血清降钙素原与C-反应蛋白对COPD急性期患者肺部细菌感染的临床诊断研究

Clinical value of serum procalcitonin and C-reactive protein in diagnosis of pulmonary bacterial infection in patients with acute exacerbations of COPD

目的探讨降钙素原(PCT)、C-反应蛋白(CRP)对慢性阻塞性肺疾病急性加重期(AECOPD)患者细菌感染的诊断价值,以期为临床诊疗提供参考。方法选取2016年1月-2016年12月医院于呼吸重症监护室或呼吸内科住院的210例AECOPD患者,依据痰培养结果将患者分为痰培养阳性组(PC组)86例及痰培养阴性组(NC组)124例,检测两组患者临床指标,依据ROC曲线计算PCT、CRP最大约登指数对应的灵敏度及特异度。结果 PC组患者PCO2(58.6±11.7)mmHg显著高于NC组(53.1±10.8)mmHg,而SaO2(87.2±5.5)%则显著低于NC组(89.4±4.6)%(P<0.05);PC组患者PCT(2.43±0.44)ng/mL、CRP浓度(108.5±18.4)mg/L均显著高于NC组(1.47±0.60)ng/mL、(95.5±12.5)mg/L(P<0.05);PCT浓度ROC曲线结果显示,PCT最大约登指数为0.701,对应敏感度为91.9%,特异度为78.2%。结论 PCT对AECOPD患者细菌感染具有一定诊断价值,而CRP对AECOPD患者细菌感染的诊断价值尚待评估。

OBJECTIVE To explore the clinical value of procalcitonin （PCT） and C-reactive protein （CRP） in diagnosis of bacterial infection in patients with acute exacerbations of chronic obstructive pulmonary disease （AECOPD） so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 210 patients with AECOPD who were hospitalized respiratory intensive care unit or department of respiratory medicine from Jan 2016 to Dec 2016 were enrolled in the study and were divided into the sputum culture-positive group （PC group） with 86 cases and the sputum culture-negative group （NC group） with 124 cases according to the result of sputum culture.The clinical indexes of the two groups of patients were detected, and the maximum Youden indexes of PCT and CRP and their corresponding sensitivity and specificity were calculated on the basis of ROC curve.RESULTS The PCO2 of the PC group was （58.6±11.7）mmHg, significntly higher than （53.1±10.8）mmHg of the NC group, however, the SaO2 of the PC group was （87.2±5.5）%, significantly lower than （89.4±4.6）% of the NC group （P〈0.05）.The PCT level of the PC group was （2.43±0.44）ng/mL, significntly higher than （1.47±0.60）ng/mL of the NC group;the CRP concentration of the PC group was （108.5±18.4）mg/L, significntly higher than （95.5±12.5）mg/L of the NC group （P〈0.05）.The result of ROC curve analysis of the PCT concentration showed that the maximum Youden index of the PCT was 0.701, its corresponding sensitivity was 91.9%, the specificity 78.2%.CONCLUSION The PCT has certain value in diagnosis of bacterial infections in the patients with AECOPD, however, the value of the CRP in diagnosis of the bacterial infections remains to be evaluated.