Effects of combined acupuncture and medication on hyperarousal state and serum copeptin in patients with chronic insomnia / 针灸推拿医学（英文版）

Objective:To observe the effect of combined acupuncture and medication on hyperarousal state and serum copeptin(CPT)in patients with chronic insomnia(CI),and to explore its possible mechanism of action.Methods:A total of 70 CI patients meeting the inclusion criteria were divided into an observation group and a control group by the random number table method,with 35 cases in each group.The control group was given estazolam tablets before bedtime,1 mg/time,once a day.The observation group was treated with additional Yi Nao An Shen acupuncture therapy(acupuncture for benefiting the brain and tranquillization)on the basis of the medication treatment,4 times a week.After 4 weeks of treatment,the Pittsburgh sleep quality index(PSQI)score,insomnia severity index(ISI)score,pre-sleep arousal scale(PSAS)score,hyperarousal scale(HAS)score,and the change in serum CPT level were compared between the two groups.Results:During the study,there were 2 dropout cases in the observation group and 1 dropout case in the control group.After treatment,the PSQI,ISI,PSAS,and HAS scores and the serum CPT level in both groups decreased compared with the same group before treatment,and the intra-group differences were statistically significant(P<0.05).After treatment,changes in each above scale score and the serum CPT level in the observation group were much more significant and were statistically different from those in the control group(P<0.05).Conclusion:Acupuncture plus medication can improve sleep quality,reduce the degree of insomnia,and regulate hyperarousal state in patients with CI,and its mechanism of action may be related to the down-regulation of serum CPT level.

Application value of BIS and S100β combined with Copeptin in patients with acute severe carbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective: To explore the application value of bispectral index(BIS) , specific protein 100β(S100β) combined with Copeptinin patients with acute severe carbon monoxide poisoning (ASCMP). Methods: A total of 256 patients with acute carbon monoxide poisoning admitted to Hengshui People's Hospital from June 2018 to June 2020 were collected, and they were divided into 30 mild cases, 40 moderate cases and 186 severe cases according to the degree of poisoning. Among them, patients with severe carbon monoxide poisoning were divided into a poor prognosis group (20 cases) and a good prognosis group (166 cases) according to whether adverse events occurred. The changes of creatine kinase isoenzyme (CK-MB) , N-terminal precursor B-type brain natriuretic peptide (NT-proBNP) , BIS, S100β, and Copeptin in poisoned patients were measured. Logistic regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the significance of relevant indicators for ASCMP patients. Results: Compared with the mild-to-moderate group, CK-MB, NT-proBNP, S100β, Copeptin increased, and BIS value decreased in the severe group (P< 0.05). 24 hours after admission, compared with the good prognosis group, CK-MB, NT-proBNP, S100β, Copeptin in the poor prognosis group increased, and the BIS value decreased (P<0.05). In the poor prognosis group, CK-MB, NT-proBNP, S100β, and Copeptin at 72 hours after admission were all lower than those at 24 hours after admission, and the BIS value was higher than that at 24 hours after admission (P<0.05). Logistic regression analysis showed that ASCMP patients with increased S100β, Copeptin, and decreased BIS values had an increased risk of adverse events (P<0.05). The ROC curve showed that the area under the curve of the combined detection of BIS, S100β and Copeptin was 0.859, which had a great predictive value for the prognosis of ASCMP patients. Conclusion: BIS, S100β combined with Copeptin detection is of great value for early assessment of ASCMP disease and prognosis prediction.

The value of copeptin combined with troponin I in assessing the prognosis of elderly patients with acute myocardial infarction / 中华老年医学杂志

Objective:To investigate the prognostic value of copeptin(COP)and troponin I(cTnI)for elderly patients with acute myocardial infarction(AMI).Methods:81 elderly AMI patients admitted to the Department of Emergency of Beijing Hospital from August 2016 to August 2018 were included as study subjects.COP and cTnI were measured and other relevant examinations were conducted.The correlation between each factor and the risk of death was evaluated in a 6-month follow-up, and the prognostic value of each indicator was assessed.Results:There were statistically significant differences in COP, cTnI, arterial lactic acid(LAC), the acute physiology and chronic health evaluation(APACHE)Ⅱ score, D-Dimer and N-terminal brain natriuretic peptide precursor(NT-pro-BNP)between the survival group and the death group(all P<0.05).COP and cTnI levels in the death group were significantly higher than those in the survival group[COP: 29.08(13.73, 43.19)ng/L vs.13.76(4.81, 20.82)ng/L; cTnI: 0.78(0.35, 2.23)μg/L vs.0.33(0.19, 0.57)μg/L].Binary Logistic regression analysis showed that COP( OR=1.071, 95% CI: 1.016-1.130, P=0.040)and cTnI( OR=3.261, 95% CI: 1.058-10.045, P=0.011)were independent risk factors for death within 6 months in elderly AMI patients.The ROC curves were constructed for cTnI, COP and their combination, and the AUCs(95% CI)were 0.742(0.593-0.892), 0.752(0.655-0.910)and 0.790(0.648-0.932), respectively. Conclusions:COP and cTnI may be used to assess the prognosis for elderly patients with AMI, and their combination can further increase the predictive value for short-term death risk.

