本文選題：社區(qū)獲得性肺炎　切入點：病情　出處：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:肺炎指各種病原微生物、理化因素、免疫損傷、藥物等引起的終末氣道、肺泡和肺間質的炎癥。按獲得環(huán)境分社區(qū)獲得性肺炎(Community-acquired pneumonia,CAP)和醫(yī)院獲得性肺炎(Hospital-acquired pneumonia,HAP)。CAP發(fā)病率約為12/1000,是危害人類健康的主要感染性疾病。隨著影像技術的發(fā)展,CAP診斷不難確立,但如何在臨床中快速識別患者病情,關系到治療方案的選擇及預后的判斷。然而CAP指南推薦的各種評分系統(tǒng)計算繁雜,不便于實際應用,因此,尋求方便可靠的炎性生物標志物成為研究熱點。C-反應蛋白(C-reactive protein,CRP)和降鈣素原(Procalcitonin,PCT)在炎癥過程中反應迅速,半衰期短,已有廣泛研究證實,可用于及時判斷CAP的病情和預后。血凝分析是臨床常規(guī)檢驗項目。其中D-二聚體(D-dimer,D-Di)是交聯(lián)纖維蛋白的降解產(chǎn)物,其水平升高提示高凝狀態(tài)和繼發(fā)性纖溶活性亢進。在呼吸系疾病中,目前常用于肺栓塞的診斷和治療評估。纖維蛋白原(Fibrinogen,FIB)即為凝血因子Ⅰ,同時也是急性炎癥反應的重要指標,炎癥發(fā)生時,通過誘導血小板聚集產(chǎn)生炎癥屏障作用。近年來,越來越多的學者開始關注炎癥與凝血的關系。機體發(fā)生炎癥反應后,直接或間接損傷血管內(nèi)皮細胞,激活凝血途徑,引起高凝狀態(tài),同時導致繼發(fā)性纖溶亢進。目前已有廣泛研究證實膿毒癥患者體內(nèi)也存在上述病理表現(xiàn),但肺炎作為一種局部感染性疾病是否也存在D-Di、FIB異常,以及此兩項指標在患者病情評估及預后判斷中的應用價值,目前研究尚較少,且結果不一。本研究旨在探討D-Di、FIB在CAP患者中臨床應用價值。方法:收集CAP患者81例,進行分組:a)按CURB-65評分分為:低危組、中危組、高危組。b)按累及節(jié)段分為:單側肺炎組和雙側肺炎組。c)按肺炎旁積液情況分為:未合并肺炎旁積液組、合并單側肺炎旁積液組、合并雙側肺炎旁積液組。d)按機械通氣與否分為:不需機械通氣組和需要機械通氣組。e)按轉歸分為:生存組和死亡組。收集入院24h內(nèi)化驗結果,比較各亞組之間D-Di、FIB水平,并與CRP、PCT進行相關分析。結果:1 CURB-65低危組D-Di顯著低于中危組、高危組(P0.05),而后兩組之間差異不顯著(P0.05)。單側肺炎組D-Di顯著低于雙側肺炎組(P0.05)。未合并肺炎旁積液組D-Di顯著低于合并單側肺炎旁積液組、雙側肺炎旁積液組(P0.05),而后兩組之間差異不顯著(P0.05)。FIB在各亞組之間均無差異(P0.05)。2需要機械通氣組D-Di、FIB與不需機械通氣組之間無顯著差異(P0.05)。3生存組D-Di、FIB與死亡組之間無顯著差異(P0.05)。4 D-Di與CRP、PCT相關系數(shù)分別為0.459、0.613(P0.01);FIB與CRP相關系數(shù)為0.701(P0.01),與PCT相關系數(shù)為0.261(P=0.050.01)。結論:1入院24h內(nèi),D-Di在一定程度可反映CAP患者病情嚴重程度,但不能全面反映臨床轉歸,FIB尚不能反映CAP患者病情嚴重程度及預后,但結合相關文獻,認為動態(tài)監(jiān)測更有助于全面評價其在CAP診治中的應用價值。2 CAP患者D-Di、FIB均與CRP、PCT存在相關性,可能成為一種新的肺炎生物標志物。3 CAP患者體內(nèi)存在高凝、繼發(fā)性纖溶亢進,適時的相關治療可能成為其輔助治療。
[Abstract]:Objective: pneumonia refers to various pathogenic microorganisms, physicochemical factors, immune injury caused by drugs, at the end of the airway, alveolar and pulmonary interstitial inflammation. According to the acquired environment of community acquired pneumonia (Community-acquired pneumonia, CAP) and hospital acquired pneumonia (Hospital-acquired pneumonia, HAP.CAP) the incidence rate is about 12/1000, is the main infectious diseases harmful to human health. With the development of imaging technology, CAP diagnosis is difficult to establish, but how to quickly identify patients in clinical disease, related to the treatment and prognosis judgment. However, all the CAP scoring system recommended calculation is complex. It is difficult for application, therefore, to seek a convenient and reliable inflammatory biomarkers has become a research hotspot of.C- reactive protein (C-reactive protein, CRP) and procalcitonin (Procalcitonin, PCT) in the inflammatory process rapid reaction, short half-life, extensive research Study confirmed that can be used to timely diagnose the condition and prognosis of CAP. Blood coagulation analysis is a clinical routine test. The two D- dimer (D-dimer, D-Di) is a degradation product of cross-linked fibrin, elevated levels suggest that hypercoagulability and secondary hyperfibrinolysis. In respiratory diseases, diagnosis and treatment commonly used to assess pulmonary embolism at present. Fibrinogen (Fibrinogen, FIB) is a coagulation factor, but also an important indicator of acute inflammation, inflammation, platelet aggregation