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前肾上腺髓质素对社区获得性肺炎严重程度和结果的预测价值
引用本文:康福新,王瑞兰,魏乔.前肾上腺髓质素对社区获得性肺炎严重程度和结果的预测价值[J].中国综合临床,2009,25(2).
作者姓名:康福新  王瑞兰  魏乔
作者单位:上海交通大学附属第一人民医院急诊危重病科,201620
摘    要:目的 研究前肾上腺髓质素(pro-ADM)浓度对社区获得性肺炎(CAP)严重程度评估的预测价值.方法 采用前瞻性分析方法 测定214例入住急诊科的CAP患者血浆pro-ADM浓度,同时检测降钙素原(PCT)、C-反应蛋白(CRP)、IL-6浓度及WBC、临床变量和肺炎严重指数(PSI).pro-ADM浓度由新型夹心免疫荧光测量法测量.结果 按照PSI评分分为Ⅰ、Ⅱ、Ⅲ、Ⅳ和Ⅴ级,各组中pro-ADM浓度和PCT、IL-6相比,随着CAP严重程度升高而升高(F值分别为141.78、104.87、40.40,P均<0.05).在随访中死亡患者pro-ADM浓度和存活者相比有明显的升高(2.08与4.94,Z=-4.081,P<0.001).在存活者的受试者工作特征曲线(ROC)分析中,pro-ADM的ROC曲线下面积(AUC)为0.79,与PCT(0.72)、CRP(0.58)、IL-6(0.64)和WBC(0.50)相比明显升高,与PSI(0.75)的AUC相似.结论 pro-ADM可以作为CAP患者危险分层的有指导意义的标志物.

关 键 词:社区获得性肺炎  前肾上腺髓质素  降钙素原  C-反应蛋白  白细胞介素-6

The value of pro-adrenomedullin for predicting the severity and outcome of community-acquired pneumonia
KANG Fu-xin,WANG Rui-lan,WEI Qiao.The value of pro-adrenomedullin for predicting the severity and outcome of community-acquired pneumonia[J].Clinical Medicine of China,2009,25(2).
Authors:KANG Fu-xin  WANG Rui-lan  WEI Qiao
Abstract:Objective To investigate the value of pro-adrenomedullin (pro-ADM) levels for severity as-sessment of community-acquired pneumonia (CAP).Methods 214 CAP patients who were admitted to the emer-gency department were prospectively studied.The levels of plasma pro-ADM were determined using a new sandwich immunoassay.At the same time, procalcitonin, C-reactive protein, interleukin-6 levels, leukocyte count, clinical varia-bles and the pneumonia severity index (PSI) were measured.Results Pro-ADM levels,in contrast to procalcitonin,interleukin-6 levels, increased with increasing of the severity of CAP, which was classified according to the PSI score (P<0.05).In patients who died during follow-up, pro-ADM levels on admission were significantly higher than that in survivors 2.08 vs.4.94 μg/L,Z=-4.081 ,P<0.001].In a receiver operating characteristic (ROC) analysis for survival, the area under the ROC curve (AUC) for pro-ADM was 0.79, which was significantly higher than that for procalcitonin(0.72), C-reactive protein (0.58), interleukin-6 (0.64 ), and total leukocyte count (0.50) and sim-ilar to the AUC of the PSI (0.75).Conclusion Pro-ADM is a useful biomarker for the risk stratification of CAP patients.
Keywords:Community-acquired pneumonia  Pre-adrenomedullin  Procalcitonin  C-reactive protein  Interleukin-6
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