Can copeptin predict the severity of coronavirus disease 2019 infection?

SUMMARY OBJETIVE Coronavirus disease 2019 (COVID-19) has quickly turned into a health problem globally. Early and effective predictors of disease severity are needed to improve the management of the patients affected with COVID-19. Copeptin, a 39-amino acid glycopeptide, is known as a C-terminal unit of the precursor pre-provasopressin (pre-proAVP). Activation of AVP system stimulates copeptin secretion in equimolar amounts with AVP. This study aimed to determine serum copeptin levels in the patients with COVID-19 and to examine the relationship between serum copeptin levels and the severity of the disease. METHODS The study included 90 patients with COVID-19. The patients with COVID-19 were divided into two groups according to disease severity as mild/moderate disease (n=35) and severe disease (n=55). All basic demographic and clinical data of the patients were recorded and blood samples were collected. RESULTS Copeptin levels were significantly higher in the patients with severe COVID-19 compared with the patients with mild/moderate COVID-19 (p<0.001). Copeptin levels were correlated with ferritin and fibrinogen levels positively (r=0.32, p=0.002 and r=0.25, p=0.019, respectively), and correlated with oxygen saturation negatively (r=-0.37, p<0.001). In the multivariate logistic regression analysis, it was revealed that copeptin (OR: 2.647, 95%CI 1.272-5.510; p=0.009) was an independent predictor of severe COVID-19 disease. A cutoff value of 7.84 ng/mL for copeptin predicted severe COVID-19 with a sensitivity of 78% and a specificity of 80% (AUC: 0.869, 95%CI 0.797-0.940; p<0.001). CONCLUSION Copeptin could be used as a favorable prognostic biomarker while determining the disease severity in COVID-19.

Effects of the prophylactic use of escitalopram on the prognosis and the plasma copeptin level in patients with acute cerebral infarction

This study aimed to investigate whether the routine administration of escitalopram for three months would improve the prognosis of patients with ischemic stroke and decrease the plasma copeptin level. A total of 97 patients with acute cerebral infarction were randomly allocated to receive escitalopram (5-10 mg once per day, orally; n=49) or not to receive escitalopram (control group; n=48) for 12 weeks starting at 2-7 days after the onset of stroke. Both groups received conventional treatments, including physiotherapy and secondary prevention of stroke. The National Institutes of Health Stroke Scale (NIHSS) score was used to evaluate the disability of patients at the initial evaluation and at the monthly follow-up visits for three months. Impairment in the daily activities was assessed using the Barthel Index (BI), while cognitive impairment was assessed using Mini-Mental State Examination (MMSE) score. The psychiatric assessment included the administration of the Present State Examination modified to identify Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptoms of depression. The severity of depression was measured using the 17-item Hamilton Rating Scale for Depression (HAMD). During the 3-month follow-up period, 95 patients were included in the analysis (two patients withdrew from the escitalopram group). NIHSS and BI improvement at the 90th day were significantly greater in the escitalopram group (P<0.05), while HAMD and plasma copeptin levels significantly decreased, compared to the control group (P<0.01). In patients with acute ischemic stroke, the earlier administration of escitalopram for three months may improve neurological functional prognosis and decrease copeptin level.

Performance of Copeptin for Early Diagnosis of Acute Myocardial Infarction in an Emergency Department Setting

BACKGROUND: Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI). METHODS: We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed. RESULTS: The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P=0.022, ≤1 hour; STEMI: P=0.017, ≤1 hour and P=0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients. CONCLUSIONS: The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.

