呼吸机相关性肺炎血清脂联素水平变化的临床意义  

Clinical Value of Changes of Serum Adiponectin Level in Patients with Ventilator-associated Pneumonia

作　　者：夏敏[1] 聂时南[1] 韦梅[1] 韩小琴[1] XIA Min NIE Shi-nan WEI Mei HAN Xiao-qin(Emergency Department, Nanjing General Hospital of Nanjing Military Ar- ea Command, Nanjing 210002, China)

机构地区：[1]南京军区南京总医院急救医学科,南京210002

出　　处：《临床误诊误治》2017年第3期71-74,共4页Clinical Misdiagnosis & Mistherapy

基　　金：全军后勤面上项目(CNJ14L002);南京军区南京总医院院管课题(2015073)

摘　　要：目的探讨血清脂联素对呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的诊断及预后评估价值。方法选取我院收治的VAP 78例(VAP组),选择接受机械通气治疗未并发VAP 45例(对照组),VAP组在机械通气开始时(T0)、确诊VAP后第1天(T1)及第7天(T2)抽取静脉血,对照组在机械通气开始时(T0)、机械通气第4天(T1)和第11天(T2)抽取静脉血。比较两组血清脂联素水平的变化,并统计28 d死亡率及重症监护病房(ICU)住院时间。结果两组28 d死亡率及ICU住院时间比较差异有统计学意义(P<0.05)。T0时两组血清脂联素水平比较差异无统计学意义(P>0.05);与对照组比较,VAP组T1和T2时血清脂联素水平降低,差异有统计学意义(P<0.05)。VAP组的死亡组和生存组于T0时血清脂联素水平比较无统计学差异(P>0.05);死亡组T1和T2时血清脂联素水平明显低于生存组,差异有统计学意义(P<0.05)。血清脂联素水平与患者的预后、临床肺部感染评分、C反应蛋白水平及白细胞水平呈负相关,且血清脂联素水平是VAP死亡的独立危险因素。结论 VAP患者血清脂联素水平明显降低,监测其水平变化具有良好的诊断及预后评估价值。Objective To investigate value of serum adiponectin level in diagnosis and prognosis evaluation of patients with ventilator-associated pneumonia （VAP）. Methods A total of 78 VAP patients were enrolled as VAP group, and 45 patients undergoing mechanical ventilation without VAP were chosen as control group. Venous blood samples in VAP groups were measured on the day of mechanical ventilation （ TO）, the lS＇ day （ T1 ） and 7＇h day （T2） after confirming VAP di- agnosis, while samples in control group were measured on the day of mechanical ventilation （T0） , the 4th day （ T1 ） and 1 lth day （T2） after mechanical ventilation. Changes of adiponectin levels were compared in different groups, and mortality within 28 days and length of ICU stay were calculated. Results There were significant differences in mortality within 28 days and length of ICU stay between two subgroups in VAP group （ P 〈 0.05 ）. There was no significant difference in adiponeetin levels at TO between two groups （P 〉 0. 05）. Compared with those in control group, adiponectin levels at T1 and T2 were significantly decreased in VAP group （P 〈 0. 05）. There was no significant difference in adiponectin level at TO between death and survival subgroups in VAP group （P 〉 0.05） ; adiponectin levels at T1 and T2 in death group were significantly decreased compared with those in survival group （ P 〈 0.05 ）. Adiponectin level was negatively correlated with prognosis, clinical pulmo- nary infection score （CPIS） , c-reactive protein （CRP） and leukocyte levels, and adiponectin level was independent risk fac- tor of death for VAP patients. Conclusion Serum adiponectin levels in VAP patients can obviously decrease, and therefore it has good value to monitoring the level change for evaluating diagnosis and prognosis of VAP patients.

关 键 词：脂联素 肺炎 呼吸机相关性 预后 死亡 诊断 

分 类 号：R563.1[医药卫生—呼吸系统]