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

不同病情程度慢性阻塞性肺疾病伴意识障碍患者血清与脑脊液胱抑素C变化及临床意义 　　 　　[摘要] 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。 　　[关键词] 慢性阻塞性肺疾病；意识障碍；胱抑素C 　　[中图分类号] R563[文献标识码] A[文章编号] 1673-7210（2014）05（b）-0031-04 　　 　　Changes and clinical significance of serum and cerebrospinal fluid CysC in patients with COPD merging conscious disturbance in various degree 　　HONG Yuancheng HUANG Zhongjie FAN Hongtao HONG Liyue 　　Department of Respiratory Internal Medicine, the 180th Hospital of PLAFujian Medical University 180th Teaching Hospital, Fujian Province, Quanzhou 362000, China 　　[Abstract] 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 cerebr