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| 入院时的血清嗜铬素A水平：重症患者病情严重程度的早期生物标志物 |
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| Serum concentration of chromogranin A at admission: An early biomarker of severity in critically ill patients |
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| Zhang D., Lavaux T., Sapin R., Lavigne T., Castelain V., Aunis D., Metz-Boutigue M.-H., Schneider F. 2009/5/29 18:39:20 |
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Annals of Medicine, 2009, Volume 41, Issue 1
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| Background. Chromogranin A (CGA), a stress marker released with catecholamines by the adrenal medulla, has never been associated with acute inflammation in critically ill patients. Aim. To determine evidence for a link between serum concentration of CGA, biomarkers of inflammation, and outcome in patients admitted with or without the systemic inflammatory response syndrome (SIRS). Methods. At admission, we measured in 53 patients and 14 healthy controls the serum concentrations of CGA, procalcitonin, and C-reactive protein. We also assessed the Simplified Acute Physiological Score (SAPS) in the patients. Results. Serum CGA concentrations were significantly increased in SIRS patients with a median value of 115 μg/L (68.0-202.8), when compared to healthy controls (P<0.001). In cases where infection was associated with SIRS, patients had the highest increase in CGA with a median value of 138.5 μg/L (65-222.3) (P<0.001). CGA concentrations positively correlated with inflammation markers (procalcitonin, C-reactive protein), but also with SAPS. Receiver operating characteristic (ROC) analysis showed that CGA is equivalent to SAPS as an indicator for 28-day mortality (area under curve (AUC) for both: 0.810). Conclusions. Patients with CGA concentration superior to 71 μg/L have a significantly shorter survival. A Cox model confirmed that CGA and SAPS were independent predictors of outcome. © 2009 Informa UK Ltd. |
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| Correspondence Address: Metz-Boutigue, M.-H.; Inserm U575, 5 rue Blaise Pascal, 67084 Strasbourg, France; email: metz@neurochem.u-strasbg.fr |
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 疾病资源中心
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
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