【摘要】：目的 肺部感染是老年人常見的疾病之一,據(jù)統(tǒng)計16%以上的老年人直接死于肺部感染,并且有隨著年齡增長而增高的趨勢,因此,早期診斷、早期治療對疾病的評估至關重要。本研究通過收集老年肺部感染患者及對照組的臨床基本資料,檢測血清脂聯(lián)素(Adiponectin,APN)、C-反應蛋白(C-reactive protein,CRP)等臨床指標,探討APN水平在老年肺部感染中的變化及與肺部感染的聯(lián)系,以期為老年肺部感染患者臨床診斷及病情監(jiān)測提供依據(jù),同時為臨床醫(yī)師提供一種輔助診斷及監(jiān)測病情變化的方法。 方法 選取2012年4月--2013年6月在我院連續(xù)入住的60歲的社區(qū)獲得性肺炎及醫(yī)院獲得性肺炎患者70例,作為感染組；按照重癥肺炎診斷標準,重癥肺炎患者27例,作為重癥組,余43例非重癥患者,作為輕癥組；選取同期在我院體檢中心60歲的健康受檢者20例,作為對照組。應用酶聯(lián)免疫吸附法測定APN水平、乳膠增強的免疫比濁法測定CRP水平,并觀察血清APN水平及CRP水平的變化。 結(jié)果 1.與對照組比較,感染組中性粒細胞比率(Neutrophile granulocyte, N%)、白細胞數(shù)(White blood cell,WBC)明顯升高,差異有統(tǒng)計學意義(P0.05)；其余臨床指標兩組間比較,差異無統(tǒng)計學意義(P0.05)。 2.與對照組比較,輕癥組、重癥組血清APN水平均明顯降低[(8.89±1.93)mg/Lvs(6.79±1.87) mg/L vs (4.89±1.13)mg/L,P0.05];與輕癥組比較,重癥組血清APN水平明顯降低[(6.79±1.87) mg/Lvs (4.89±1.13) mg/L,P0.05];與對照組比較,輕癥組、重癥組CRP水平均明顯升高[(1.69±1.12) mg/L vs (13.38±3.07) mg/L vs (18.41±4.6)mg/L,P0.05];與輕癥組比較,重癥組CRP水平明顯升高[(13.38±3.07)mg/Lvs (18.41±4.6) mg/L,P0.05]. 3.經(jīng)內(nèi)科積極治療后,輕癥組、重癥組血清APN水平分別升高約41.1%、20%,且輕癥組升高更為顯著,差異有統(tǒng)計學意義(P0.05)；CRP水平分別降低約64.3%、60.1%,差異有統(tǒng)計學意義(P0.05)。 4.APN水平與臨床指標的相關分析,發(fā)現(xiàn)血清APN與CRP、SBP、DBP相關,相關系數(shù)分別為：r=-0.534、0.420、0.266(P0.05)。 5.進一步行多元逐步回歸分析,以APN為應變量,SBP、DBP、TG、CH、HDL、 LDL、FPG、2hPG、N%、WBC為自變量進行多元逐步回歸分析顯示,CRP、SBP均進入APN的回歸方程,結(jié)果表明在排除多種因素的交互影響后,CRP、SBP是血清APN的獨立影響因素。回歸方程為：APN=3.051-0.181CRP+0.043SBP 6.經(jīng)多元逐步Logistic回歸分析,APN是老年肺部感染的獨立影響因素。 結(jié)論 1.APN水平隨著肺部感染程度呈一動態(tài)演變,提示APN與老年肺部感染的發(fā)生發(fā)展密切相關,可能是老年肺部感染的顯著影響因素。 2.APN可能是一種新的抗炎因子。 3.APN有望作為老年人肺部感染診斷和病情監(jiān)測的新的標志物。
[Abstract]:Objective Pulmonary infection is one of the most common diseases in the elderly. According to statistics, more than 16% of the elderly die directly from pulmonary infection and have a tendency to increase with age. Early treatment is essential for disease assessment. In this study, serum adiponectin (Adiponectin,APN), C-reactive protein (C-reactive protein,CRP) and other clinical indexes were detected by collecting the clinical data of the elderly patients with pulmonary infection and the control group. To explore the changes of APN level in elderly patients with pulmonary infection and its relationship with pulmonary infection in order to provide a basis for clinical diagnosis and disease monitoring in elderly patients with pulmonary infection and to provide a method to assist clinicians to diagnose and monitor the changes of the disease. Methods from April 2012 to June 2013, 70 patients with community acquired pneumonia (CPAP) and nosocomial pneumonia (NAP) who were admitted to our hospital from April 2012 to June 2013 were selected as infection group. According to the diagnostic criteria of severe pneumonia, 27 cases of severe pneumonia were selected as severe group and 43 cases as mild group, and 20 cases of healthy subjects aged 60 years old in physical examination center of our hospital were selected as control group. The levels of APN and CRP were determined by enzyme-linked immunosorbent assay (Elisa) and latex enhanced immunoturbidimetry respectively. The changes of serum APN and CRP levels were observed. Result 1. Compared with the control group, the neutrophil ratio (Neutrophile granulocyte, N%) and the white blood cell count (White blood cell,WBC) in the infected group were significantly higher than those in the control group (P0.05). Other clinical indicators between the two groups, the difference was not statistically significant (P0.05). 2. Compared with the control group, the serum APN levels in the mild group and the severe group were significantly decreased [(8.89 鹵1.93) mg/Lvs (6.79 鹵1.87) mg/L vs (4.89 鹵1.13) mg/L,P0.05]. Compared with the mild group, the serum APN level in the severe group was significantly decreased [(6.79 鹵1.87) mg/Lvs (4.89 鹵1.13) mg/L,P0.05]. Compared with the control group, the level of CRP in the mild group and the severe group was significantly increased [(1.69 鹵1.12) mg/L vs (13.38 鹵3.07) mg/L vs (18.41 鹵4.6) mg/L,P0.05]. The level of CRP in severe group was significantly higher than that in mild group [(13.38 鹵3.07) mg/Lvs (18.41 鹵4.6) mg/L,P0.05]. 3. After active medical treatment, the level of serum APN in mild group and severe group were increased by 41.1% and 20% respectively, and the level of serum APN in mild group was higher than that in control group (P0.05). CRP level decreased about 64.3% and 60.1%, the difference was statistically significant (P0.05). The correlation analysis between 4.APN level and clinical indexes showed that serum APN was correlated with CRP,SBP,DBP, and the correlation coefficients were: r = -0.534 ~ (0.420) ~ (0.266) (P0.05). 5. Further multivariate stepwise regression analysis showed that CRP,SBP entered the regression equation of APN with APN as dependent variable and SBP,DBP,TG,CH,HDL, LDL,FPG,2hPG,N%,WBC as independent variable in multivariate stepwise regression analysis. The results showed that CRP,SBP was an independent factor of serum APN after the interaction of many factors was excluded. The regression equation is APN=3.051-0.181CRP 0.043SBP 6. Multiple stepwise Logistic regression analysis showed that APN was an independent factor of pulmonary infection in the elderly. Conclusion the level of 1.APN changes dynamically with the degree of pulmonary infection, suggesting that APN is closely related to the occurrence and development of pulmonary infection in the elderly, and may be a significant influencing factor of pulmonary infection in the elderly. 2.APN may be a new anti-inflammatory factor. 3.APN is expected to be a new marker for the diagnosis and monitoring of pulmonary infection in the elderly.
【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R563.1