Serum Copeptin Levels Predict Clinical Outcomes After Successful Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

BACKGROUND: Serum copeptin has been demonstrated to be useful in early risk stratification and prognostication of patients with acute myocardial infarction (AMI). However, the prognostic value of copeptin after percutaneous coronary intervention (PCI) for clinical outcomes remains uncertain. We investigated the prognostic role of serum copeptin levels immediately after successful PCI as a prognostic marker for major adverse cardiac events (MACE; comprising death, repeat PCI, recurrent MI, or coronary artery bypass grafting) in patients with AMI. METHODS: A retrospective study was performed in 149 patients with AMI who successfully received PCI. Serum copeptin levels were analyzed in blood samples collected immediately after PCI. The association between copeptin levels and MACE during the follow-up period was evaluated. RESULTS: MACE occurred in 34 (22.8%) patients during a median follow-up of 30.1 months. MACE patients had higher copeptin levels than non-MACE patients did. Multiple logistic regression analysis showed that the increase in serum copeptin levels was associated with increased MACE incidence (odds ratio=1.6, P=0.005). CONCLUSIONS: A high level of serum copeptin measured immediately after PCI was associated with MACE in patients with AMI during long-term follow-up. Serum copeptin levels can serve as a prognostic marker in patients with AMI after successful PCI.

The diagnostic value of copeptin in the cardiorenal syndrome rats and the association with heart and kidney impairment / 中华内科杂志

To explore the diagnostic value of copeptin (CPP) in cardiorenal syndrome (CRS) in rats and the association between CPP and impairment of heart and kidney, 60 male SD rats were randomly divided into blank control group (CK group), kidney failure group (SNX group), heart failure group (MI group), and CRS group. Heart and kidney function and their histology changes in rats from each group were detected. The correlation between serum CPP and heart and kidney function indexes was performed with Pearson correlation analysis. The HE staining of heart and kidney showed that the tissue lesion was more severe in CRS group than in SNX group and MI group. There was a significant positive correlation between serum CPP and brain natriuretic peptide (BNP) (r=0.638, P<0.05). No correlation was observed between serum CPP and cardiac function index (left ventricular systolic pressure, left ventricular diastolic pressure, left ventricular end-diastolic pressure) or renal function index (serum creatinine, urine creatinine, blood urea nitrogen) (r=0.512, 0.189, -0.063, 0.207, 0.290, 0.595, respectively, all P>0.05). The CPP level is associated with the degree of heart and kidney damage in CRS rats.

Changes and significance of serum Copeptin and MMP-9 in children with chronic heart failure / 临床儿科杂志

Objective To investigate the changes of serum Copeptin and matrix metalloproteinase-9 (MMP-9) in children with chronic heart failure (CHF) and its clinical significance. Methods A total of 186 children with CHF were selected for CHF group, including 78 cases of cardiac function grade Ⅱ, 65 cases of grade Ⅲ, and 43 cases of grade Ⅳ. There were 57 cases of dilated cardiomyopathy, 68 cases of congenital heart disease and 61 cases of other diseases. Another 85 healthy children from health checkup were chosen as controls. The levels of serum Copeptin and MMP-9 were determined by enzyme linked immunosorbent assay (ELISA), and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) was measured by bidirectional lateral flow immunoassay. The left ventricular end diastolic dimension (LVEDD), left ventricular end systolic dimension (LVESD), left ventricular ejection fraction (LVEF), and left ventricular short fraction shortening (LVFS) were measured by echocardiography. ROC curve was used to analyze the diagnostic value of serum Copeptin and MMP-9 in CHF. The correlation of serum Copeptin and MMP-9 with the cardiac function indices were examined by Pearson correlation analysis. Results The levels of serum copeptin, MMP-9, and NT-proBNP in different cardiac function groups (Ⅱ, Ⅲ, Ⅳ) increased gradually with the aggravation of the cardiac function damage and were higher than those in control group, and the differences were statistically significant (P<0.05). Compared with the control group and cardiac function grade Ⅱ group, the levels of LVESD and LVEDD were increased and the levels of LVEF and LVFS were decreased in the grade Ⅲ and Ⅳ groups. Compared with the grade Ⅲ group, the levels of LVESD and LVEDD were increased and the levels of LVEF and LVFS were decreased in the grade Ⅳ groups. There were significant differences (P<0.05). The ROC curve showed that the area under the curve (AUC) and 95％ CI of serum Copeptin, MMP-9, NT-proBNP and combinations of these three biomarkers in the diagnosis of CHF were 0.845 (0.781～0.914), 0.806 (0.736～0.883), 0.894 (0.828～0.962) and 0.925 (0.846～0.983) respectively, and the optimal thresholds were 12.5 pmol/L, 175.3 μg/L and 2037.0ng/L. The level of serum Copeptin was positively correlated with MMP-9 (r=0.807, P<0.001). Conclusion Serum Copeptin and MMP-9 may be involved in the ventricular remodeling in CHF children and they are expected to be a good indicator for the diagnosis of CHF and cardiac function.

