联合检测血清PCT、CRP在细菌感染引起AECOPD患者的诊断价值

Procalcitonin and C-reactive Protein in Diagnosis of Bacterial Infection in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients

目的探讨检测血清降钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)水平对指导细菌感染引起慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者临床诊治中的意义。方法对AECOPD患者58例(A组)及COPD稳定期患者31例(B组),采用免疫发光法测定其血清PCT及CRP水平,并进行诱导痰细菌定量培养;以痰中下呼吸道潜在病原菌(PPM)浓度107CFU/mL作为诊断AECOPD细菌感染的标准,将AECOPD患者分为有细菌感染组(A1组35例)、无细菌感染组(A2组23例)。结果 AECOPD有细菌感染组血清PCT(0.22±0.03)ng/mL,CRP(59.79±10.23)mg/mL水平高于无细菌感染组PCT(0.11±0.02)ng/mL,CRP(18.34±3.15)mg/mL及稳定期组PCT(0.08±0.01)ng/mL,CRP(10.06±1.63)mg/mL,差异有统计学意义(P<0.05)。COPD急性加重期无细菌感染组PCT(0.11±0.02)ng/mL水平高于稳定期组PCT(0.08±0.01)ng/mL,差异无统计学意义(P>0.05),急性加重期无细菌感染组CRP(18.34±3.15)mg/mL水平高于CRP(10.06±1.63)mg/mL,差异有统计学意义(P<0.05)。结论 COPD患者PCT水平升高可能与细菌感染有关、而CRP水平升高可能提示急性加重,联合检测血清PCT及CRP可以帮助了解AECOPD的细菌感染及指导抗生素应用。

Objective To evaluate the clinical significance of concurrent determination of serum procalcitonin （PCT） and C-reactive protein （CRP） in the diagnosis of bacterial infection in acute exacerbation of chronic obstructive pulmonary disease patients. Methods The serum PCT and CRP level of 58 AECOPD patients and 31 stable COPD patients was measured by immunofluorescence method, and the 58 AECOPD patients were simultaneously done semi-quantitative sputum culture, PPMs were only regarded as significant if they reached a growth of 107cfu/mL, indicating the presence of bacterial infection. Results The serum level of PCT and CRP in the bacterial infection AECOPD group was （0.22±0.03） ng/mL and （59.79±10.23） mg/mL respectively, which were much higher than those without bacterial infection AECOPD group （0.11 ±0.02） ng/mL and （18.34±3.15） mg/mL respectively, also much higher than those stable COPD group （0.08±0.01） ng/mL and （10.06±1.63） mg/mL. There was statistical difference between bacterial infection group and without bacterial infection group （P〈 0.05）. There was not statistic difference between the serum level of PCT without bacterial infection AECOPD group and stable COPD group （P〉 0.05）, and there was statistic difference between the serum level of CRP without bacterial infection AECOPD group and stable COPD group （P〈 0.05）. Conclusion The serum PCT level is some clinical value for judging bacterial infection of COPD, the serum CRP level is some clinical value for judging AECOPD. The combined detection of PCT and CRP level is clinical value for judging bacterial infection of COPD and offer a guidance of AECOPD.