不同病情程度慢性阻塞性肺疾病伴意识障碍患者血清和脑脊液胱抑素 C 变化及临床意义

目的 探讨不同病情程度慢性阻塞性肺疾病（COPD）伴意识障碍患者血清和脑脊液胱抑素C（CysC）水平的变化及其临床意义。方法 收集2011年7月～2012年12月于解放军第一八○医院呼吸科就诊的COPD合并意识障碍患者90例（COPD组）,根据意识障碍程度分为清醒组（37例）、嗜睡组（32例）和昏迷组（21例）,以同期住院的非COPD患者15例为对照组。采用免疫比浊法分别测定各组患者血清和脑脊液CysC水平;分别测定各组患者动脉血气指标。结果 COPD组患者血清CysC水平[（1.25±0．34）mg/L]显著高于对照组[（0．84±0．17）mg/L],而脑脊液CysC水平[（2．16±0．42）mg／L]显著低于对照组[（5．21±0．33）mg/L],差异均有统计学意义（P〈0．05或P〈0．01）。随着意识障碍程度加重,清醒组、嗜睡组和昏迷组血清CysC水平及二氧化碳分压（PaCO2）递增,脑脊液CysC水平、酸碱度（pH）值及氧分压（PaO2）递减,各组间差异均有统计学意义（P〈0．05）。结论 当COPD患者伴意识障碍发生时,血清和脑脊液CysC水平以及动脉血气状况均会出现异常,其水平变化可反映患者意识障碍的程度。

Changes and clinical significance of serum and cerebrospinal fluid CysC in patients with COPD merging conscious disturbance in various degree

Objective To investigate the changes and clinical significance of level CysC in serum and cerebrospinal fluid in patients with COPD merging conscious disturbance in various degree. Methods 90 patients with COPD and disturbance of consciousness from July 2011 to December 2012 in Department of Respiratory Internal Medicine, the 180th Hospital of PLA were collected as COPD group. According to the degree of disturbance of consciousness, patients were divided into sobriety group （37 cases）, sleepiness group （32 cases） and coma group （21 cases）, 15 hospitalized patients without COPD in the same term were selected as control group. The CysC level of serum and cerebrospinal fluid in patients were detected with immune turbidimetry. Arterial blood gas. indexes were detected in each group. Results The levels of CysC in serum of COPD group [（1.25±0.34） mg/L] were higher than that of the control group [（0.84±0.17） mg/L], and the CysC level in cerebrospinal fluid of COPD group [（2.16±0.42） mg/L] was lower than that of the control group [（5.21±0.33） mg/L], the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. The serum level of CysC, PaCO2 in sobriety group, drowsiness group and coma group were progressive incremental; the CysC level in cerebrospinal fluid, pH value and PaO2 in sobriety group, drowsiness group and coma group were progressive diminishing, the differences were statistically significant （P 〈 0.05）. Conclusion The level of CysC in serum and cerebrospinal fluid, the state of arterial blood gas are all abnormal in patients with COPD when conscious disturbance occurs. These indexes can reflect the severity of conscious disturbance.