Diagnostic value of copeptin and cancer antigen 125 in acute heart failure patients with atrial fibrillation and their correlations with short-term cardiovascular events / 中华危重病急救医学

Objective To evaluate the diagnostic value of copeptin and cancer antigen 125 (Ca-125) in acute heart failure (AHF) patients with atrial fibrillation, and to explore the relationship between copeptin, Ca-125 and short-term cardiovascular events. Methods A total of 376 patients with acute left heart failure or permanent atrial fibrillation admitted to the Department of Cardiology of First Affiliated Hospital of Nanjing Medical University from January 2016 to January 2018 were enrolled as the study group. According to whether having atrial fibrillation or not, 376 patients were divided into atrial fibrillation group (n = 108), AHF group (n = 134) and AHF with atrial fibrillation group (n = 134). 102 healthy persons in the same period were enrolled as healthy control group. Copeptin, Ca-125, N-terminal pro-brain natriuretic peptide (NT-proBNP) within 24 hours after admission or on the day of physical examination were determined, and cardiac function indexes including left atrial diameter (LAD), left ventricular diameter (LVD) and left ventricular ejection fraction (LVEF) at 1 week after admission or on the day of physical examination were determined. Correlation analysis among above indexes was conducted by Pearson correlation analysis. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of copeptin and Ca-125 in AHF with atrial fibrillation. Results Compared with the healthy control group, copeptin, Ca-125, NT-proBNP, LAD, and LVD in atrial fibrillation group, AHF group and AHF with atrial fibrillation group showed a tendency of gradual increase [copeptin (pmol/L): 12.43±4.36, 18.77±5.29, 32.82±7.07 vs. 6.68±1.94; Ca-125 (kU/L): 18.82±7.39, 27.97±11.47, 61.37±25.49 vs. 4.43±1.74; NT-proBNP (ng/L): 1 070.87±428.84, 1 734.13±725.09, 2 745.92±709.91 vs. 570.40±213.87; LAD (mm): 37.24±6.35, 41.31±7.94, 46.24±10.96 vs. 33.29±4.53; LVD (mm): 49.46±5.19, 52.51±8.09, 55.96±6.49 vs. 45.99±6.26, all P < 0.05], and LVEF showed a tendency of gradual decrease (0.52±0.11, 0.46±0.10, 0.41±0.09 vs. 0.57±0.08, all P < 0.05), indicating that the deterioration of all indexes in AHF patients with atrial fibrillation was more obvious. Correlation analysis showed that copeptin was positively correlated with LAD (r = 0.479, P = 0.012) and LVD (r = 0.513, P = 0.005), and it was negatively correlated with LVEF (r = -0.626, P < 0.001). Ca-125 was positively correlated with LAD (r = 0.479, P = 0.011) and LVD (r = 0.513, P = 0.028), and it was negatively correlated with LVEF (r = -0.645, P = 0.019). ROC curve analysis showed that the area under ROC curve (AUC) of copeptin, Ca-125, NT-proBNP and copeptin combined with Ca-125 in the diagnosis of AHF with atrial fibrillation was 0.750, 0.623, 0.647 and 0.842, respectively, with diagnostic value on AHF with atrial fibrillation. The diagnostic value of copeptin combined with Ca-125 was the largest, with a sensitivity of 72.64% and a specificity of 92.47%. Compared with the healthy control group, the incidence of cardiovascular events after 3 months of follow-up in the atrial fibrillation group, AHF group and AHF with atrial fibrillation group was significantly increased [6.5% (7/108), 9.0% (12/134), 30.6% (41/134) vs. 1.0% (1/102), χ2 = 56.574, P = 0.000], indicating that patients with AHF and atrial fibrillation were more likely to have cardiovascular events. Copeptin combined with Ca-125 showed a significant positive correlation with short-term cardiovascular events (r = 0.641, P = 0.004). Conclusions The combination of copeptin and Ca-125 has a higher diagnostic accuracy for AHF patients with atrial fibrillation. Copeptin and Ca-125 were positively correlated with short-term cardiovascular events. It may be used to assess the prognosis of AHF patients with atrial fibrillation.

