高血压脑出血患者肺部感染血清炎性指标与和肽素的变化及意义
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摘要
目的 探讨高血压脑出血(Hypertensive cerebral hemorrhage,HICH)肺部感染患者血清C-反应蛋白(CRP)、降钙素原(PCT)、和肽素的变化及与患者感染病情的关系。方法 选取2014年6月-2017年12月医院收治的120例HICH在医院接受开颅或微创血肿清除手术患者,根据患者术后是否发生肺部感染分为感染组38例、非感染组82例,对比两组患者术前及术后第1、3、5、7天的血清CRP、PCT、和肽素水平。结果 术后第1天,两组患者的血清CRP、PCT、和肽素水平差异无统计学意义;术后第3天,感染组患者的血清PCT、和肽素高于非感染组(P<0.05),而两组CRP差异无统计学意义;术后第5天、第7天,感染组患者的血清CRP、PCT、和肽素水平均高于非感染组(P<0.05);感染组患者术后第5天的CPIS评分为(7.79±0.66)分,CPIS评分与血清CRP、PCT、和肽素水平均呈正相关(P<0.05);感染组患者治疗5天后,血清CRP、PCT、和肽素水平较治疗前均降低(P<0.05)。结论 HICH并发肺部感染患者血清CRP、PCT、和肽素水平升高,三种指标与患者的肺炎病情严重程度具有一定的相关性,具有一定的临床价值。
OBJECTIVE To investigate the changes of serum C-reactive protein(CRP), procalcitonin(PCT), and copeptin in patients with hypertensive intracerebral hemorrhage(HICH) complicated by pulmonary infection and the relationship with the patients' infection. METHODS Totally 120 patients with HICH admitted to the hospital from Jun. 2014 to Dec. 2017 were selected. All patients underwent craniotomy or minimally invasive hematoma evacuation in the hospital. According to the occurrence of pulmonary infection after operation, the patients were divided into the infection group(38 cases) and the non-infected group(82 cases). The changes in serum CRP, PCT, and copeptin levels before operation and 1 day, 3 days, 5 days or 7 days after operation were compared between the two groups. RESULTS On the first day after surgery, there was no significant difference in serum CRP, PCT, and copeptin levels between the two groups. On the third day after surgery, the serum PCT and copeptin levels were higher in the infected group than in the non-infected group(P<0.05). There was no significant difference in CRP between the two groups. On the 5 th and 7 th day after surgery, the serum CRP, PCT, and copeptin levels in the infected group were significantly higher than those in the non-infected group(P<0.05). The CPIS score of patients in the infected group was(7.79±0.66) on the 5 th day after operation. The CPIS score was significantly positively correlated with serum CRP, PCT, and copeptin levels(P<0.05). After 5 days of treatment, the serum CRP, PCT, and copeptin levels in the infected group were significantly lower than those before treatment(P<0.05). CONCLUSION Serum levels of CRP, PCT and copeptin are elevated in patients with HICH complicated with pulmonary infection. These three indicators have a certain correlation with the severity of pneumonia in the patients, and have certain clinical value.
OBJECTIVE To investigate the changes of serum C-reactive protein(CRP), procalcitonin(PCT), and copeptin in patients with hypertensive intracerebral hemorrhage(HICH) complicated by pulmonary infection and the relationship with the patients' infection. METHODS Totally 120 patients with HICH admitted to the hospital from Jun. 2014 to Dec. 2017 were selected. All patients underwent craniotomy or minimally invasive hematoma evacuation in the hospital. According to the occurrence of pulmonary infection after operation, the patients were divided into the infection group(38 cases) and the non-infected group(82 cases). The changes in serum CRP, PCT, and copeptin levels before operation and 1 day, 3 days, 5 days or 7 days after operation were compared between the two groups. RESULTS On the first day after surgery, there was no significant difference in serum CRP, PCT, and copeptin levels between the two groups. On the third day after surgery, the serum PCT and copeptin levels were higher in the infected group than in the non-infected group(P<0.05). There was no significant difference in CRP between the two groups. On the 5 th and 7 th day after surgery, the serum CRP, PCT, and copeptin levels in the infected group were significantly higher than those in the non-infected group(P<0.05). The CPIS score of patients in the infected group was(7.79±0.66) on the 5 th day after operation. The CPIS score was significantly positively correlated with serum CRP, PCT, and copeptin levels(P<0.05). After 5 days of treatment, the serum CRP, PCT, and copeptin levels in the infected group were significantly lower than those before treatment(P<0.05). CONCLUSION Serum levels of CRP, PCT and copeptin are elevated in patients with HICH complicated with pulmonary infection. These three indicators have a certain correlation with the severity of pneumonia in the patients, and have certain clinical value.
