D-二聚体、血浆纤维蛋白原在社区获得性肺炎病情及预后判断中的应用价值

发布时间：2018-03-30 04:26

本文选题：社区获得性肺炎　切入点：病情　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:肺炎指各种病原微生物、理化因素、免疫损伤、药物等引起的终末气道、肺泡和肺间质的炎症。按获得环境分社区获得性肺炎(Community-acquired pneumonia,CAP)和医院获得性肺炎(Hospital-acquired pneumonia,HAP)。CAP发病率约为12/1000,是危害人类健康的主要感染性疾病。随着影像技术的发展,CAP诊断不难确立,但如何在临床中快速识别患者病情,关系到治疗方案的选择及预后的判断。然而CAP指南推荐的各种评分系统计算繁杂,不便于实际应用,因此,寻求方便可靠的炎性生物标志物成为研究热点。C-反应蛋白(C-reactive protein,CRP)和降钙素原(Procalcitonin,PCT)在炎症过程中反应迅速,半衰期短,已有广泛研究证实,可用于及时判断CAP的病情和预后。血凝分析是临床常规检验项目。其中D-二聚体(D-dimer,D-Di)是交联纤维蛋白的降解产物,其水平升高提示高凝状态和继发性纤溶活性亢进。在呼吸系疾病中,目前常用于肺栓塞的诊断和治疗评估。纤维蛋白原(Fibrinogen,FIB)即为凝血因子Ⅰ,同时也是急性炎症反应的重要指标,炎症发生时,通过诱导血小板聚集产生炎症屏障作用。近年来,越来越多的学者开始关注炎症与凝血的关系。机体发生炎症反应后,直接或间接损伤血管内皮细胞,激活凝血途径,引起高凝状态,同时导致继发性纤溶亢进。目前已有广泛研究证实脓毒症患者体内也存在上述病理表现,但肺炎作为一种局部感染性疾病是否也存在D-Di、FIB异常,以及此两项指标在患者病情评估及预后判断中的应用价值,目前研究尚较少,且结果不一。本研究旨在探讨D-Di、FIB在CAP患者中临床应用价值。方法:收集CAP患者81例,进行分组:a)按CURB-65评分分为:低危组、中危组、高危组。b)按累及节段分为:单侧肺炎组和双侧肺炎组。c)按肺炎旁积液情况分为:未合并肺炎旁积液组、合并单侧肺炎旁积液组、合并双侧肺炎旁积液组。d)按机械通气与否分为:不需机械通气组和需要机械通气组。e)按转归分为:生存组和死亡组。收集入院24h内化验结果,比较各亚组之间D-Di、FIB水平,并与CRP、PCT进行相关分析。结果:1 CURB-65低危组D-Di显著低于中危组、高危组(P0.05),而后两组之间差异不显著(P0.05)。单侧肺炎组D-Di显著低于双侧肺炎组(P0.05)。未合并肺炎旁积液组D-Di显著低于合并单侧肺炎旁积液组、双侧肺炎旁积液组(P0.05),而后两组之间差异不显著(P0.05)。FIB在各亚组之间均无差异(P0.05)。2需要机械通气组D-Di、FIB与不需机械通气组之间无显著差异(P0.05)。3生存组D-Di、FIB与死亡组之间无显著差异(P0.05)。4 D-Di与CRP、PCT相关系数分别为0.459、0.613(P0.01);FIB与CRP相关系数为0.701(P0.01),与PCT相关系数为0.261(P=0.050.01)。结论:1入院24h内,D-Di在一定程度可反映CAP患者病情严重程度,但不能全面反映临床转归,FIB尚不能反映CAP患者病情严重程度及预后,但结合相关文献,认为动态监测更有助于全面评价其在CAP诊治中的应用价值。2 CAP患者D-Di、FIB均与CRP、PCT存在相关性,可能成为一种新的肺炎生物标志物。3 CAP患者体内存在高凝、继发性纤溶亢进,适时的相关治疗可能成为其辅助治疗。
[Abstract]:Objective: pneumonia refers to various pathogenic microorganisms, physicochemical factors, immune injury caused by drugs, at the end of the airway, alveolar and pulmonary interstitial inflammation. According to the acquired environment of community acquired pneumonia (Community-acquired pneumonia, CAP) and hospital acquired pneumonia (Hospital-acquired pneumonia, HAP.CAP) the incidence rate is about 12/1000, is the main infectious diseases harmful to human health. With the development of imaging technology, CAP diagnosis is difficult to establish, but how to quickly identify patients in clinical disease, related to the treatment and prognosis judgment. However, all the CAP scoring system recommended calculation is complex. It is difficult for application, therefore, to seek a convenient and reliable inflammatory biomarkers has become a research hotspot of.C- reactive protein (C-reactive protein, CRP) and procalcitonin (Procalcitonin, PCT) in the inflammatory process rapid reaction, short half-life, extensive research Study confirmed that can be used to timely diagnose the condition and prognosis of CAP. Blood coagulation analysis is a clinical routine test. The two D- dimer (D-dimer, D-Di) is a degradation product of cross-linked fibrin, elevated levels suggest that hypercoagulability and secondary hyperfibrinolysis. In respiratory diseases, diagnosis and treatment commonly used to assess pulmonary embolism at present. Fibrinogen (Fibrinogen, FIB) is a coagulation factor, but also an important indicator of acute inflammation, inflammation, platelet aggregation induced by inflammatory barrier function. In