目的 探讨血清总皮质醇检测对社区获得性肺炎( CAP) 患者病情严重程度及预后评估的价值。方法 对78 例确诊的CAP 患者进行前瞻性研究, 根据Fine 危险分层将CAP 患者分成两组: 普通CAP组( n =48) 和重症CAP 组( n =30) 。采用化学发光免疫法测定血清总皮质醇水平。统计分析各组血清总皮质醇水平的差异, 血清总皮质醇与肺炎严重度指数( PSI) 的相关性, 以及PSI 评分、血清总皮质醇、C 反应蛋白( CRP) 及白细胞总数的预后评估价值, 进行ROC 曲线分析。结果 血清总皮质醇水平与PSI 之间存在较强的正相关( r=0. 742, P lt;0. 001) 。重症CAP 组与普通CAP 组比较[ ( 306. 86 ±79. 32) μg/L 比( 164. 61 ±73. 25 ) μg/L] , 治疗失败患者与治疗成功患者比较[ ( 341. 19 ±100. 90) 比( 211. 62 ±97. 91) μg/L] , 血清总皮质醇水平明显升高, 差异均有统计学意义( P 均 lt;0. 01) 。血清总皮质醇的预测准确度同PSI 评分较接近, 优于CRP 及白细胞总数。结论 血清总皮质醇检测能较好预测轻、重CAP患者, 血清总皮质醇越高, 病情越严重, 预后越差。
Citation：
周宗爱,张霖,周昌盛,梁艳,薛盛东,蔡跃林. 社区获得性肺炎患者血清总皮质醇检测的临床价值. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(2): 193-195. doi:
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- 1. 许丽, 李春盛. 全身炎症反应综合征患者血甲状腺激素和皮质醇水平的变化. 中华全科医师杂志, 2006, 5: 625 -626.
- 2. 李旭, 章志丹, 朱然, 等. 危重症患者血清甲状腺激素及皮质醇水平的变化研究. 中华外科杂志, 2006 , 44: 1203-1205.
- 3. 中华医学会呼吸病学分会. 社区获得性肺炎诊断与治疗指南. 中华结核与呼吸杂志, 2006, 29: 651-655.
- 4. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med, 1997, 336: 243-250 .
- 5. Schuetz P, Müller B. The hypothalamic-pituitary-adrenal axis in critical illness. Endocrinol Metab Clin North Am, 2006, 35: 823-838 .
- 6. Hamrahian AH, Oseni TS, Arafah BM. Measurements of serum free cortisol in critically ill patients. N Engl J Med, 2004, 350 : 1629 -1638.
- 7. Almirall J, Bolíbar I, Toran P, et al. Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest, 2004 , 125: 1335-1342.
- 8. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology, 1990, 73 : 308-327.
- 9. Christ-Crain M, Stolz D, Jutla S, et al. Free and Total Cortisol Levels as Predictors of Severity and Outcome in Community-acquired Pneumonia. Am J Respir Crit Care Med, 2007 , 176: 913-920 .
