慢性阻塞性肺疾病患者急性加重期血清降钙素原水平的变化及临床意义

The changes and clinical implications of serum procaldtonin in acute exacerbations of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(COPD)患者急性加重期血清降钙素原(PCT)水平的变化及其临床意义。方法2004年10月至2005年3月在我院呼吸科门诊45例COPD急性加重期患者,治疗前采用免疫发光法测定其血清PCT水平,并进行诱导痰细菌定量培养;治疗后达稳定期时再次进行血清PCT水平测定及诱导痰细菌定量培养作为自身对照。以痰中下呼吸道潜在病原菌(PPM)浓度≥107CFU／ml作为诊断COPD急性加重期细菌感染的标准,将COPD急性加重期患者分为有细菌感染组(A组,15例)、无细菌感染组(B组,30例)。结果(1)45例患者在急性加重期时,有21例(46．7％)痰培养出PPM,其中15例痰中PPM浓度≥107CFU／ml。稳定期时有9例患者的病原菌仍存留[2．8×106(1．3×106,1．9×107)CFU／ml],但细菌浓度较急性加重期显著降低[7．0×107 (4．5×107,7．1×108)CFU／ml,Z=-2．666,P=0．008]。(2)在急性加重期,A组血清PCT水平[0．24 (0．17,0．28)μgL]显著高于B组[0．13(0．10,0．18)μg/L,Z=-3．531,P=0．000]。A组患者稳定期血清PCT含量为0．12(0．10,0．14)μg/L,显著低于急性加重期[0．24(0．17,0．28)μg／L,Z= -3．298,P=0．001];B组患者稳定期血清PCT含量为0．13(0．10,0．15)μg/L,与急性加重期[0．13 (0．10,0．18)μg／L]比较,差异无统计学意义(Z=-1．614,P=0．107)。在稳定期2组血清PCT含量比较差异亦无统计学意义(Z=-0．382,P=0．703)。结论COPD急性加重期患者血PCT水平升高可能与细菌感染有关。

Objective To investigate the changes and clinical implications of serum procalcitonin （PCT） in acute exacerbations of chronic obstructive pulmonary disease （COPD）. Methods A total of 45 patients with an acute exacerbation of COPD were studied. On presentation, serum PCT concentrations were measured, and quantitative sputum culture was also performed. The patients were reevaluated when they had returned to their stable clinical state. Potentially pathogenic microorganism （PPM） was only regarded as significant if they reached a growth of ≥ 10^7 CFU/ml, indicating the presence of bacterial exacerbation of COPD. Results （ 1 ） On presentation, sputum samples from 21 （ 46. 7% ） patients yielded PPM. When reevaluated in stable clinical state, sputum samples from 9 （20%） patients had a positive PPM culture [2. 8 × 10^6 （ 1.3 × 10^6, 1.9 × 10^7 ） CFU/ml ], but with a significantly lower bacterial load than on presentation[ 7. 0 × 10^7 （4. 5 × 10^7,7.1 × 10^8 ） CFU/ml, Z = - 2. 666, P = 0. 008 ]. （2） The patients were classified into two groups： group A included patients with bacterial exacerbation of COPD （n = 15 ） , group B included patients with nonbacterial exacerbation of COPD （n = 30 ）. The levels of PCT for patients of group A[0. 24（0. 17,0. 28）μg/L]were significantly higher than group B[0. 13（0. 10,0. 18）μg/L,Z = -3. 531, P = 0. 000 ]. When they had returned to their stable state, the levels of PCT for patients of group A decreased to 0. 12（0. 10,0. 14）μg/L,which was significantly lower than in exacerbation[0. 24（0. 17,0. 28） μg/L,Z = - 3. 298 ,P = 0. 001 ] ; But compared with exacerbation [ 0. 13 （ 0. 10,0. 18 ） μg/L], the levels of PCT for patients of group B did not changed [0. 13（0.10,0.15） μg/L,Z = - 1.614,P =0. 107]. In the stable state, there were no differences in the PCT measurement between the two groups （Z = -0. 382, P = 0. 703 ）. Conclusion In patients presented with an acute exacerbation of COPD, the elevation of serum PCT is associated with bacterial infection.