肺炎患儿其血浆和肽素、CRP、PCT、白细胞(WBC)水平及中性粒细胞(NEU)百分比均显著高于对照组(P<0.05),重症肺炎患儿其血浆和肽素、CRP和PCT水平较普通肺炎明显升高(P<0.05);重症肺炎患儿中死亡组血浆和肽素、CRP和PCT水平显著高于存活组(P<0.05),而两者在WBC水平及NEU百分比上比较无差异(P>0.05);血清和肽素评估重症肺炎患儿其病情及预后的灵敏度和特异度均显著高于CRP和PCT评估重症肺炎患儿其病情和预后的特异度和灵敏度(P<0.05)。结论重症肺炎患儿其血清和肽素水平显著高于普通肺炎和正常体检者,且血清和肽素在评估重症肺炎患儿病情和预后上具有较好的灵敏度和特异度,有较高的预测价值,值得临床借鉴。
Objective To investigate the correlation of plasma copeptin and illness severity and prognosis in children with severe pneumonia. Methods 225 patients with pneumonia and 80 healthy children in our hospital from Jan. 2015 to Jan. 2016 were selected as the study objects. They were retrospectively analyzed and divided into severe pneumonia children(103 cases) and common pneumonia children(122 cases). The severe pneumonia children were divided into death group(10 cases) and survival group(93 cases). The gender, age, plasma Copeptin, CRP and PCT indexes of patients were recorded. The differences of the above data were compared. The sensitivity and specificity of different clinical indexes in the evaluation of illness severity, prognosis were analyzed. Results The levels of plasma copeptin, CRP, PCT, WBC and NEU percentage in severe pneumonia children and common pneumonia children were significantly higher than those in normal children. The severe pneumonia children had higher levels of plasma Copeptin, CRP, PCT, the difference was statistic significant(P<0.05). The levels of plasma copeptin, CRP, PCT in died children were significantly higher than those in survival children(P<0.05), but there was no statistic significance in the WBC level and NEU percentage between the two groups(P>0.05). The non-conditional Logistic regression analysis showed that, higher levels of plasma copeptin, CRP, PCT were independent risk factors of severe pneumonia(P<0.05). The higher copeptin level, the larger influence was. Conclusion The serum copeptin level in severe pneumonia children is significantly higher than that in common pneumonia children and normal physical examinees. With the aggravated illness condition, the serum copeptin level increased gradually. The serum copeptin combined with CRP and PCT are independent risk factors of death in severe pneumonia children, and which can be seen as one of the effective indexes in the prognosis in severe pneumonia children.
Objective To investigate the correlation of plasma copeptin and illness severity and prognosis in children with severe pneumonia. Methods 225 patients with pneumonia and 80 healthy children in our hospital from Jan. 2015 to Jan. 2016 were selected as the study objects. They were retrospectively analyzed and divided into severe pneumonia children(103 cases) and common pneumonia children(122 cases). The severe pneumonia children were divided into death group(10 cases) and survival group(93 cases). The gender, age, plasma Copeptin, CRP and PCT indexes of patients were recorded. The differences of the above data were compared. The sensitivity and specificity of different clinical indexes in the evaluation of illness severity, prognosis were analyzed. Results The levels of plasma copeptin, CRP, PCT, WBC and NEU percentage in severe pneumonia children and common pneumonia children were significantly higher than those in normal children. The severe pneumonia children had higher levels of plasma Copeptin, CRP, PCT, the difference was statistic significant(P<0.05). The levels of plasma copeptin, CRP, PCT in died children were significantly higher than those in survival children(P<0.05), but there was no statistic significance in the WBC level and NEU percentage between the two groups(P>0.05). The non-conditional Logistic regression analysis showed that, higher levels of plasma copeptin, CRP, PCT were independent risk factors of severe pneumonia(P<0.05). The higher copeptin level, the larger influence was. Conclusion The serum copeptin level in severe pneumonia children is significantly higher than that in common pneumonia children and normal physical examinees. With the aggravated illness condition, the serum copeptin level increased gradually. The serum copeptin combined with CRP and PCT are independent risk factors of death in severe pneumonia children, and which can be seen as one of the effective indexes in the prognosis in severe pneumonia children.