引文
[1] 官念,吴碧华,刘黎明,等.脑出血病因及相关机制的研究进展[J].中华老年心脑血管病杂志,2016,18(6):670-672.
[2] 毕惠珍,朱道华,刘润霞,等.高血压脑出血患者肺部感染的相关危险因素调查[J].中华医院感染学杂志,2015,25(5):1079-1081.
[3] Othman AE,Afat S,Nikoubashman O,et al.Volume perfusion CT imaging of cerebral vasospasm:diagnostic performance of different perfusion maps[J].Neuroradiology,2016,58(8):787-792.
[4] 于朝霞,王毅,于湘友,等.高血压脑出血微创术后肺部感染的病原菌分布及药敏性分析[J].中国老年学杂志,2015,35(23):6760-6762.
[5] 陈建时,郭蕾,戴凌燕,等.血浆Presepsin测定在脑出血患者术后医院获得性肺炎诊断中的价值[J].中华临床感染病杂志,2015,8(1):79-82.
[6] Rivera-Lara L,Murthy SB,Nekoovaght-Tak S,et al.Influence of bleeding pattern on ischemic lesions after spontaneous hypertensive intracerebral hemorrhage with intraventricular hemorrhage[J].Neurocrit Care,2018,29(2):180-188.
[7] Boehme AK,Comeau ME,Langefeld CD,et al.Systemic inflammatory response syndrome,infection,and outcome in intracerebral hemorrhage[J].Neurol Neuroimmunol Neuroinflamm,2017,5(2):e428.
[8] Kunze E,Stetter C,Willner N,et al.Effects of fluid treatment with hydroxyethyl starch on renal function in patients with aneurysmal subarachnoid hemorrhage[J].J Neurosurg Anesthesiol,2016,28(3):187-194.
[9] Zeynalov E,Jones SM.Recent advances and future directions in preclinical research of arginine-vasopressin (AVP) receptor blocker conivaptan in the context of stroke[J].Neural Regen Res,2016,11(3):392-393.
[10] 中华医学会神经病学分会.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[11] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[12] 耿莉华.医院感染控制指南[M].北京:科学技术文献出版社,2004:28.
[13] Randell A,Chokshi K,Kane B,et al.Alterations to the middle cerebral artery of the hypertensive-arthritic rat model potentiatesintracerebral hemorrhage[J].PeerJ,2016,4:e2608.
[14] Charidimou A,Boulouis G,Haley K,et al.White matter hyperintensity patterns in cerebral amyloid angiopathy and hypertensivearteriopathy[J].Neurology,2016,86(6):505-511.
[15] Carteron L,Patet C,Solari D,et al.Non-ischemic cerebral energy dysfunction at the early brain injury phase following aneurysmal subarachnoid hemorrhage[J].Front Neurol,2017,8:325.
[16] 张功义,孟庆勇,阮金成,等.降钙素原联合C反应蛋白在重症患者合并肺部感染的诊断价值[J].实用医药杂志,2016,33(10):888-890.
[17] Nilsson ED,Melander O,Elmstahl S,et al.Copeptin,a marker of vasopressin,predicts vascular dementia but not Alzheimer's disease[J].J Alzheimers Dis,2016,52(3):1047-1053.
[18] Beseoglu K,Etminan N,Hanggi D.The value of perfusion computed tomography (PCT) imaging after aneurysmal subarachnoid hemorrhage:a review of the current data[J].Acta Neurochir Suppl,2015,120:35-38.
[19] 祝超,李黎欣.高血压脑出血并发院内肺部感染临床分析[J].中华肺部疾病杂志(电子版),2018,11(2):212-213.
[20] Carcel C,Sato S,Zheng D,et al.Prognostic significance of hyponatremia in acute intracerebral hemorrhage:pooled analysis of the intensive blood pressure reduction in acute cerebral hemorrhage trial studies[J].Crit Care Med,2016,44(7):1388-1394.
[21] 庞敏.MMP、IGF和PCT水平变化在脑梗死合并肺部感染患者中的意义[J].临床肺科杂志,2018,23(11):2069-2073.
[22] Yaghi S,Elkind MS.Lipids and cerebrovascular disease:research and practice[J].Stroke,2015,46(11):3322-3328.
[23] Christ-Crain M,Morgenthaler NG,Fenske W.Copeptin as a biomarker and a diagnostic tool in the evaluation of patients with polyuria-polydipsia and hyponatremia[J].Best Pract Res Clin Endocrinol Metab,2016,30(2):235-247.
[24] 杨丽,郭炜炜,丁水印,等.心力衰竭合并肺部感染患者血清RAAS与MMP及TIMP指标的变化研究[J].中华医院感染学杂志,2017,27(6):1259-1262.
[25] Siddiqui AS,Zimmerman JL.Pulmonary infection secondary to Chrysosporium zonatum in an immunocompetent man[J].Ann Am Thorac Soc,2016,13(5):757-758.
