内源性一氧化碳在老年肺炎患者中的变化及临床意义

摘要

目的 探讨内源性一氧化碳(CO)在老年人肺炎中的变化及意义.方法 选取30例老年肺炎患者及12例中年肺炎患者,分别于急性期和恢复期抽取静脉血测定血浆CO、TNF-α、IL-6浓度,入院时进行APACHEⅡ评分判断患者病情严重程度.分别比较老年肺炎组急性期与恢复期各指标之间的差异以及相同病程的老年肺炎组和中年肺炎组间各指标之间的差异.分析老年肺炎组血浆CO与TNF-α、IL-6及APACHEⅡ评分之间的相关性.结果 ①老年肺炎组急性期的CO、TNF-α和IL-6水平较中年组明显升高(P＜0.01).②老年肺炎患者的血清CO、TNF-α、IL-6水平急性期明显高于恢复期(P＜0.01),多元相关分析显示CO与TNF-α、IL-6水平及APACHEⅡ评分均呈显著正相关(P＜0.01).结论 老年肺炎患者内源性CO水平明显升高,且与炎症反应、病情轻重程度有关;内源性CO对老年肺炎患者病情和预后判断具有一定的临床意义.%Objective To investigate the changes and significance of endogenous carbon monoxide(CO)in old patients with pneumonia.Methods Thirty old patients and twelve adult patients with pneumonia were collected.Blood samples of the selected patients were respectively collected at the acute stage and convalescent stage.The levels of CO,tumor necrosis factor(TNF)-αt and interleukin(IL)-6 in plasma were examined.According to APACHE Ⅱ scores,the severity of the patients were estimated.The indexes were compared between the old patients with pneumonia at the acute stage and the convalescent stage,and between the old patients and the adult patients with pneumonia at the same stage.The correlation between plasma CO and TNF-α,IL-6,APACHE Ⅱ scores were analyzed respectively in the old patients with pneumonia.Results ①The CO level in the old patients at the acute stage was significantly higher than that of the adult patients (P ＜ 0.01).②The levels of CO,TNF-α and IL-6 were higher in old patients with pneumonia at the acute stage than that at the convalescent stage(P ＜ 0.01).The level of CO was positively correlated with APACHE Ⅱ scores,TNF-α and IL-6,respectively (P ＜ 0.01).Conclusion ①Endogenous CO increases in old patients with pneumonia.②The level of plasma CO may serve as a marker of severity and prognosis of pneumonia in old patients.