皮质醇、和肽素的早期检测在社区获得性肺炎中的应用价值评估

发布时间：2018-10-26 11:55

【摘要】：目的：探讨皮质醇、和肽素的早期检测在社区获得性肺炎中病情严重程度及预后评估的临床价值。方法：选取2014年6月至2015年6月在广州军区广州总医院呼吸内科住院的社区获得性肺炎患者(n=110),根据相关标准分为普通肺炎组(n=54)和重症肺炎组(n=56),根据临床结局分为存活组(n=82)和死亡组(n=28),以同期体检中心健康成人为对照组(n=26)。检测肺炎患者第1、4天和对照组体检当天皮质醇、和肽素、C反应蛋白(CRP)、降钙素原(PCT)水平,比较上述指标在各组间的差异。对肺炎患者行CURB-65评分、肺炎严重指数(peumonia severity index, PSI)评分、APACHE Ⅱ评分,以评估患者病情严重程度,应用ROC曲线分析各指标对重症肺炎诊断价值以及患者死亡风险的预测价值。结果：一、各组炎症指标水平(1)CRP、PCT:重症肺炎组及普通肺炎组患者第1天CRP水平均高于对照组(P=0.000,P=0.000),重症肺炎组第1天CRP水平与同期普通肺炎组比较,差异无统计学意义(P=0.261),重症肺炎组第4天CRP水平高于同期普通肺炎组(P=0.000)。死亡组第1、4天CRP水平均高于同期存活组(P=0.006,P=0.000)。重症肺炎组及普通肺炎组患者第1天PCT水平均高于对照组(P=0.000,P=0.000),重症肺炎组第1、4天PCT水平均高于同期普通肺炎组,差异有统计学意义(P=0.000,P=0.000)。死亡组第1、4天PCT水平均高于同期存活组(P=0.000,P=0.002)。(2)皮质醇、和肽素：重症肺炎组及普通肺炎组患者第1天皮质醇、和肽素水平均高于对照组,重症肺炎组第1、4天皮质醇、和肽素水平高于同期普通肺炎组,差异有统计学意义(P0.05)。死亡组第1、4天皮质醇水平均高于同期存活组(P=0.000,P=0.000),死亡组第1天和肽素水平与同期存活组比较,差异无统计学意义(P=0.058),死亡组第4天和肽素水平高于同期存活组(P=0.000)。二、炎症指标水平与临床评分的相关性肺炎患者第1、4天皮质醇、和肽素、PCT与同期CURB-65评分、PSI评分、APACHEII评分存在正相关(P0.05)。三、炎症指标对诊断重症肺炎及预测死亡风险的价值(1)单个炎症指标对诊断重症肺炎及预测死亡风险的价值：第1天皮质醇诊断重症肺炎的价值(AUC=0.864)与同期PCT(AUC=0.784)、和肽素(AUC=0.753)相近(P0.05),三者均高于CRP(AUC=0.607)的诊断价值(P0.05)。第1天皮质醇预测患者死亡的价值(AUC=0.875)高于同期CRP(AUC=0.673)、PCT(AUC=0.722)、和肽素(AUC=0.620)(P0.05)。第4天皮质醇、和肽素诊断重症肺炎的价值(AUC=0.894,AUC=0.886)相近(P0.05),但均高于同期CRP(AUC=0.774)、PCT(AUC=0.803)(0.05)。第4天皮质醇预测患者死亡的价值(AUC=0.810)与同期PCT(AUC=0.773)、CRP(AUC=0.766)、和肽素(AUC=0.768)相近(P0.05)。(2)联合皮质醇、和肽素对诊断重症肺炎及预测死亡风险的价值：联合第1天皮质醇、和肽素对重症肺炎的诊断价值(AUC=0.868)与单独皮质醇、单独PCT相近(P0.05),但均高于单独和肽素的诊断价值(P0.05)。联合第1天皮质醇、和肽素对死亡的预测价值(AUC=0.872)与单独皮质醇相近(P0.05),高于单独和肽素、单独PCT的预测价值(PO.05)。联合第4天皮质醇、和肽素对重症肺炎的诊断价值(AUC=0.915)与单独皮质醇、单独和肽素相近(P0.05),高于单独PCT的诊断价值(P0.05)。联合第4天皮质醇、和肽素对死亡的预测价值(AUC=0.826)与单独皮质醇、单独和肽素、单独PCT相近(P0.05)。结论：早期皮质醇、和肽素水平与CAP病情严重程度相关,在诊断重症肺炎和预测患者临床结局的价值较大。联合皮质醇、和肽素对重症肺炎的诊断及患者的预后的临床价值并不明显优于单独皮质醇、单独和肽素。
[Abstract]:Objective: To investigate the clinical value of the early detection of cortisol and peptide in community-acquired pneumonia. Methods: The patients with community-acquired pneumonia (n = 110) hospitalized in Guangzhou Military Hospital of Guangzhou Military Region from June 2014 to June 2015 were divided into general pneumonia group (n = 54) and severe pneumonia group (n = 56). The clinical outcome was divided into survival group (n = 82) and death group (n = 28), and the healthy adults in the same period were the control group (n = 26). The levels of cortisol, peptide, C-reactive protein (CRP) and calcitonin (PCT) were measured on day 1, 4 and control in patients with pneumonia. The CURB-65 score, the pneumonia severity index (PSI) score, the APACHE II score were scored in the patients with pneumonia to assess the severity of the patient's condition, and the ROC curve was used to analyze the diagnostic value of the severe pneumonia and the predictive value of the patient's death risk. Results: 1 (1) CRP, PCT: severe pneumonia group and common pneumonia group were significantly higher than those in control group (P = 0.000, P = 0.000), and the level of CRP in severe pneumonia group was not statistically significant (P = 0. 261). The level of CRP in the 4th day of the severe pneumonia group was higher than that of the common pneumonia group (P = 0.000). The levels of CRP in the 1st and 4th day of death group were higher than those in the same period (P = 0. 