Expression of copeptin and midkine in diabetic retinopathy and their significance / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the expression of copeptin and midkine(MK)in patients with diabetic retinopathy and their clinical significance. <p>METHODS: Totally 180 patients with type 2 diabetes mellitus(T2DM)admitted to our hospital from June 2016 to October 2017 were divided into three groups according to the criteria of diabetic retinopathy staging. Among them, there were no retinopathy group(68 cases), non-proliferative retinopathy group(72 cases), proliferative retinopathy group(40 cases)and 90 healthy subjects in the same period as the control group. The copeptin level was detected by double antibody immunosorbent assay and the MK level by ELISA. The glycosylated hemoglobin(HbA1c)was detected by TOSOH automatic glycosylated hemoglobin analyzer and the whole blood hs-CRP was detected by using blood routine instrument. Fasting plasma glucose(FPG), triglyceride(TG), cholesterol(TC), low density lipoprotein(LDL-C)and high density lipoprotein(HDL-C)were detected by automatic biochemical analyzer and the systolic blood pressure(SBP)and diastolic blood pressure(DBP)of each group were recorded. The relationship between copeptin and MK levels and blood lipid, blood pressure, biochemical parameters and the course of diabetes mellitus were also analyzed. <p>RESULTS: The levels of copeptin and MK in patients with diabetic retinopathy were significantly higher than those in controls, and the levels of copeptin and MK were gradually increased with the progress of disease(<i>P</i><0.05). The levels of copeptin and MK were correlated with the levels of HbA1c, hs-CRP and course of T2DM(<i>P</i><0.05), but no significant correlation with plasma lipids, blood pressure and FPG(all <i>P</i>>0.05). <p>CONCLUSION: The copeptin and MK levels are closely related to the course of diabetic retinopathy and the severity of the disease, both of which may be involved in the development of diabetic retinopathy.

Level of copeptin for early prediction of cardiorenal syndrome in rats / 中国病理生理杂志

AIM:To study the value of copeptin(CPP)level for the prediction of cardiorenal syndrome (CRS)in the rats with subtotal nephrectomy(SNX)combined with myocardial infarction(MI).METHODS: Male SD rats(n=60)were divided into blank control group(Con group), renal failure group(SNX group), heart failure group (MI group)and heart failure+renal failure group(CRS group).The concentrations of CPP in the serum and urine,hemo-dynamic indexes,blood pressure and renal function indexes were measured 1~5 weeks after modeling.The predictive val-ue of CPP for CRS in the rats was evaluated by the receiver operating characteristic(ROC)curve.RESULTS:Compared with Con group,left ventricular systolic pressure(LVSP)at 9 d in CRS group was significantly decreased(P<0.05),left ventricular end-diastolic pressure(LVEDP)at 9 d in CRS group was significantly increased(P<0.05), and the differ-ence of blood pressure at each time point was not statistically significant.The levels of blood urea nitrogen(BUN)and uri-nary creatinine(Ucr)in CRS group were significantly increased at 1 and 3 weeks(P<0.05).Compared with Con group, serum CPP level was significantly increased at 1,3 and 5 weeks(P<0.05), and urine CPP level was significantly in-creased at 3 weeks in CRS group.Serum brain natriuretic peptide(BNP)level was significantly increased at 1 and 3 weeks,while urine BNP level was significantly increased at 5 weeks after modeling in CRS group(P<0.05).No correla-tion between serum or urine CPP and BNP or BUN levels at 1 week in CRS group was observed.The results of ROC curve analysis indicated that the area under the curve(AUC)of serum CPP was 0.908(95%CI:0.789~1.028),and the cut-off value was 56.59 ng/L(sensitivity 0.875,specificity 0.800).CONCLUSION:The combination of SNX and MI estab-lishes a CRS rat model with both heart and kidney injury,and serum CPP can be used as a sensitive and specific biomarker for early prediction of CRS.

Estratificación de riesgo de muerte a 28 días en pacientes con infarto agudo de miocardio con base en sus concentraciones séricas de copeptina / Early death risk stratification in post-myocardial infarction patients based on plasma copeptin levels

