血浆和肽素水平在不同小儿社区获得性肺炎病情中的意义

摘要

目的 通过观察小儿社区获得性肺炎(CAP)患者体内血浆和肽素(copeptin)水平的改变,探讨其对病情判断的临床意义.方法 入选住院CAP组患儿46例,其中普通CAP 30例,重症16例;同时选健康儿童30例作为正常对照组.检测入院诊断时CAP患儿和对照组血浆中和肽素、白细胞计数(WBC)及中性粒细胞(N)计数、C-反应蛋白(CRP)、降钙素原(PCT)及血清钠水平.结果 CAP患儿(包括普通和重症病例)血浆和肽素[(0.65±0.25) ng/mL,(1.02±0.45)ng/L]均显著高于对照组[(0.37±0.13)ng/L] (P＜ 0.01),同时普通和重症CAP比较差异也有统计学意义(P＜0.01);各组间CRP及血清钠水平差异无统计学意义(P＞0.05),而WBC、N及PCT在普通和重症CAP比较差异无统计学意义(P＞0.05).且血浆中和肽素水平与WBC、N、CRP及血清钠无显著相关性.血浆和肽素水平对重症CAP患儿诊断的受试者工作特征曲线(ROC曲线)分析显示出一定诊断效能(AUC=0.753,95％CI 0.605～ 0.902,P=0.005),以和肽素＞0.92 ng/mL为界点,对诊断重症CAP有50％敏感度和86.67％特异度.结论 检测小儿CAP体内血浆和肽素的水平可能有助于判断CAP患儿的病情及其严重程度,但仍需更深入的研究.%Objective To explore the clinical significance of the changes of plasma copeptin levels in children with community acquired pneumonia (CAP).Methods Forty-six cases of hospitalized children with CAP were selected,including 30 cases with common pneumonia and 16 severe ones,and 30 healthy children as normal control group.At the same time,plasma levels of copeptin,white blood cell (WBC) and neutrophil (N) count,serum levels of C-reactive protein (CRP),procalcitonin (PCT) and sodium in children with CAP at diagnosis and control group were detected.Results Plasma copeptin in children with CAP (including common and severe cases) [(0.65±0.25)ng/mL,(1.02±0.45)ng/L]were significantly higher than that in the control group [(0.37±0.13)ng/L] (P＜ 0.01) and there was also statistical significance between common and severe cases (P ＜ 0.01);and no statistically significant difference for plasma CRP and serum sodium levels among 3 groups (P＞ 0.05),also for WBC,N and PCT between common and severe cases (P ＞ 0.05).And there was no significant correlation between serum copeptin levels and others.By analysis of receiver operating characteristic curve (ROC curve),plasma copeptin levels in children showed some diagnostic performance of severe cases [with area under the curve =0.753,95％ confidence interval (CI)0.605 ～ 0.902,P =0.005].When copeptin ＞ 0.92 ng/mL was taken as the cut-off value the sensitivity was 50％ and specificity 86.67％.Conclusion The determination of plasma copeptin levels in children with CAP might be helpful to judge the patient's condition and severity of CAP,that still needs further research.