006, P = 0.000). The PCT level was higher in the severe pneumonia group and the general pneumonia group than in the control group (P = 0.000, P = 0.000). The PCT level of the severe pneumonia group was higher than that of the common pneumonia group in the same period (P = 0.000, P = 0.000). The PCT level of Day 1 and 4 of death group was higher than that of the same group (P = 0. 000, P = 0. 002). (2) Cortisol and peptide: the first day cortisol and the level of peptide in severe pneumonia group and common pneumonia group were higher than those of the control group, the first and fourth day cortisol of the severe pneumonia group and the level of the peptide were higher than those of the common pneumonia group in the same period (P0.05). The levels of cortisol in the first and fourth days of the death group were higher than those of the same group (P = 0. 000, P = 0.000). The difference was not statistically significant (P = 0.058), and the level of day 4 and peptide in the death group was higher than that of the same group (P = 0.000). 2. There was positive correlation between the level of inflammation index and clinical score in patients with pneumonia (P0.05). 3. The value of inflammation index in diagnosing severe pneumonia and predicting the risk of death (1) The value of single inflammation index in diagnosing severe pneumonia and predicting the risk of death: the value of the first day cortisol diagnosis of severe pneumonia (AUC = 0.864) was similar to that of the same period PCT (AUC = 0.784), and the peptide (AUC = 0. 753) was similar (P0.05). The diagnostic value of CRP (AUC = 0. 607) was higher than that of CRP (P0.05). The value of death in the first day of cortisol prediction (AUC = 0. 875) was higher than CRP (AUC = 0.673), PCT (AUC = 0.722), and peptide (AUC = 0.620) (P0.05). The value of cortisol and peptide in the diagnosis of severe pneumonia (AUC = 0.9894, AUC = 0. 886) were similar (P0.05), but were higher than that of CRP (AUC = 0.774), PCT (AUC = 0.803) (0.05). The value of the death of the 4-day cortisol prediction was similar to that of the same period PCT (AUC = 0. 773), CRP (AUC = 0. 766), and peptide (AUC = 0.768) (P0.05). (2) The value of joint cortisol and peptide in diagnosing severe pneumonia and predicting death risk: The diagnostic value of cortisol and peptide in severe pneumonia (AUC = 0.868) was similar to that of single cortisol alone (P0.05). The predicted value of cortisol (AUC = 0. 872) was similar to that of individual cortisol (P0.05). The diagnostic value of cortisol and peptide in severe pneumonia (AUC = 0. 915) was similar to that of individual cortisol alone (P0.05), which was higher than that of individual PCT (P0.05). The predicted value (AUC = 0. 826) of cortisol and peptide in combination with cortisol, alone and in peptide alone, was similar to the individual PCT (P0.05). Conclusion: Early cortisol and peptide levels are related to the severity of CAP, and the value of clinical outcome in diagnosis of severe pneumonia and prognosis is greater. The clinical value of combined cortisol, and peptide in the diagnosis of severe pneumonia and the prognosis of patients is not significantly superior to the individual cortisol, alone and in peptide elements.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.1

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