induced by inflammatory barrier function. In recent years, more and more scholars began to pay attention to the relationship between inflammation and coagulation. The body inflammation after direct or indirect damage to vascular endothelial cells, activation of the coagulation pathway, induce a hypercoagulable state and lead to secondary hyperfibrinolysis. There are extensive research confirmed that in vivo sepsis is shown in the above pathological However, pneumonia as a local infectious disease whether there is D-Di, FIB anomaly, and the application value of the two indexes in the patient's condition and prognosis assessment of the present study is less, and the results are different. This study aimed to investigate the clinical value of D-Di and FIB in CAP patients. Methods: 81 cases of CAP patients were divided into two groups: a) according to the CURB-65 score: low risk group, medium risk group, high risk group.B) according to the involved segments divided into unilateral pneumonia group and bilateral pneumonia group.C) in parapneumonic effusion were divided into: parapneumonic effusion group combined with single side parapneumonic effusion group, with bilateral parapneumonic effusion group.D) according to the mechanical ventilation and can be divided into: without mechanical ventilation group and mechanical ventilation group) according to the outcome of.E is divided into: survival group and death group. 24h test results were collected, each subgroup were compared between D-Di and FIB levels, and CRP and PCT. The correlation analysis results: 1 CURB-65 low risk group D-Di was significantly lower than in the risk group, high risk group (P0.05), and no significant difference between the two groups (P0.05). Unilateral pneumonia group D-Di was significantly lower than the bilateral pneumonia group (P0.05). Not complicated parapneumonic effusion group was significantly lower than that of D-Di with unilateral parapneumonic effusion group, bilateral group (parapneumonic effusion P0.05), and no significant difference between the two groups (P0.05.FIB) there was no significant difference between every sub group (P0.05).2 mechanical ventilation group D-Di, there was no significant difference between FIB and non mechanical ventilation group (P0.05).3 D-Di FIB between survival group and death group, no significant difference (P0.05.4) D-Di and CRP PCT, the correlation coefficients were 0.459,0.613 (P0.01); FIB and CRP correlation coefficient was 0.701 (P0.01), and the PCT correlation coefficient was 0.261 (P=0.050.01). Conclusion: 1 24h of admission, D-Di can reflect the severity of CAP in a certain extent, but can not fully reflect the clinical outcome, not FIB reflect CA The severity of the condition and prognosis of patients with P, but with the relevant literature, that dynamic monitoring can help to fully evaluate its application value in the diagnosis and treatment of CAP in patients with CAP.2 D-Di, FIB and CRP, the relationship of PCT, may be a new biomarker for pneumonia hypercoagulable.3 in patients with CAP, secondary fiber solution of hyperthyroidism, timely treatment may become the adjuvant therapy.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.1

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