和肽素对呼吸机相关性肺炎预后判断的临床意义  

Clinical significance of copeptin in predicting prognosis of ventilator-associated pneumonia

作　　者：华锋[1] 王斌[1] 崔恩海[1] 

机构地区：[1]湖州市中心医院呼吸内科,浙江湖州313000

出　　处：《中华医院感染学杂志》2013年第4期743-745,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅(2011KYA153)

摘　　要：目的评估和肽素(Copeptin)在呼吸机相关性肺炎(VAP)预后中的价值,为临床应用提供依据。方法因慢性阻塞性肺疾病急性加重而收住呼吸重症监护病房疑诊为VAP的患者作为观察对象,测定Copeptin、前降钙素原(PCT)与C-反应蛋白(CRP)水平,计算临床肺部感染评分(CPIS)及APACHEⅡ评分。结果总共42例机械通气患者入选,其中确诊VAP 24例;VAP组Copeptin(55.6±18.8)pmol/L、PCT血浆水平(1.6±0.5)μg/L及APACHEⅡ评分(22±4.2)显著高于非VAP组(32.4±13.6)pmol/L、(0.5±0.2)μg/L、(16.3±3.6);VAP死亡组Copeptin(78.5±12.0)pmol/L及PCT血浆水平(1.8±0.6)μg/L显著高于VAP存活组(55.8±8.6)pmol/L、(1.2±0.2)μg/L;以40pmol/L为截断值,Copeptin预测VAP死亡的敏感性为0.67,特异性为0.67,AUC值为0.70高于CPIS和CRP。结论血浆Copeptin水平判断VAP预后,其敏感性和特异性较高,优于CPIS、CRP。OBJECTIVE To evaluate the value of copeptin in predicting the prognosis of ventilator-associated pneumonia（VAP） so as to provide basis for the clinical application.METHODS The acute exacerbation of chronic obstructive pulmonary disease patients who were admitted into the respiratory intensive care unit and were clinically suspected as VAP were enrolled in the study.Copeptin,PCT and C-reactive protein（CRP） levels were measured,and the clinical pulmonary infection score（CPIS） and APACHE Ⅱscore were calculated.RESULTS Forty two patients with mechanical ventilation were enrolled,and 24 cases were confirmed with VAP.The plasma levels of copeptin and PCT,APACH Ⅱscores were significantly higher in VAP patients than in the controls（55.6±18.8） pmol/L vs.（32.4±13.6） pmol/L,（1.6±0.5）μg/L vs.（0.5±0.2）μg/L,（22±4.2） vs.（16.3±3.6）.The death group had significantly higher copeptin and PCT levels than did the survival group（78.5±12.0） pmol/L vs.（55.8±8.6）pmol/L,（1.8±0.6）μg/L vs.9 1.2±0.2）μg/L）.Using 40pmol/L as the best cutoff,copeptin had the sensitivity of 0.67and the specificity of 0.67,the value of AUC for copeptin was 0.70,higher than CPIS and CRP.CONCLUSION It is concluded that the serum copeptin is superior to CPIS and CRP in the sensitivity and specificity to predict the prognosis of the patients with VAP.

关 键 词：呼吸机相关性肺炎 和肽素 前降钙素原 临床肺部感染评分 C-反应蛋白 

分 类 号：R181.32[医药卫生—流行病学]