老年大面积脑梗死患者血浆和肽素水平和早期死亡的关系  

Plasma copeptin levels in elderly victims of massive cerebral infarction and its relationship to early death

作　　者：李瀛[1,2] 余丹[1,2] 谢逸群[3] 

机构地区：[1]中南大学附属海口医院 [2]海口市人民医院神经内科,海口570208 [3]中南大学湘雅二医院老年病科,长沙410011

出　　处：《中南大学学报（医学版）》2012年第6期586-590,共5页Journal of Central South University ：Medical Science

摘　　要：目的:探讨和肽素(copeptin)在急性大面积脑梗死患者血浆中的变化及其与早期死亡的关系。方法:检测49例老年急性大面积脑梗死患者copeptin水平在起病后24 h,36 h,5 d,14 d的变化,并对copeptin水平进行分级,于起病24 h内用格拉斯哥-匹斯堡昏迷量表(glasgow-pittsburgh coma scale,GPCS)评分,并进行分级。起病14 d时计数生存和死亡患者。分析血浆copeptin浓度分级、GPCS评分与病死率的关系,并做一致性和准确性检验。结果:病例组起病24 h,36 h,5 d 3个时间点血浆copeptin浓度无明显差异(P>0.05),14 d较其他时间点降低,但各检测时间点均较对照组增高(P<0.01或P<0.05)。死亡患者24 h copeptin浓度较生存患者明显增高(P<0.01)。Copeptin分级和GPCS评分分级均与14 d内的早期死亡呈正相关(r=0.58,P<0.001;r=0.46,P<0.001)。Copeptin水平3级与预测早期死亡的一致性较好,其一致性和总符合率高于GPCS评分3级。结论:老年急性大面积脑梗死患者血浆copeptin水平增高,对预测早期死亡、病情评估具较高临床价值。Objective： To investigate copeptin levels in elderly patients who have suffered massive cerebral infarction, and to establish its correlation with early death. Methods： Forty-nine elderly patients with acute massive cerebral infarction and an age-matched control group of thirty normal people were established. Plasma copeptin levels of patient group were measured by ELISA at 24 h, 36 h, 5 d, and 14 d after onset of infarction. Glasgow-Pittsburgh coma scale （GPCS） were recorded within 24 h after onset, and both results were graded. Based on the 14-day mortality the patient was divided into a death group and a survival group, and the correlations between graded copeptin level and GPCS to mortality were analyzed, as well as the consistency and accuracy of prognosis. Results： Plasma copeptin levels in the patient group were no differences between the 24 h, 36 h and 5 d point, and that of the 14 d was lower than that of the other points. Copeptin levels were significantly higher than in the control group at each test point （P 〈 0.01 or P 〈 0.05）. The copeptinlevel at 24 h among those dead by 14 days was higher than in those of the survival group （P〈0.01）. There were significant associations of early death （within 14 d） with copeptin levels and with GPCS grade（r=0.58, P〈0.001, r=0.46, P〈0.001, respectively）. Copeptin level of the third-grade （〉25.0 pmol/L） showed better consistency and coincidence rate than GPCS score （〈 20） in predicting early death. Conclusion： Plasma copeptin level was increased in early phases of acute massive cerebral infarction in elderly patients; it may have predictive value for early death.

关 键 词：脑梗死 老年 和肽素 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]