血浆皮质醇与老年性社区获得性肺炎预后的关系研究  

Correlative study on the prognosis of community-acquired pneumonia in the elderly with plasma cortisol

作　　者：王萌 沈雁波[1] 王艳[1] 王霆[1] 李山峰[1] 周忠霞[1] 梁桂文[1] 曹志龙 WANG Meng;SHEN Yanbo;WANG Yan;WANG Ting;LI Shanfeng;ZHOU Zhongxia;LIANG Guiwen;CAO Zhilong(Department of Emergency,the Affiliated Hospital of Nantong University,Nantong 226001;1CU,Nantong Third People＇s Hospital,Jiangsu Province)

机构地区：[1]南通大学附属医院急诊科,南通226001 [2]江苏省南通市第三人民医院ICU

出　　处：《南通大学学报（医学版）》2018年第5期335-338,共4页Journal of Nantong University(Medical sciences)

基　　金：南通大学附属医院科技项目(TDFY0311)

摘　　要：目的 :探讨血浆皮质醇质量浓度与老年性社区获得性肺炎(community-acquired pneumonia, CAP)患者预后的关系。方法:前瞻性选取2014年1—12月南通大学附属医院急诊科收住院符合CAP诊断的老年患者,入选后第1个24 h内对CAP患者进行CURB-65评分、血浆皮质醇、促肾上腺皮质激素(adrenocorticotropic hormone, ACTH)、C反应蛋白(C-reactive protein, CRP)、白细胞等指标的检测,并记录患者的一般资料、既往病史、达到临床稳定的时间,以28 d是否存活为二分法分为存活组和死亡组,比较28 d存活组与死亡组患者之间各指标的差异,通过Logistic回归进行相关统计学分析。结果:研究最终入选CAP患者60例,所有患者的28 d病死率为25%,Logistic回归分析显示28 d病死率的独立危险因素是血浆皮质醇及血钠,血浆皮质醇比值比(odds ratio, OR)1.016,95%CI(1.005, 1.028),血钠OR0.893,95%CI(0.812, 0.983)。与存活组相比,死亡组的血浆皮质醇较有明显增高,而血钠显著降低(P<0.05)。结论:血浆皮质醇、血钠是老年住院CAP患者判断临床预后的独立危险因素,血浆皮质醇升高和血钠水平的降低与不良预后有关。Objective： To evaluate the relationships between the prognosis of community-acquired pneumonia（CAP） and plasma cortisol. Methods： A prospective observational study was conducted, elderly patients who fulfillied the CAP criteria ad- mitted to the ED of Affiliated Hospital of Nantong University from January to December 2014 were enrolled. The elderly whose physical examination were healthy at the same period were chosen as the control group. Plasma cortisol, adrenocorti- cotropic hormone（ACTH）, C-reactive protein（CRP）, leucocyte count and other indicators were detected and CURB-65 scores were calculated at enrollment. Record the patients＇ general characteristics, past history, the time to clinical stability. Various indicators were compared between patients with survivors and non-survivors. The differences were assessed by Logistic re- gression analysis. Results： 60 CAP patients were included in the study. The 28-day mortality of all the CAP patients was 25%. In Logistic regression analysis, serum sodium and plasma cortisol levels were independently associated with 28-day mortality（P〈0.05）. Plasma cortisol levels in non-survivors were significantly higher than survivors（P〈0.05）, while serum sodi- um levels were significantly lower in non-survivors（P〈0.05）. Conclusion： Plasma cortisol and serum sodium are independently associated with the clinical outcomes in hospitalised CAP elderly patients. The increase of plasma cortisol together with low serum sodium are associated with poor prognosis.

关 键 词：社区获得性肺炎 血浆皮质醇 预后 老年人 LOGISTIC回归分析 

分 类 号：R563.1[医药卫生—呼吸系统]