【作者】 宋迎春； 杨丽萍； 任国庆； 张浩；

【Author】 SONG Yingchun;YANG Liping;REN Guoqing;ZHANG Hao;Department of Emergency,Affiliated Hospital of Jiangsu University;

【机构】 江苏大学附属医院急诊科；

【摘要】 目的探讨和肽素检测对急性中毒患者病情评估的价值。方法入选175例急性中毒患者。入院时ELISA法检测血浆Copeptin含量,予APACHEⅡ评分,并进一步对二者进行相关分析。记录患者30天死亡率,分析血浆Copeptin水平及APACHEⅡ评分在死亡组和存活组的差别。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估血浆copeptin水平及APACHEⅡ评分对患者死亡的预测价值。结果(1)死亡组患者血浆copeptin水平及APACHEⅡ评分显著高于对照组和存活组,差异均有统计学意义(P<0.05);血浆Copeptin水平与APACHEⅡ评分呈正相关(r=0.71、P<0.01)。(2)根据ROC曲线分析:和肽素及APACHEⅡ评分的AUC分别为0.748、0.665;95%可信区间分别为0.649~0.847、0.528~0.801。(3)copeptin分界值为18.5pmol/l时灵敏度为81%,特异度为35.1%。APACHEⅡ评分的分界值为7.5时灵敏度为66.7%,特异度为44.8%。结论急性中毒患者血浆Copeptin水平升高。联合和肽素及对及APACHEⅡ评分有助于对中毒患者预后的评估。更多还原

【Abstract】 Objective To study the level of plasma Copeptin and its clinical significance in the course of acute poisoning.Methods Total of 175 patients with acute poisoning were enrolled in this study.The levels of plasma Copeptin were measured by ELISA in all subjects.The relationship of the level of plasma Copeptin in patients with acute poisoning and APACHE Ⅱ score were analysed.The diagnostic performance of them was assessed using ROC analysis.The sensitivity and specificity were inferred based on the positive rate of two clinical index.Results(1) The levels of copeptin and APACHE Ⅱ score in death group were obviously higher than that of non- death group and control group(P<0.05);The APACHE Ⅱ score in nonsurvivors were significantly higher than in survivors(Kruskal-Wallis test,p<0.0001 and p=0.0001,respectively).Plasma Copeptin was positively correlated with APACHE Ⅱ score(r=0.71、P<0.01).(2) The primary endpoint of this study was the predictive value of copeptin and APACHE Ⅱ score for 30-day mortality in patients with acute poisoning.The 30-day survival AUC for copeptin is 0.748(95%CI=0.649 to 0.847) and for APACHE Ⅱ score is 0.665(95%CI=0.528 to 0.801).(3) Usingl8.5pmol/L as cut off value,the sensitivity and specificity of copeptin were81%and 35.1%to predict death.Using 7.5 as cut off value,the sensitivity and specificity of APACHE Ⅱ score were66.7%and 44.8%.Conclusion Copeptin may be involved in the pathogenesis of AOPP,and may be an important clinical parameter to predict severity and prognosis,guide therapy in patient with AOPP.更多还原