Resumen: ANTECEDENTES: la copeptina es un biomarcador reciente que ha demostrado su utilidad en el diagnóstico temprano de pacientes con infarto agudo de miocardio; sin embargo, no se ha establecido su utilidad en el pronóstico de la supervivencia a corto plazo en estos pacientes. OBJETIVO: determinar el valor pronóstico de la copeptina en la predicción de muerte temprana (28 días) en pacientes posinfarto agudo de miocardio. MATERIAL Y MÉTODO: estudio prospectivo, observacional, realizado del 1 de enero de 2014 al 30 de septiembre de 2015 en una cohorte de pacientes con infarto agudo de miocardio, en el que se cuantificó la copeptina sérica inicial y se analizó la mortalidad en 28 días, ajustada con factores de riesgo conocidos. RESULTADOS: se incluyeron 34 pacientes que se clasificaron en riesgo bajo si tenían concentraciones séricas de copeptina iniciales ≤ 12 pmol/L; en riesgo intermedio entre 12.1 y 32.5 pmol/L y en riesgo alto ≥ 32.5 pmol/L, con mortalidad de 0, 15 y 30%, respectivamente. Se encontró una razón de riesgos entre altos y bajos ajustado a factores de confusión de 15.9 (intervalo de confianza a 95% [IC95%] de 1.3 a 190; p = 0.02 por análisis multivariable de regresión de Cox). CONCLUSIONES: la elevación de copeptina está directamente relacionada con el riesgo de muerte temprana en pacientes posinfarto agudo de miocardio y puede usarse como marcador de pronóstico.

Abstract: BACKGROUND: Copeptin is a novel biomarker that has demonstrated good diagnostic performance in the early diagnosis of patients with acute coronary syndrome; however, its prognostic performance in the short-term survival (28 days) has not been established. OBJECTIVE: To determine the prognostic performance of copeptin for 28 day-mortality in patients with acute coronary syndrome. MATERIAL AND METHOD: A prospective, observational cohort of patients with acute coronary syndrome was done from January 1st 2014 to November 30 2015, measuring copeptin at presentation, registering deaths and event-free survivors over 28 days. RESULTS: Thirty-four patients were included, stratified as having low risk of death if copeptin was ≤ 12 pmol/L, intermediate risk between 12.1 and 32.5 pmol/L, and high risk ≥ 32.5 pmol/L, with a mortality of 0%, 15% and 30%, respectively; hazard ratio between high and low adjusted to confuse factors of 15.9 (CI95% 1.3-190; p = 0.02, Cox multivariable regression model). CONCLUSION: Elevated concentrations of copeptin are directly proportional to a higher risk of all-cause mortality, hence it could be used as a prognostic marker.

Value of the combination of troponin and copeptin in the early diagnosis of acute myocardial infarction: A meta-analysis / 临床检验杂志

Objective To evaluate the value of the combination of troponin and copeptin in the early diagnosis of acute myocardial infarction(AMI) by a meta-analysis.Methods The studies about the application of the combination of troponin and copeptin in the early diagnosis of AMI were searched from Pubmed,CNKI,Wan Fang and VIP databases during their inception and May 2016,and were analyzed by the Meta-DiSc 1.4 software.Results A total of 19 relevant studies were enrolled,including 11 176 patients.95％ CI was calculated with the random effect model.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio(DOR) and the area under curve(AUCROC) of troponin alone and the combination of troponin and copeptin in the early diagnosis of AMI were 77％ (75％-79％) and 92％ (91％-93％),0.85 (0.85-0.86) and 0.60 (0.59-0.61),5.78 (4.01-8.32) and 2.25 (1.98-2.55),0.22(0.18-0.28) and 0.12 (0.09-0.17),32.21 (23.72-43.75) and 20.23 (14.33-28.55),and 0.911 8 and 0.788 8,respectively.Conclusion The combined detection of troponin and copeptin has high sensitivity,which may reduce the rate of missed diagnosis of AMI.However,the detection of troponin alone has high specificity and diagnostic accuracy.

Clinical Observation of Breviscapine Combined with Vinpocetine in the Treatment of Acute Cerebral In-farction / 中国药房

OBJECTIVE:To investigate clinical efficacy and safety of breviscapine combined with vinpocetine in the treatment of acute cerebral infraction. METHODS:A total of 80 patients with acute cerebral infraction were selected from our hospital during Jan. 2014-Dec. 2015,and then divided into observation group and control group according to random number table,with 40 cases in each group. Control group was given Vinpocetine injection 20 mL+0.9％ Sodium chloride injection 250 mL,ivgtt,qd. Observa-tion group was additionally given Breviscapine injection 20 mL+5％ Glucose injection 250 mL,ivgtt,qd,at intervals of 2-3 h on the basis of control group. Both groups were treated for 2 weeks. Clinical efficacies as well as serum copeptin,NT-proBNP,albu-min cobalt binding(ACB)value,European stroke scale(ESS)and functional independence measurement(FIM)score before and after treatment were observed in 2 groups,and the occurrence of ADR was recorded. RESULTS:Total response rate of observation group(90.0％)was significantly higher than that of control group(67.5％),with statistical significance(P0.05). After treatment,serum copeptin and NT-proBNP levels of 2 groups were decreased significantly,while ACB value,ESS and FIM score were increased significantly;the improvement of observation group was significantly better than that of control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Breviscapine combined with vinpocetine can improve neurological function of acute cerebral infraction patients and show good therapeutic efficacy with good safety.

