老年肺部感染患者脂联素水平变化及临床意义

发布时间：2018-11-15 08:49

【摘要】：目的肺部感染是老年人常见的疾病之一,据统计16%以上的老年人直接死于肺部感染,并且有随着年龄增长而增高的趋势,因此,早期诊断、早期治疗对疾病的评估至关重要。本研究通过收集老年肺部感染患者及对照组的临床基本资料,检测血清脂联素(Adiponectin,APN)、C-反应蛋白(C-reactive protein,CRP)等临床指标,探讨APN水平在老年肺部感染中的变化及与肺部感染的联系,以期为老年肺部感染患者临床诊断及病情监测提供依据,同时为临床医师提供一种辅助诊断及监测病情变化的方法。方法选取2012年4月--2013年6月在我院连续入住的60岁的社区获得性肺炎及医院获得性肺炎患者70例,作为感染组；按照重症肺炎诊断标准,重症肺炎患者27例,作为重症组,余43例非重症患者,作为轻症组；选取同期在我院体检中心60岁的健康受检者20例,作为对照组。应用酶联免疫吸附法测定APN水平、乳胶增强的免疫比浊法测定CRP水平,并观察血清APN水平及CRP水平的变化。结果 1.与对照组比较,感染组中性粒细胞比率(Neutrophile granulocyte, N%)、白细胞数(White blood cell,WBC)明显升高,差异有统计学意义(P0.05)；其余临床指标两组间比较,差异无统计学意义(P0.05)。 2.与对照组比较,轻症组、重症组血清APN水平均明显降低[(8.89±1.93)mg/Lvs(6.79±1.87) mg/L vs (4.89±1.13)mg/L,P0.05];与轻症组比较,重症组血清APN水平明显降低[(6.79±1.87) mg/Lvs (4.89±1.13) mg/L,P0.05];与对照组比较,轻症组、重症组CRP水平均明显升高[(1.69±1.12) mg/L vs (13.38±3.07) mg/L vs (18.41±4.6)mg/L,P0.05];与轻症组比较,重症组CRP水平明显升高[(13.38±3.07)mg/Lvs (18.41±4.6) mg/L,P0.05]. 3.经内科积极治疗后,轻症组、重症组血清APN水平分别升高约41.1%、20%,且轻症组升高更为显著,差异有统计学意义(P0.05)；CRP水平分别降低约64.3%、60.1%,差异有统计学意义(P0.05)。 4.APN水平与临床指标的相关分析,发现血清APN与CRP、SBP、DBP相关,相关系数分别为：r=-0.534、0.420、0.266(P0.05)。 5.进一步行多元逐步回归分析,以APN为应变量,SBP、DBP、TG、CH、HDL、 LDL、FPG、2hPG、N%、WBC为自变量进行多元逐步回归分析显示,CRP、SBP均进入APN的回归方程,结果表明在排除多种因素的交互影响后,CRP、SBP是血清APN的独立影响因素。回归方程为：APN=3.051-0.181CRP+0.043SBP 6.经多元逐步Logistic回归分析,APN是老年肺部感染的独立影响因素。结论 1.APN水平随着肺部感染程度呈一动态演变,提示APN与老年肺部感染的发生发展密切相关,可能是老年肺部感染的显著影响因素。 2.APN可能是一种新的抗炎因子。 3.APN有望作为老年人肺部感染诊断和病情监测的新的标志物。
[Abstract]:Objective Pulmonary infection is one of the most common diseases in the elderly. According to statistics, more than 16% of the elderly die directly from pulmonary infection and have a tendency to increase with age. Early treatment is essential for disease assessment. In this study, serum adiponectin (Adiponectin,APN), C-reactive protein (C-reactive protein,CRP) and other clinical indexes were detected by collecting the clinical data of the elderly patients with pulmonary infection and the control group. To explore the changes of APN level in elderly patients with pulmonary infection and its relationship with pulmonary infection in order to provide a basis for clinical diagnosis and disease monitoring in elderly patients with pulmonary infection and to provide a method to assist clinicians to diagnose and monitor the changes of the disease. Methods from April 2012 to June 2013, 70 patients with community acquired pneumonia (CPAP) and nosocomial pneumonia (NAP) who were admitted to our hospital from April 2012 to June 2013 were selected as infection group. According to the diagnostic criteria of severe pneumonia, 27 cases of severe pneumonia were selected as severe group and 43 cases as mild group, and 20 cases of healthy subjects aged 60 years old in physical examination center of our hospital were selected as control group. The levels of APN and CRP were determined by enzyme-linked immunosorbent assay (Elisa) and latex enhanced immunoturbidimetry respectively. The changes of serum APN and CRP levels were observed. Result 1. Compared with the control group, the neutrophil ratio (Neutrophile granulocyte, N%) and the white blood cell count (White blood cell,WBC) in the infected group were significantly higher than those in the control group (P0.05). Other clinical indicators between the two groups, the difference was not statistically significant (P0.05). 2. Compared with the control group, the serum APN levels in the mild group and the severe group were significantly decreased [(8.89 卤1.93) mg/Lvs (6.79 卤1.87) mg/L vs (4.89 卤1.13) mg/L,P0.05]. Compared with the mild group, the serum APN level in the severe group was significantly decreased [(6.79 卤1.87) mg/Lvs (4.89 卤1.13) mg/L,P0.05]. Compared with the control group, the level of CRP in the mild group and the severe group was significantly increased [(1.69 卤1.12) mg/L vs (13.38 卤3.07) mg/L vs (18.41 卤4.6) mg/L,P0.05]. The level of CRP in severe group was significantly higher than that in mild group [(13.38 卤3.07) mg/Lvs (18.41 卤4.6) mg/L,P0.05]. 3. After active medical treatment, the level of serum APN in mild group and severe group were increased by 41.1% and 20% respectively, and the level of serum APN in mild group was higher than that in control group (P0.05). CRP level decreased about 64.3% and 60.1%, the difference was statistically significant (P0.05). The correlation analysis between 4.APN level and clinical indexes showed that serum APN was correlated with CRP,SBP,DBP, and the correlation coefficients were: r = -0.534 ~ (0.420) ~ (0.266) (P0.05). 5. Further multivariate stepwise regression analysis showed that CRP,SBP entered the regression equation of APN with APN as dependent variable and SBP,DBP,TG,CH,HDL, LDL,FPG,2hPG,N%,WBC as independent variable in multivariate stepwise regression analysis. The results showed that CRP,SBP was an independent factor of serum APN after the interaction of many factors was excluded. The regression equation is APN=3.051-0.181CRP 0.043SBP 6. Multiple stepwise Logistic regression analysis showed that APN was an independent factor of pulmonary infection in the elderly. Conclusion the level of 1.APN changes dynamically with the degree of pulmonary infection, suggesting that APN is closely related to the occurrence and development of pulmonary infection in the elderly, and may be a significant influencing factor of pulmonary infection in the elderly. 2.APN may be a new anti-inflammatory factor. 3.APN is expected to be a new marker for the diagnosis and monitoring of pulmonary infection in the elderly.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R563.1

【参考文献】