CAJ | 학술논문

目的观察胸腔积液患者抗炎和强心利尿治疗的效果及治疗前后血浆B型钠尿肽（BNP）和C-反应蛋白（CRP）、降钙素原（PCT）浓度的变化。方法采用前瞻性研究方法，将2012年7月至2013年1月本院急诊住院治疗的57例胸腔积液患者按病因分为两组：老年肺炎胸腔积液患者（肺炎组）30例和肺癌胸腔积液患者（肺癌组）27例。两组患者抗感染与强心、利尿和限制液体出入量的治疗原则相同。所有患者分别于治疗前和治疗后7 d进行胸部CT扫描，同时检测患者的血浆BNP、CRP及PCT浓度。结果①治疗前肺炎组以美国纽约心功能分级（NYHA）Ⅲ级患者居多，而肺癌组以NYHAⅠ级较多见；且肺炎组充血性心力衰竭（CHF）发病率明显高于肺癌组（86.7%比14.8%，P＜0.01）。治疗前肺炎组血浆BNP明显高于肺癌组（ng/L：582.67±126.53比146.27±43.77，P＜0.01）；与治疗前比较，肺炎组治疗后血浆BNP（ng/L：225.59±131.33）明显降低（P＜0.05），而肺癌组无明显变化（ng/L：149.34±51.05）。肺炎组胸腔积液疗效明显优于肺癌组〔治愈：70.0%（21例）比0（0），P＜0.01〕。②治疗前肺炎组血浆CRP、PCT明显低于肺癌组（均P＜0.05）；治疗后两组患者CRP、PCT均下降到或接近正常生理范围，组间比较差异无统计学意义〔CRP（mg/L）：20.21±16.32比22.76±18.53，PCT（ng/L）：0.46±0.13比0.55±0.17，均P＞0.05〕。肺炎组肺炎疗效明显优于肺癌组〔基本治愈：86.7%（26例）比0（0），P＜0.05〕。肺炎组治疗后CRP、PCT下降与肺部炎症阴影的消散相一致；肺癌组治疗后CRP、PCT下降与肺部影像学显示阴影的消散程度不一致，显然与癌瘤浸润性占位有关。结论血浆BNP和CRP、PCT浓度的变化对于胸腔积液者心功能不全的筛查和强心、抗炎治疗效果的评估有重要的临床意义。
목적관찰흉강적액환자항염화강심이뇨치료적효과급치료전후혈장B형납뇨태（BNP）화C-반응단백（CRP）、강개소원（PCT）농도적변화。방법채용전첨성연구방법，장2012년7월지2013년1월본원급진주원치료적57례흉강적액환자안병인분위량조：노년폐염흉강적액환자（폐염조）30례화폐암흉강적액환자（폐암조）27례。량조환자항감염여강심、이뇨화한제액체출입량적치료원칙상동。소유환자분별우치료전화치료후7 d진행흉부CT소묘，동시검측환자적혈장BNP、CRP급PCT농도。결과①치료전폐염조이미국뉴약심공능분급（NYHA）Ⅲ급환자거다，이폐암조이NYHAⅠ급교다견；차폐염조충혈성심력쇠갈（CHF）발병솔명현고우폐암조（86.7%비14.8%，P＜0.01）。치료전폐염조혈장BNP명현고우폐암조（ng/L：582.67±126.53비146.27±43.77，P＜0.01）；여치료전비교，폐염조치료후혈장BNP（ng/L：225.59±131.33）명현강저（P＜0.05），이폐암조무명현변화（ng/L：149.34±51.05）。폐염조흉강적액료효명현우우폐암조〔치유：70.0%（21례）비0（0），P＜0.01〕。②치료전폐염조혈장CRP、PCT명현저우폐암조（균P＜0.05）；치료후량조환자CRP、PCT균하강도혹접근정상생리범위，조간비교차이무통계학의의〔CRP（mg/L）：20.21±16.32비22.76±18.53，PCT（ng/L）：0.46±0.13비0.55±0.17，균P＞0.05〕。폐염조폐염료효명현우우폐암조〔기본치유：86.7%（26례）비0（0），P＜0.05〕。폐염조치료후CRP、PCT하강여폐부염증음영적소산상일치；폐암조치료후CRP、PCT하강여폐부영상학현시음영적소산정도불일치，현연여암류침윤성점위유관。결론혈장BNP화CRP、PCT농도적변화대우흉강적액자심공능불전적사사화강심、항염치료효과적평고유중요적림상의의。
Objective To observe the therapeutic effect of anti-inflammatory combined with cedilanid and diuretic therapy for treatment of patients with senile pneumonia and lung cancer accompanied by pleural effusion and to investigate the changes of concentrations in plasma levels of B-type natriuretic peptide(BNP)and C-reactive protein(CRP),procalcitonin(PCT)before and after treatment. Methods From July 2012 to January 2013, a prospective study was carried out to investigate 57 emergently hospitalized patients with pleural effusion,and according to the etiology,they were divided into two groups:a senile pneumonia group(30 cases)and a lung cancer group(27 cases). The same therapeutic measures were taken in the two groups,such as anti-infection,enhancement of cardiac function,diuresis,and limitation of the amount of liquid intake. Respectively,all the patients took the CT scan of the chest before treatment and on the 7th day after treatment,and at the same time,plasma concentrations of BNP,CRP and PCT were detected. Results ①According to the gradation of the New York Heart Association (NYHA),before treatment most of the cardiac function of patients in pneumonia group was at the Ⅲ grade,while that in the lung cancer group was at theⅠgrade,and the incidence of congestive heart failure(CHF)in pneumonia group was significantly higher than that in lung cancer group(86.7% vs. 14.8%,P<0.01). Before treatment,the plasma BNP level in pneumonia group was obviously higher than that in lung cancer group(ng/L:582.67±126.53 vs. 146.27±43.77,P<0.01);compared with that before treatment,BNP was significantly decreased in the pneumonia group(ng/L:225.59±131.33,P<0.05)after treatment,but no such obvious change in the lung cancer group(ng/L:149.34±51.05)was seen. The therapeutic effect of pleural effusion in the pneumonia group was markedly better than that in lung cancer group〔cure:70.0%(21 cases)vs. 0(0),P<0.01〕. ②Before treatment,the plasma levels of CRP and PCT in pneumonia group were remarkably lower than those in lung cancer group(both P<0.05);after treatment,CRP and PCT levels were decreased or decreased to close to the normal physiological range in patients of the two groups,but the comparisons between the two groups there were no statistically significant differences〔CRP(mg/L):20.21±16.32 vs. 22.76±18.53,PCT(ng/L):0.46±0.13 vs. 0.55±0.17,both P>0.05〕. Anti-inflammatory effect in pneumonia group was much superior to that in lung cancer group〔basically cured:86.7%(26 cases)vs. 0(0),P<0.05〕. In pneumonia group,the decrease of the above two indexes after treatment was consistent with the pneumonia shadow dissipation,while in the lung cancer group,no such consistency was found,apparently,the latter phenomenon was associated with the tumor invasive occupation. Conclusion To detect the concentration changes of plasma BNP, CRP and PCT has important clinical significance in screening the cardiac insufficiency and evaluating the curative effect of anti-inflammatory combined with cedilanid and diuretic therapy in patients of lung diseases complicated by pleural effusion.