监测血清胱抑素C在老年社区获得性肺炎治疗中的临床价值  

Clinical value of serum Cystatin C monitoring in the treatment of community acquired pneumonia in the elderly

作　　者：杨涛[1] 徐丽[1] 周敏[1] 钟杉[1] 肖春海[1] 杜晓梅[1] 

机构地区：[1]上海市第六人民医院金山分院呼吸科,上海市201599

出　　处：《老年医学与保健》2016年第6期375-377,400,共4页Geriatrics & Health Care

基　　金：金山区科委科研项目(2012-3-17);金山区卫计委科研项目(JSKJ-KTQN-2014-09)

摘　　要：目的探讨血清胱抑素C(Cys-C)动态监测在老年社区获得性肺炎(CAP)治疗中的临床价值。方法纳入我院呼吸科住院80例CAP患者,随机分成胱抑素C(Cys-C)评估组(观察组)及标准指南组(对照组),观察组CURB-65评分系统中肾功能指标依据Cys-C进行评判并指导治疗,动态比较两组病情转归、感染指标、血清Cys-C、尿素氮(BUN)、肌酐(Cr)及尿β2微球蛋白(β2-MG)等指标,并且评估Cys-C指导下的抗菌素使用情况、住院费用和时间等指标。结果与对照组比较,观察组血清Cys-C于第7天及第14天均低于对照组(P<0.01);研究终点时观察组β2-MG、BUN和Cr均低于对照组(P<0.01),观察组患者住院时间、住院费用和抗菌素使用的时间均低于对照组,差异有统计学意义(P<0.01)。结论在遵循CAP指南基础上,动态监测血清Cys-C并联合β2-MG,有利于早期发现老年CAP患者肾损害、合理使用抗菌素、缩短病程及降低住院费用。Objective To explore the clinical value of dynamically monitoring serum cystatin C （Cys-C） in the treatment of community acquired pneumonia （CAP） in the elderly. Methods 80 hospitalized patients with CAP were enrolled in the study and were randomly divided into 2 groups： observation group and control group; the renal function index in CURB-65 score of the patients in observation group was assessed by Cys-C while that of the patients in control group was assessed by blood uria nitroge （BUN）; Cys-C guided treatment was applied to patients in observation group; the clinical outcome, infection indices, serum Cys-C, BUN, urea nitrogen （Cr） and β2-microglobulin （β2-MG） of the patients in the 2 groups were dynamically monitored and compared; Cys-C guided apllication of antibiotics, hospitalization cost and duration were estimated. Results The levels of Cys-C of the patients in observation group on the 7th day and the 14th day were lower than those of the patients in control group （P 〈 0.01）; at the end of the study, the levels of β2-MG, BUN and C r of the patients in observation group were all lower than those of the patients in control group, as well as the hospitalization duration and cost, the time length of antibiotics application, the difference was of statistical significance （P〈0.01）. Conclusions Dynamically monitoring serum Cys-C plus β2-MG detection is of help to fred the renal lesion in elderly patients with CAP, to make a reasonable application of antibiotics and to shorten the disease course and to cut down the hospitalization cost.

关 键 词：老年 社区获得性肺炎 胱抑素C Β2微球蛋白 肾功能损害 

分 类 号：R563.1[医药卫生—呼吸系统]