引文
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[3] 卢家泉,刘影.血浆BNP水平与老年重症肺炎患者APACHEⅡ评分及近期预后相关性分析[J].陕西医学杂志,2015,43(6):714-717.
[4] 闫孝永.血浆肌钙蛋白I和NT-proBNP含量对儿童肺炎合并心力衰竭的诊断价值[J].江苏大学学报(医学版),2017,27(4):312-315.
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[7] 林群,蔡建勇,陆川,等.血浆和肽素与自发性动脉瘤性蛛网膜下血预后相关性研究[J].中国急救医学,2016,36(1):368-370.
[8] 张迁,杨国庆,段娅,等.航空航天医学专业人才培养模式的探讨[J].空军医学杂志,2017,33(4):234-236.
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[10] 郝柯,陈维永,陈兵阳.雾化吸入阿米卡星治疗重症肺炎的疗效及安全性[J].西部医学,2016,28(1):77-79.
[11] 朱佩华,李东辉,谢睿,等.脑梗死与血浆和肽素相关性分析[J].脑与神经疾病杂志,2015,23(1):37-39.
[12] 侯艳娇,罗欲承,邵晨,等.快速检测肺炎链球菌recA、ply及16S rRNA基因的多重降落PCR方法建立及应用[J].江苏大学学报(医学版),2014,24(1):40-43.
[13] 莫新,唐皓,曾丽金,等.血清胆碱酯酶含量对重症肺炎患者病情和预后的评估价值[J].中华危重病急救医学,2016,27(1):38-43.
[14] 宁波,张莉莉,张晓慧,等.重症患者转运中不良事件原因分析[J].空军医学杂志,2014,29(3):152-154.
[15] 雷娟,范光伟,申雪莹.层级护理模式对提高护理人员技能与ICU重症肺炎患者的临床效果研究[J].西部医学,2016,28(7):1025-1029.
[16] Caggiano S,Ullmann N,Vitis E D,et al.Factors That Negatively Affect the Prognosis of Pediatric Community-Acquired Pneumonia in District Hospital in Tanzania[J].International Journal of Molecular Sciences,2017,18(3):623.
[17] 孙慧,李秀芝,郭霞,等.脑钠肽及降钙素原在老年重症肺炎患者早期评估中的作用[J].临床肺科杂志,2015,19(5):877-880.
[18] Christcrain M,Fenske W.Copeptin in the diagnosis of vasopressin-dependent disorders of fluid homeostasis[J].Nature Reviews Endocrinology,2016,12(3):91-102.
[19] 王振华,翁发林,黄瑞.血浆和肽素及N末端脑钠肽前体与射血分数保留的心力衰竭相关性研究[J].检验医学与临床,2016,13(20):2942-2944.
[20] Imamura T,Kinugawa K.Urine Aquaporin-2:A Promising Marker of Response to the Arginine Vasopressin Type-2 Antagonist,Tolvaptan in Patients with Congestive Heart Failure[J].International Journal of Molecular Sciences,2016,17(1):105.
[21] 尹为民,贾彦敏,薛贝,等.俯卧位机械通气联合小剂量多巴胺及多巴酚丁胺对重症肺炎患儿肺功能的影响[J].保健医学研究与实践,2016,13(2):69-70.
[22] Zittema D,Ja V D B,Bakker S J,et al.Copeptin,a surrogate marker for arginine vasopressin,is associated with disease severity and progression in IgA nephropathy patients[J].Nephrol Dial Transplant,2017,32(1):328-330.
[23] 吕沛华,曲淼,王忠东,等.重症医学科患者发生呼吸机相关性肺炎的危险因素及防控措施[J].西部医学,2015,27(7):1116-1118.
[2] 侯明山,蔺鹏祯,杨军,等.血浆和肽素水平与脑外伤患者病情严重程度相关性研究[J].现代检验医学杂志,2016,31(4):98-99.
[3] 卢家泉,刘影.血浆BNP水平与老年重症肺炎患者APACHEⅡ评分及近期预后相关性分析[J].陕西医学杂志,2015,43(6):714-717.