Prognostic value of serumal copeptinin patientswith acute exacerbation of COPD complicated with respiratory failure / 国际检验医学杂志

Objective To analyse the prognostic value of serumal copeptin in patients with acute exacerbation of COPD compli-cated withrespiratory failure.Methods The serumal copeptin were detected in 60 hospitalized AECOPD patients before and after the treatment and in 30 healthy controls.Results Comparing with control groups,the serumal levels was significantly elevated in the patient with AECOPD before thetreatment and declinied two months later(P <0.05).The level of serum copeptin wereincreasing with the increase in the severity of the disease in acertain extent;The serumalcopeptin were positively correlated with lung function and CAT (r=0.058 and 0.821,P =0.00)and were negativelycorrelated with 6MWD(r=-0.652,P =0.00).Conclusion Serum copeptin could as-sess the incidence of acute exacerbations ofchronic obstructive pulmonary disease and its therapeutic effect;Serum copeptin can reflect the se-verity of AECOPD patients in a certain extent,and has certain clinical value to evaluate the quality of life in patients.

Clinical Study of Fructose Sodium Diphosphate in the Treatment of Acute Myocardial Infarction / 中国药房

OBJECTIVE:To investigate the effects and safety of fructose sodium diphosphate on cardiac function,myocardial injury markers,ischemia modified albumin (IMA) and copeptin in patients with acute myocardial infarction (AMI).METHODS:In retrospective study,102 AMI patients were collected from Nanyang Second People's Hospital during Feb.2014-Apr.2015,and then divided into observation group and control group according to therapy plan,with 51 cases in each group.Both groups received routine therapy and symptomatic therapy as intravenous dripping of urokinase+ intravenous pump of heparin+oral admin istration of aspirin.Observation group was additionally given fructose sodium diphosphate 10 g intravenously,bid.Treatment courses of 2 groups lasted for 7-10 d.The changes of cardiac function indexes (LVDd,LVSd,LVEF),myocardial injury mark ers (cTn Ⅰ,CK-MB),IMA and copeptin were recorded in 2 groups before and after treatment.The cardiac function grading,the occurrence of ADR and adverse events were also recorded in 2 groups.RESULTS:Before treatment,there was no statistical significance in above indexes between 2 groups (P＞0.05).12,24 h after treatment,LVDd and LVSd of 2 groups were shortened significantly,while LVEF and IMA levels were increased significantly,and CK-MB and copeptin levels were decreased significantly,compared to before treatment;the improvement of observation group was significantly better than control group,with statistical significance (P＜0.05).cTn Ⅰ levels of 2 groups were increased gradually compared to before treatment [there was no statistical significance in observation group between 12 h after treatment and before treatment (P＞0.05)];the increase of obser vation group was significantly smaller than that of control group,with statistical significance (P＜0.05).24 h after treatment,the proportion of cardiac function Killip grade Ⅰ-Ⅱ was 96.1％ in observation group,which significantly higher than 78.4％ in control group,with statistical significance (P＜0.05).No severe ADR was found in 2 groups,and there was no statistical significance in the incidence of ADR (P＞0.05).In respect of adverse events,the number of adverse events as severe arrhythmia,re current myocardial infarction,postinfarction angina pectoris and total incidence of ADE in observation group was significantly less or under than control group,with statistical significance (P＜0.05),besides there was no statistical significance in mortality between 2 groups (P＞0.05).CONCLUSIONS:Routine symptomatic treatment combined with sodium fructose diphosphate in the treatment of AMI can effectively increase myocardial injury markers,copeptin and IMA levels,improve cardiac function and reduce the risk of adverse events so as to improve the quality of prognosis.

