PCT、ApoE和Nampt对呼吸机相关性肺炎的诊断作用
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摘要
目的探讨机械通气患者血清及支气管肺泡灌洗液中降钙素原(PCT)、载脂蛋白E(ApoE)、烟酰胺磷酸核糖转移酶(Nampt)水平对呼吸机相关性肺炎(VAP)的诊断作用。方法选取2015年12月—2016年12月行有创呼吸机辅助通气发生VAP患者23例为VAP组,以及同时期未发生VAP患者8例为非VAP组。分别于机械通气24、96和144 h取患者血清及支气管肺泡灌洗液标本,分别检测PCT、ApoE和Nampt水平。结果机械通气96和144 h,VAP组血清和灌洗液的PCT和ApoE水平高于非VAP组(P<0.01)。机械通气24、96和144 h,VAP组和非VAP组血清及灌洗液的Nampt水平比较差异均无统计学意义(P>0.05)。结论血清及支气管肺泡灌洗液PCT及ApoE水平测定,对VAP的早期诊断有着重要的指导意义。
Objective To investigate levels of procalcitonin(PCT), apolipoprotein E(ApoE) and nicotinamide phosphoribosyltransferase(Nampt) in serum and bronchoalveolar lavage fluid and their effects in diagnosis of ventilator-associated pneumonia(VAP). Methods A total of 23 patients with VAP, when they underwent invasive ventilator-assisted ventilation during December 2015 and December 2016, were selected as VAP group, and other 8 patients without VAP at the same period were selected as non-VAP group. Samples of serum and bronchoalveolar lavage fluid were collected at the 24~(th), 96~(th) and 144~(th) h after mechanical ventilation, and then PCT, ApoE and Nampt levels were detected respectively. Results At the 96~(th) and 144~(th) h after mechanical ventilation, PCT and APOE levels in serum and lavage fluid in VAP group were significantly higher than those in non-VAP group(P<0.01). There were no significant differences in Nampt levels in serum and lavage fluid at the 24~(th), 96~(th) and 144~(th) h after mechanical ventilation between VAP and non-VAP groups(P>0.05). Conclusion Determination of PCT and ApoE levels in serum and bronchoalveolar lavage fluid has important guiding significance in early diagnosis of VAP.
Objective To investigate levels of procalcitonin(PCT), apolipoprotein E(ApoE) and nicotinamide phosphoribosyltransferase(Nampt) in serum and bronchoalveolar lavage fluid and their effects in diagnosis of ventilator-associated pneumonia(VAP). Methods A total of 23 patients with VAP, when they underwent invasive ventilator-assisted ventilation during December 2015 and December 2016, were selected as VAP group, and other 8 patients without VAP at the same period were selected as non-VAP group. Samples of serum and bronchoalveolar lavage fluid were collected at the 24~(th), 96~(th) and 144~(th) h after mechanical ventilation, and then PCT, ApoE and Nampt levels were detected respectively. Results At the 96~(th) and 144~(th) h after mechanical ventilation, PCT and APOE levels in serum and lavage fluid in VAP group were significantly higher than those in non-VAP group(P<0.01). There were no significant differences in Nampt levels in serum and lavage fluid at the 24~(th), 96~(th) and 144~(th) h after mechanical ventilation between VAP and non-VAP groups(P>0.05). Conclusion Determination of PCT and ApoE levels in serum and bronchoalveolar lavage fluid has important guiding significance in early diagnosis of VAP.
引文
[1] 陆朝强.重症医学科老年重症患者呼吸机相关性肺炎的危险因素分析[J].重庆医学,2014,43(17):2213-2215.
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[3] Halpern N A, Hale K E, Sepkowitz K A, et al. A world without ventilator-associated pneumonia: time to abandon surveillance and deconstruct the bundle[J].Crit Care Med, 2012,40(1):267-270.
[4] Zagli G, Cozzolino M, Terreni A, et al. Diagnosis of ventilator-associated pneumonia: a pilot, exploratory analysis of a new score based on procalcitonin and chest echography[J].Chest, 2014,146(6):1578-1585.
[5] Ramirez P, Carcia M A, Ferrer M, et al. Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia[J].Eur Respir J, 2008,31(2):356-362.