[4] 闫孝永.血浆肌钙蛋白I和NT-proBNP含量对儿童肺炎合并心力衰竭的诊断价值[J].江苏大学学报(医学版),2017,27(4):312-315.
[5] 张细江,曹同瓦,赵锋.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[J].中华急诊医学杂志,2016,25(3):338-342.
[6] 梁亚鹏,刘志祯,尹其翔.血浆和肽素与多发伤患者损伤严重度评分及短期死亡的相关性分析[J].实用医学杂志,2015,43(12):2064-2065.
[7] 林群,蔡建勇,陆川,等.血浆和肽素与自发性动脉瘤性蛛网膜下血预后相关性研究[J].中国急救医学,2016,36(1):368-370.
[8] 张迁,杨国庆,段娅,等.航空航天医学专业人才培养模式的探讨[J].空军医学杂志,2017,33(4):234-236.
[9] Jiang L,Feng B,Gao D,et al.Plasma concentrations of copeptin,C-reactive protein and procalcitonin are positively correlated with APACHE II scores in patients with sepsis[J].Journal of International Medical Research,2015,43(2):188-95.
[10] 郝柯,陈维永,陈兵阳.雾化吸入阿米卡星治疗重症肺炎的疗效及安全性[J].西部医学,2016,28(1):77-79.
[11] 朱佩华,李东辉,谢睿,等.脑梗死与血浆和肽素相关性分析[J].脑与神经疾病杂志,2015,23(1):37-39.
[12] 侯艳娇,罗欲承,邵晨,等.快速检测肺炎链球菌recA、ply及16S rRNA基因的多重降落PCR方法建立及应用[J].江苏大学学报(医学版),2014,24(1):40-43.
[13] 莫新,唐皓,曾丽金,等.血清胆碱酯酶含量对重症肺炎患者病情和预后的评估价值[J].中华危重病急救医学,2016,27(1):38-43.
[14] 宁波,张莉莉,张晓慧,等.重症患者转运中不良事件原因分析[J].空军医学杂志,2014,29(3):152-154.
[15] 雷娟,范光伟,申雪莹.层级护理模式对提高护理人员技能与ICU重症肺炎患者的临床效果研究[J].西部医学,2016,28(7):1025-1029.
[16] Caggiano S,Ullmann N,Vitis E D,et al.Factors That Negatively Affect the Prognosis of Pediatric Community-Acquired Pneumonia in District Hospital in Tanzania[J].International Journal of Molecular Sciences,2017,18(3):623.
[17] 孙慧,李秀芝,郭霞,等.脑钠肽及降钙素原在老年重症肺炎患者早期评估中的作用[J].临床肺科杂志,2015,19(5):877-880.
[18] Christcrain M,Fenske W.Copeptin in the diagnosis of vasopressin-dependent disorders of fluid homeostasis[J].Nature Reviews Endocrinology,2016,12(3):91-102.
[19] 王振华,翁发林,黄瑞.血浆和肽素及N末端脑钠肽前体与射血分数保留的心力衰竭相关性研究[J].检验医学与临床,2016,13(20):2942-2944.
[20] Imamura T,Kinugawa K.Urine Aquaporin-2:A Promising Marker of Response to the Arginine Vasopressin Type-2 Antagonist,Tolvaptan in Patients with Congestive Heart Failure[J].International Journal of Molecular Sciences,2016,17(1):105.
[21] 尹为民,贾彦敏,薛贝,等.俯卧位机械通气联合小剂量多巴胺及多巴酚丁胺对重症肺炎患儿肺功能的影响[J].保健医学研究与实践,2016,13(2):69-70.
[22] Zittema D,Ja V D B,Bakker S J,et al.Copeptin,a surrogate marker for arginine vasopressin,is associated with disease severity and progression in IgA nephropathy patients[J].Nephrol Dial Transplant,2017,32(1):328-330.
[23] 吕沛华,曲淼,王忠东,等.重症医学科患者发生呼吸机相关性肺炎的危险因素及防控措施[J].西部医学,2015,27(7):1116-1118.