Effect of daptomycin on serum copeptin and procalcitonin in septicopyemia induced by MRSA / 中国生化药物杂志

Objective To investigate the effect of daptomycin on the serum levels of proclacitonin (PCT) and copeptin in septicopyemia patients induced by methicillin-resistant Staphylococcus aureus (MRSA). Methods 54 cases septicopyemia patients induced by MRSA were selected and divided into two groups, 27 cases in each group. The two groups received fluid replacement therapy and nutrition support, the control group received vancomycin (0.5g per times, three times daily) with intravenous drip, and the study group received daptomycin (6mg/kg, once daily) with intravenous drip. The serum PCT, proclacitonin levels pre-and post-treatment in two groups were detected, the acute physiology and chronic health evaluationⅡ (APACHEⅡ) and sepsis-related organ failure assessment (SOFA) were used to evaluate the patients' condition, the clearance time of pathogenic bacteria was recorded and the clinical efficacy was compared between two groups. Results Compared with before treatment, serum PCT, C-reactive protein (CRP), interleukin-1β(IL-1β) and IL-6 in two groups decreased(P<0.01), the count of WBC, NE% and copeptin decreased (P<0.01), the APACHEⅡ and SOFA score were lower(P<0.05); compared with the control group, the PCT, CRP, IL-1 beta and IL-6 in study group were lower(P<0.05), the count of WBC, NE% and copeptin level were lower(P<0.05), APACHEⅡ and SOFA score were lower(P<0.05), the pathogen clearance rate was higher(P<0.05), clearance time was shorter(P<0.05), the total efficiency was higher(P<0.05). Conclusion Daptomycin can reduce serum PCT and copeptin in patients with septicopyemia induced by MRSA, and remove pathogenic bacteria rapidly, inhibit the inflammatory reaction, safe and reliable.

Meta-analysis for Clinical Values of Troponin Alone and Troponin Combining Copeptin in Early Diagnosis of Non-ST Segment Elevation Myocardial Infarction / 中国循环杂志

Objective: To evaluate the clinical effects of troponin alone and troponin combining copeptin in early diagnosis of Non-ST segment elevation myocardial infarction (NSTEMI) by meta-analysis. Methods: We searched Medline, EMBASE, Cochrane, Pubmed, CNKI and Wanfang database (1995-01 to 2015-10) for the publications of troponin alone and troponin combining copeptin in early diagnosis of NSTEMI. Based on inclusion and exclusion criteria, we screened the literatures and evaluated their quality by QUADAS items. Manager 5.2 and Meta-DiSc 1.4 software were used to study the pooled sensitivity and speciifcity for troponin alone and troponin combining copeptin in NSTEMI early diagnosis, and to calculate the summary receiver operating characteristic curve (SROC) with the area under curve (AUC). Results: There were 11 articles including 1 Chinese article enrolled. For NSTEMI diagnosis, compared with troponin alone, troponin combining copeptin showed the higher sensitivity (90% vs 75%), but lower speciifcity (60% vs 87%). For SROC, both AUC were > 0.7, while the AUC of troponin combining copeptin was even lower (0.805 vs 0.891). Conclusion: Combination of troponin and copeptin had the better sensitivity for NSTEMI early diagnosis, although it with lower speciifcity while increased copeptin level might suggest the patients associated with other clinical conditions such as heart failure or stroke which were important in clinical practice.

Correlation between copeptin and the disease severity, outcome and stress hyperglycemia in severe pneumonia patients / 中华急诊医学杂志

Objective To study the changes of plasma copeptin level in pneumonia patients and to explore the correlation between copeptin and disease severity,outcome as well as stress hyperglycemia.Methods A total of 45 patients with severe pneumonia were included in a prospective observation.The plasma levels of copeptin,CRP and blood glucose were measured after admission,and the APACHE Ⅱ scores were recorded within 24 hours.The patients were given insulin therapy by intravenous micro-dosage pump,and the total doses of insulin were recorded.All the patients with 28-day survival were followed up.Results The plasma levels of copeptin of severe pneumonia patients after admission were positively correlated with APACHE Ⅱ (r =0.481,P =0.001) and blood glucose (r =0.417,P =0.004),and were also correlated with the total insulin doses in patients under insulin therapy (blood glucose ≥ 10.0 mmol/L).The plasma levels of copeptin of the survival group were significanatly higher than the non-survival group,COX regression multivariate analysis showed that copeptin was an independent risk factor of death in severe pneumonia patients (P =0.005,OR =1.022,95％ CI:1.00-1.044),and the area under the ROC curve was 0.740 9 (P =0.006).Conclusion The plasma levels in all patients with copeptin of severe pneumonia after admission is positively correlated with APACHE Ⅱ and stress hyperglycemia,suggesting a useful approach to the judgment of disease severity,outcome and glucose control.