[6] 中华医学会重症分会.呼吸机相关性肺炎诊断、预防和治疗指南:2013[J].中华内科杂志,2013,52(6):524-543.
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[8] 唐小君,李燕,程琳,等.动态监测血清素原对诊断呼吸机相关肺炎的临床价值[J].齐齐哈尔医学院学报,2014,35(6):827-828.
[9] 任芳萍,刘玲莉.降钙素原检测在呼吸机相关性肺炎中的预测价值[J].吉林医学,2013,34(12):2239-2240.
[10] 袁超,游莎.血清降钙素原与临床肺部感染评分在呼吸机相关肺炎诊疗中价值[J].中华实用诊断与治疗杂志,2015,29(5):505-507.
[11] Chuang K, Elford E L, Tseng J, et al. An expanding role for apolipoprotein E in sepsis and inflammation[J].Am J Surg, 2010,200(3):391-397.
[12] 朱月清,朱小林,朱秀芳.血清载脂蛋白E检测在医院获得性肺炎诊断和预后中的价值[J].中国卫生检验杂志,2015,25(9):1382-1383,1386.
[13] Samal B, Sun Y, Steams G, et al. Cloning and characterization of the cDNA encoding a novel human pre-B-cell colony-enhancing factor[J].Mol Cell Biol, 1994,14(2):1431-1437.
[14] Ognjanovic S, Bryant-Greenwood G D. Pre-B-cell colony-enhancing factor, a novel cytokine of human fetal membranes[J].Am J Obstet Gynecol, 2002,187(4):1051-1058.
[15] 何达,杜延玲,孙静.血清标记物在COPD中的研究进展[J].临床肺科杂志,2014,19(4):731-733.
[2] 李学莉,郭旻,沙玉霞,等.免疫状态与呼吸机相关性肺炎的相关性研究[J].中华医院感染学杂志,2011,21(24):5171-5173.
[3] Halpern N A, Hale K E, Sepkowitz K A, et al. A world without ventilator-associated pneumonia: time to abandon surveillance and deconstruct the bundle[J].Crit Care Med, 2012,40(1):267-270.
[4] Zagli G, Cozzolino M, Terreni A, et al. Diagnosis of ventilator-associated pneumonia: a pilot, exploratory analysis of a new score based on procalcitonin and chest echography[J].Chest, 2014,146(6):1578-1585.
[5] Ramirez P, Carcia M A, Ferrer M, et al. Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia[J].Eur Respir J, 2008,31(2):356-362.
[6] 中华医学会重症分会.呼吸机相关性肺炎诊断、预防和治疗指南:2013[J].中华内科杂志,2013,52(6):524-543.
[7] 何博,方伟,高华.降钙素原在成人呼吸机相关性肺炎中的临床应用价值探讨[J].中国医药指南,2014,12(30):204-205.
[8] 唐小君,李燕,程琳,等.动态监测血清素原对诊断呼吸机相关肺炎的临床价值[J].齐齐哈尔医学院学报,2014,35(6):827-828.
[9] 任芳萍,刘玲莉.降钙素原检测在呼吸机相关性肺炎中的预测价值[J].吉林医学,2013,34(12):2239-2240.
[10] 袁超,游莎.血清降钙素原与临床肺部感染评分在呼吸机相关肺炎诊疗中价值[J].中华实用诊断与治疗杂志,2015,29(5):505-507.
[11] Chuang K, Elford E L, Tseng J, et al. An expanding role for apolipoprotein E in sepsis and inflammation[J].Am J Surg, 2010,200(3):391-397.
[12] 朱月清,朱小林,朱秀芳.血清载脂蛋白E检测在医院获得性肺炎诊断和预后中的价值[J].中国卫生检验杂志,2015,25(9):1382-1383,1386.
[13] Samal B, Sun Y, Steams G, et al. Cloning and characterization of the cDNA encoding a novel human pre-B-cell colony-enhancing factor[J].Mol Cell Biol, 1994,14(2):1431-1437.
[14] Ognjanovic S, Bryant-Greenwood G D. Pre-B-cell colony-enhancing factor, a novel cytokine of human fetal membranes[J].Am J Obstet Gynecol, 2002,187(4):1051-1058.
[15] 何达,杜延玲,孙静.血清标记物在COPD中的研究进展[J].临床肺科杂志,2014,19(4):731-733.