recent years, more and more scholars began to pay attention to the relationship between inflammation and coagulation. The body inflammation after direct or indirect damage to vascular endothelial cells, activation of the coagulation pathway, induce a hypercoagulable state and lead to secondary hyperfibrinolysis. There are extensive research confirmed that in vivo sepsis is shown in the above pathological However, pneumonia as a local infectious disease whether there is D-Di, FIB anomaly, and the application value of the two indexes in the patient's condition and prognosis assessment of the present study is less, and the results are different. This study aimed to investigate the clinical value of D-Di and FIB in CAP patients. Methods: 81 cases of CAP patients were divided into two groups: a) according to the CURB-65 score: low risk group, medium risk group, high risk group.B) according to the involved segments divided into unilateral pneumonia group and bilateral pneumonia group.C) in parapneumonic effusion were divided into: parapneumonic effusion group combined with single side parapneumonic effusion group, with bilateral parapneumonic effusion group.D) according to the mechanical ventilation and can be divided into: without mechanical ventilation group and mechanical ventilation group) according to the outcome of.E is divided into: survival group and death group. 24h test results were collected, each subgroup were compared between D-Di and FIB levels, and CRP and PCT. The correlation analysis results: 1 CURB-65 low risk group D-Di was significantly lower than in the risk group, high risk group (P0.05), and no significant difference between the two groups (P0.05). Unilateral pneumonia group D-Di was significantly lower than the bilateral pneumonia group (P0.05). Not complicated parapneumonic effusion group was significantly lower than that of D-Di with unilateral parapneumonic effusion group, bilateral group (parapneumonic effusion P0.05), and no significant difference between the two groups (P0.05.FIB) there was no significant difference between every sub group (P0.05).2 mechanical ventilation group D-Di, there was no significant difference between FIB and non mechanical ventilation group (P0.05).3 D-Di FIB between survival group and death group, no significant difference (P0.05.4) D-Di and CRP PCT, the correlation coefficients were 0.459,0.613 (P0.01); FIB and CRP correlation coefficient was 0.701 (P0.01), and the PCT correlation coefficient was 0.261 (P=0.050.01). Conclusion: 1 24h of admission, D-Di can reflect the severity of CAP in a certain extent, but can not fully reflect the clinical outcome, not FIB reflect CA The severity of the condition and prognosis of patients with P, but with the relevant literature, that dynamic monitoring can help to fully evaluate its application value in the diagnosis and treatment of CAP in patients with CAP.2 D-Di, FIB and CRP, the relationship of PCT, may be a new biomarker for pneumonia hypercoagulable.3 in patients with CAP, secondary fiber solution of hyperthyroidism, timely treatment may become the adjuvant therapy.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

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