摘要目的 探讨测定社区获得性肺炎(CAP)患者血清合肽素的临床意义.方法 收集南京东南大学附属中大医院呼吸科病房2009年3-6月入院的62例CAP患者,男32例,女30例,平均年龄(45±25)岁;对照组为16名健康志愿者,男8名,女8名,平均年龄(41±23)岁.62例CAP患者诊断依据及入院治疗标准符合中华医学会呼吸病学分会制定的"社区获得性肺炎诊断和治疗指南".按肺炎严重指数(PSI)将患者分为:(1)Ⅰ～Ⅲ级组24例;(2)Ⅳ级组20例;(3)Ⅴ级组18例.测定肺炎患者治疗前后及对照组的血清合肽素、血常规、血清超敏C反应蛋白、PaO_2及氧合指数(PaO_2/FiO_2),比较4组相关数值的差异.组间比较采用q检验,治疗前后的比较采用组内配对t检验.结果 治疗前Ⅴ级肺炎患者血清合肽素为(0.91±0.16)μg/L,明显高于Ⅳ级肺炎患者的(0.56±0.11)μg/L、Ⅰ～Ⅲ级肺炎患者的(0.34±0.06)μg/L及对照组的(0.08±0.02)μg/L;治疗后Ⅴ级、Ⅳ级、Ⅰ～Ⅲ级肺炎患者血清合肽素分别为(0.11±0.04)、(0.13±0.05)和(0.07±0.03)μg/L,均较治疗前显著降低.治疗前肺炎患者血清超敏C反应蛋白、白细胞总数均明显高于对照组,治疗后明显下降.治疗前Ⅴ级肺炎患者PaO_2、PaO_2/FiO_2:均明显低于Ⅳ级、Ⅰ～Ⅲ级肺炎患者及对照组,治疗后明显升高.结论 血清合肽素可作为判断社区获得性肺炎患者治疗疗效的一项指标.

abstractsObjective To study the clinical significance of serum copeptin in patients with community-acquired pneumonia (CAP). Methods Sixty-two cases of hospitalized CAP including 32 males and 30 females with a mean age of (45 ±25) years were recruited from the respiratory wards in the affiliated Zhongda Hospital of Southeast University from March 2009 to June 2009. Sixteen healthy volunteers including 8 males and 8 females with a mean age of (41 ±23) years served as the control. The CAP patients were divided into 3 groups; grade Ⅰ-Ⅲ (n =24) , grade Ⅳ (n =20) and grade Ⅴ(n = 18) according to pneumonia severity index (PSI). Serum copeptin, blood routine, serum high-sensitivity C-reactive protein, arterial partial pressure of oxygen ( PaO_2 ) and oxygenation index ( PaO_2/FiO_2 ) were detected in the patients with CAP before and after the treatment as well as the volunteers in the control group. The difference of related data among 4 groups were compared. q test was adopted in the comparison between the groups, and group paired t test was adopted in the comparison between parameters before and after the treatment. Results Serum copeptin concentration of the gradeV patients [ (0. 91±0. 16) μg/L] was significantly higher than those of thegrade IV patients [(0. 56±0. 11)μg/L] , grade I -Ⅲ patients [(0. 34±0. 06) μg/L] and the control group [ (0. 08 ±0. 02) μg/L] before the treatment . Serum copeptin concentration of the grade V patients [ (0. 11 ±0. 04) μg/L] , grade Ⅳ patients [ (0. 13 ±0. 05) μg/L] , and grade I -Ⅲ patients [ (0. 07±0. 03) μg/L] after the treatment were significantly lower than those before the treatment Serum high-sensitivity C-reactive protein and the total number of white blood cells of the patients with CAP were significantly higher than those of the control group before the treatment. Serum high-sensitivity C-reactive protein and total number of white blood cells of the patients with CAP were significantly decreased after the treatment PaO_2 and PaO_2/FiO_2 of the grade V patients were significantly lower than those of the grade IV patients,grade Ⅰ-Ⅲ patients and the control group before the treatment,and were significantly increased after the treatment.Conclusion Serum copeptin could be used as an inflanmmtory marker for judging the treatment efficacy in patients with CAP.