【參考文獻】

相關期刊論文 前10條

1 劉金波;鄧華聰;葛倩;李丙蓉;鄭宏庭;蘭麗珍;;脂聯(lián)素對TNF-α介導的血管炎癥反應的影響[J];第四軍醫(yī)大學學報;2006年18期

2 鄧建平;陳云鵬;;C反應蛋白、白細胞與中性粒細胞檢查在炎癥反應中的意義[J];實驗與檢驗醫(yī)學;2010年03期

3 李莎;鮑紅光;;脂聯(lián)素在炎癥性疾病中的研究進展[J];現(xiàn)代生物醫(yī)學進展;2009年23期

4 孫奇峰;;老年肺部感染患者的臨床特征及治療體會[J];實用心腦肺血管病雜志;2013年05期

5 陳懿建;萬通;陳方平;;脂聯(lián)素——一種新的抗炎因子[J];國際病理科學與臨床雜志;2009年01期

6 趙志強;田鳳石;;脂聯(lián)素和心血管疾病關系的研究進展[J];中國心血管雜志;2007年05期

7 廖文強;龐燕;張翼冠;李曉輝;;脂聯(lián)素抗人臍靜脈內(nèi)皮細胞氧化損傷的作用研究[J];中國病理生理雜志;2009年03期

8 夏東;曹恂;;168例老年肺部感染患者臨床特點分析[J];中華醫(yī)院感染學雜志;2011年06期

9 常利民;馬友田;;老年人群高血壓研究現(xiàn)狀[J];中國慢性病預防與控制;2008年05期

10 郁秀莉;何元兵;夏宇;王晶;齊曼古力·吾守爾;;血清降鈣素原及C反應蛋白在社區(qū)獲得性肺炎和肺結(jié)核中的診斷價值[J];中國呼吸與危重監(jiān)護雜志;2013年02期

，

本文編號：2332810