标题：血清Copeptin、hs-CRP及 IL-6水平在老年慢性肺源性心脏病患者中的表达及其临床意义

      作者：卓越，邢崇浩，陈亮，古裕鸟，吴挺洲    (海南省第三人民医院呼吸科，海南 三亚 572000)

      卷次： 2017年28卷14期

      【摘要】 目的 探讨血清和肽素(Copeptin)、超敏C反应蛋白(hs-CRP)及白细胞介素-6 (IL-6)水平在老年慢性肺源性心脏病(CPHD)患者中的表达及预后评估价值。方法 选取2013年1月至2016年9月海南省第三人民医院收治的老年CPHD患者168例作为CPHD组，同时期健康体检者150例作为对照组，根据患者住院期间及出院24 h内是否死亡，将其分为死亡组 31例和存活组 137例。比较死亡组和存活组患者第 0天、第 3天、第 7天血清Copeptin、hs-CRP及 IL-6水平的动态变化，应用单因素及多因素 Logistic回归分析影响老年CPHD患者死亡的危险因素。绘制 ROC曲线评估各指标预测老年 CPHD患者死亡的效能，相关性分析采用 Pearson相关分析。结果 CPHD组患者第0天、第3天、第7天血清Copeptin、hs-CRP及 IL-6水平均明显高于对照组，差异均有显著统计学意义(P<0.01)，且CPHD组患者第7天的血清Copeptin、hs-CRP及 IL-6水平均明显高于第0天和第3天，差异均有统计学意义(P<0.05)；死亡组患者第0天、第3天、第7天的血清Copeptin、hs-CRP及 IL-6水平均明显高于存活组，且随着住院时间的延长，存活组各指标水平逐渐下降，死亡组各指标水平逐渐升高，差异均有统计学意义(P<0.05)；多元Logistic回归分析显示，Copeptin、hs-CRP及 IL-6是老年CPHD患者死亡的独立危险因素。ROC曲线显示，第0天血清Copeptin、hs-CRP及 IL-6水平及三项联合预测老年CPHD患者死亡的AUC及95%CI分别为0.824 (0.761~0.893)、0.805 (0.738~0.862)、0.773 (0.702~0.839)、0.872 (0.793~0.942)，其中三项联合对预测老年CPHD患者死亡的敏感度和特异度最好，分别为 90.2%和 82.4%。相关性分析显示，死亡患者第 0天、第 3天、第 7天血清Copeptin与hs-CRP及 IL-6水平均呈正相关(P<0.05)。结论 血清Copeptin、hs-CRP及 IL-6水平在老年CPHD患者中明显升高，三项联合检测对预测老年CPHD患者的预后具有较好的价值。
      【关键词】 慢性肺源性心脏病；老年；和肽素；超敏C反应蛋白；白细胞介素-6
      【中图分类号】 R541.5 【文献标识码】 A 【文章编号】 1003—6350（2017）14—2297—05

Expression and clinical significance of serum Copeptin, hs-CRP and IL-6 levels in elderly patients with chronicpulmonary heart disease.
ZHUO Yue, XING Chong-hao, CHEN Liang, GU Yu-niao, WU Ting-zhou. Department ofRespiration, the Third People's Hospital of Hainan Province, Sanya 572000, Hainan, CHINA
【Abstract】 Objective To investigate the expression and prognostic value of serum Copeptin, high sensitivity Creactive protein (hs-CRP) and interleukin-6 (IL-6) in elderly patients with chronic pulmonary heart disease (CPHD).Methods A total of 168 elderly patients with CPHD in the Third People's Hospital of Hainan Province from January2013 to September 2016 were selected as CPHD group, and 150 healthy subjects were taken as control group. The CPHDpatients were divided into death group (31 cases) and survival group (137 cases) according to their death during hospital-ization and within 24 hours after discharge. The dynamic changes of serum Copeptin, hs-CRP and IL-6 levels of patientsat day 0, day 3, day 7 in two groups were compared. Univariate and multivariate logistic regression analysis were used toanalyze the risk factors of death in elderly patients with CPHD. ROC curve was used to evaluate the effectiveness of eachindex to predict the mortality of elderly patients with CPHD, and the correlation analysis was performed by Pearson corre-lation analysis. Results The serum Copeptin, hs-CRP and IL-6 levels at day 0, day 3, day 7 in CPHD group were signif-icantly higher than those of the control group (P<0.01). The serum Copeptin, hs-CRP and IL-6 levels at day 7 in CPHDgroup were significantly higher than those at day 0, day 3 (P<0.05). The serum Copeptin, hs-CRP and IL-6 levels at day0, day 3, day 7 in death group were significantly higher than those in survival group, and with the prolonging of hospital-ization duration, the indexes levels decreased in survival group and increased gradually in death group (P<0.05). Univari-ate and multivariate logistic regression analysis showed that Copeptin, hs-CRP and IL-6 were independent risk factors fordeath in elderly patients with CPHD. The ROC curve showed that the area under the curve (AUC) and 95%CI of serumCopeptin, hs-CRP, IL-6, and joint detection for prediction of mortality in elderly patients with CPHD at day 0 were re-spectively 0.824 (0.761-0.893), 0.805 (0.738-0.862), 0.773 (0.702-0.839), 0.872 (0.793-0.942). Joint detection had thehighest sensitivity and specificity, which were 90.2% and 82.4%. Correlation analysis showed that serum Copeptin werepositively correlated with hs-CRP and IL-6 levels at day 0, day 3, day 7 (P<0.05). Conclusion The levels of serum Co-peptin, hs-CRP and IL-6 are significantly increased in elderly patients with CPHD, and the combined detection of thethree indexes has good value in predicting the prognosis of elderly patients with CPHD.
      【Key words】 Chronic pulmonary heart dis