[2] 毕惠珍,朱道华,刘润霞,等.高血压脑出血患者肺部感染的相关危险因素调查[J].中华医院感染学杂志,2015,25(5):1079-1081.
[3] Othman AE,Afat S,Nikoubashman O,et al.Volume perfusion CT imaging of cerebral vasospasm:diagnostic performance of different perfusion maps[J].Neuroradiology,2016,58(8):787-792.
[4] 于朝霞,王毅,于湘友,等.高血压脑出血微创术后肺部感染的病原菌分布及药敏性分析[J].中国老年学杂志,2015,35(23):6760-6762.
[5] 陈建时,郭蕾,戴凌燕,等.血浆Presepsin测定在脑出血患者术后医院获得性肺炎诊断中的价值[J].中华临床感染病杂志,2015,8(1):79-82.
[6] Rivera-Lara L,Murthy SB,Nekoovaght-Tak S,et al.Influence of bleeding pattern on ischemic lesions after spontaneous hypertensive intracerebral hemorrhage with intraventricular hemorrhage[J].Neurocrit Care,2018,29(2):180-188.
[7] Boehme AK,Comeau ME,Langefeld CD,et al.Systemic inflammatory response syndrome,infection,and outcome in intracerebral hemorrhage[J].Neurol Neuroimmunol Neuroinflamm,2017,5(2):e428.
[8] Kunze E,Stetter C,Willner N,et al.Effects of fluid treatment with hydroxyethyl starch on renal function in patients with aneurysmal subarachnoid hemorrhage[J].J Neurosurg Anesthesiol,2016,28(3):187-194.
[9] Zeynalov E,Jones SM.Recent advances and future directions in preclinical research of arginine-vasopressin (AVP) receptor blocker conivaptan in the context of stroke[J].Neural Regen Res,2016,11(3):392-393.
[10] 中华医学会神经病学分会.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[11] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[12] 耿莉华.医院感染控制指南[M].北京:科学技术文献出版社,2004:28.
[13] Randell A,Chokshi K,Kane B,et al.Alterations to the middle cerebral artery of the hypertensive-arthritic rat model potentiatesintracerebral hemorrhage[J].PeerJ,2016,4:e2608.
[14] Charidimou A,Boulouis G,Haley K,et al.White matter hyperintensity patterns in cerebral amyloid angiopathy and hypertensivearteriopathy[J].Neurology,2016,86(6):505-511.
[15] Carteron L,Patet C,Solari D,et al.Non-ischemic cerebral energy dysfunction at the early brain injury phase following aneurysmal subarachnoid hemorrhage[J].Front Neurol,2017,8:325.
[16] 张功义,孟庆勇,阮金成,等.降钙素原联合C反应蛋白在重症患者合并肺部感染的诊断价值[J].实用医药杂志,2016,33(10):888-890.
[17] Nilsson ED,Melander O,Elmstahl S,et al.Copeptin,a marker of vasopressin,predicts vascular dementia but not Alzheimer's disease[J].J Alzheimers Dis,2016,52(3):1047-1053.
[18] Beseoglu K,Etminan N,Hanggi D.The value of perfusion computed tomography (PCT) imaging after aneurysmal subarachnoid hemorrhage:a review of the current data[J].Acta Neurochir Suppl,2015,120:35-38.
[19] 祝超,李黎欣.高血压脑出血并发院内肺部感染临床分析[J].中华肺部疾病杂志(电子版),2018,11(2):212-213.
[20] Carcel C,Sato S,Zheng D,et al.Prognostic significance of hyponatremia in acute intracerebral hemorrhage:pooled analysis of the intensive blood pressure reduction in acute cerebral hemorrhage trial studies[J].Crit Care Med,2016,44(7):1388-1394.
[21] 庞敏.MMP、IGF和PCT水平变化在脑梗死合并肺部感染患者中的意义[J].临床肺科杂志,2018,23(11):2069-2073.
[22] Yaghi S,Elkind MS.Lipids and cerebrovascular disease:research and practice[J].Stroke,2015,46(11):3322-3328.
[23] Christ-Crain M,Morgenthaler NG,Fenske W.Copeptin as a biomarker and a diagnostic tool in the evaluation of patients with polyuria-polydipsia and hyponatremia[J].Best Pract Res Clin Endocrinol Metab,2016,30(2):235-247.
[24] 杨丽,郭炜炜,丁水印,等.心力衰竭合并肺部感染患者血清RAAS与MMP及TIMP指标的变化研究[J].中华医院感染学杂志,2017,27(6):1259-1262.
[25] Siddiqui AS,Zimmerman JL.Pulmonary infection secondary to Chrysosporium zonatum in an immunocompetent man[J].Ann Am Thorac Soc,2016,13(5):757-758.