老年肺部感染患者脂聯(lián)素水平變化及臨床意義
發(fā)布時(shí)間：2018-11-15 08:49
【摘要】：目的 肺部感染是老年人常見的疾病之一,據(jù)統(tǒng)計(jì)16%以上的老年人直接死于肺部感染,并且有隨著年齡增長(zhǎng)而增高的趨勢(shì),因此,早期診斷、早期治療對(duì)疾病的評(píng)估至關(guān)重要。本研究通過收集老年肺部感染患者及對(duì)照組的臨床基本資料,檢測(cè)血清脂聯(lián)素(Adiponectin,APN)、C-反應(yīng)蛋白(C-reactive protein,CRP)等臨床指標(biāo),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(cè)提供依據(jù),同時(shí)為臨床醫(yī)師提供一種輔助診斷及監(jiān)測(cè)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(biāo)準(zhǔn),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(duì)照組。應(yīng)用酶聯(lián)免疫吸附法測(cè)定APN水平、乳膠增強(qiáng)的免疫比濁法測(cè)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(duì)照組比較,感染組中性粒細(xì)胞比率(Neutrophile granulocyte, N%)、白細(xì)胞數(shù)(White blood cell,WBC)明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；其余臨床指標(biāo)兩組間比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 2.與對(duì)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(duì)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(jì)學(xué)意義(P0.05)；CRP水平分別降低約64.3%、60.1%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 4.APN水平與臨床指標(biāo)的相關(guān)分析,發(fā)現(xiàn)血清APN與CRP、SBP、DBP相關(guān),相關(guān)系數(shù)分別為：r=-0.534、0.420、0.266(P0.05)。 5.進(jìn)一步行多元逐步回歸分析,以APN為應(yīng)變量,SBP、DBP、TG、CH、HDL、 LDL、FPG、2hPG、N%、WBC為自變量進(jìn)行多元逐步回歸分析顯示,CRP、SBP均進(jìn)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(dú)立影響因素�；貧w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(dú)立影響因素。 結(jié)論 1.APN水平隨著肺部感染程度呈一動(dòng)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(guān),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(cè)的新的標(biāo)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(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R563.1
本文編號(hào)：2332810
[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(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R563.1
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