Krüger Stefan, Ewig Santiago, Kunde Jan, Hanschmann Alexa, Marre Reinhard, Suttorp Norbert, Welte Tobias
Medical Clinic I, University Clinic RWTH Aachen, Germany.
J Antimicrob Chemother. 2009 Jul;64(1):159-62. doi: 10.1093/jac/dkp148. Epub 2009 Apr 29.
Recently, C-terminal provasopressin (copeptin) turned out to be predictive for mortality in community-acquired pneumonia (CAP). The aim of this study was to evaluate the influence of antibiotic pre-treatment on copeptin levels in CAP.
We enrolled 370 hospitalized patients (66 +/- 17 years; 42% females) with proven CAP. Venous blood samples were collected at the time of inclusion into the study and as soon as possible after the diagnosis of CAP. Copeptin (B.R.A.H.M.S. AG, Henningsdorf, Germany) levels were determined in venous blood on admission.
Eighty-five patients had antibiotic pre-treatment and 285 patients did not. Copeptin levels increased with increasing severity of CAP in patients without antibiotic pre-treatment but not in patients with antibiotic pre-treatment. Patients with prior antibiotic treatment showed significantly lower levels of copeptin [median (interquartile range): 12.8 (5.3-22.6) versus 20.8 (11.1-37.8) pmol/L, P < 0.0001] and procalcitonin [0.15 (0.07-0.38) versus 0.27 (0.10-1.52) ng/mL, P = 0.0003], but not C-reactive protein [113 (46-229) versus 122 (49-231) mg/mL, not significant] and leucocytes [12.2 x 10(3) (8.1 x 10(3)-15.4 x 10(3)) versus 12.5 x 10(3) (9.4 x 10(3)-16.3 x 10(3)) cells/mm(3), not significant] compared with those without antibiotic pre-treatment.
Copeptin serum levels are higher in patients without antibiotic pre-treatment compared with those with antibiotic pre-treatment. Copeptin serum levels increase with an increasing severity of CAP in patients without, but not in patients with, antibiotic pre-treatment. Thus, antibiotic pre-treatment has to be taken into account for the correct interpretation of copeptin levels in CAP.
最近，C 端前血管加压素（copeptin）被证明可预测社区获得性肺炎（CAP）的死亡率。本研究的目的是评估抗生素预处理对 CAP 患者 copeptin 水平的影响。
我们纳入了 370 例确诊为 CAP 的住院患者（年龄 66±17 岁；42%为女性）。在纳入研究时以及 CAP 诊断后尽快采集静脉血样。入院时测定静脉血中的 copeptin（德国亨宁斯多夫的 BRAHMS 公司生产）水平。
85 例患者接受了抗生素预处理，285 例患者未接受。在未接受抗生素预处理的患者中，copeptin 水平随 CAP 严重程度增加而升高，但在接受抗生素预处理的患者中并非如此。与未接受抗生素预处理的患者相比，先前接受抗生素治疗的患者 copeptin 水平显著降低[中位数（四分位间距）：12.8（5.3 - 22.6）对 20.8（11.1 - 37.8）pmol/L，P < 0.0001]以及降钙素原[0.15（0.07 - 0.38）对 0.27（0.10 - 1.52）ng/mL，P = 0.0003]，但 C 反应蛋白[113（46 - 229）对 122（49 - 231）mg/mL，无显著差异]和白细胞[12.2×10³（8.1×10³ - 15.4×10³）对 12.5×10³（9.4×10³ - 16.3×10³）个细胞/mm³，无显著差异]并非如此。
与接受抗生素预处理的患者相比，未接受抗生素预处理的患者 copeptin 血清水平更高。在未接受抗生素预处理的患者中，copeptin 血清水平随 CAP 严重程度增加而升高，但在接受抗生素预处理的患者中并非如此。因此，在正确解读 CAP 患者的 copeptin 水平时必须考虑抗生素预处理情况。
