系统性炎症指标及痰液细菌培养在慢性阻塞性肺疾病患者中的临床价值

Clinical value of systemic inflammation and sputum culture in the detection of patients with chronic obstructive pulmonary disease

目的探讨系统性炎症指标及痰液细菌培养在COPD患者诊疗中的应用价值。方法选取266例入院的COPD患者作为研究对象,将其分为稳定期组和急性加重期组,随机抽取200例健康体检者设为对照组。对其进行痰液培养,并动态监测治疗前后血中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、C-反应蛋白(CRP)和降钙素原(PCT)等炎症指标。结果稳定期组182例发生细菌感染62例(34.07%),其中2种细菌同时感染为10例(5.5%)。急性加重期组84例发生细菌感染40例(47.62%),其中2种细菌同时感染为12例(14.29%)。稳定期组患者治疗前的各炎症指标水平均高于对照组(P<0.05);经过治疗后,NLR、PLR、CRP水平均显著下降(P<0.05)。急性加重期组与对照组比,各炎症指标都有明显升高(P<0.05);然而急性加重期组诊疗前后各炎症指标差异无统计学意义(P>0.05)。结论NLR、PLR可作为评估COPD全身炎症反应状态的指标,对COPD患者危险分层及预后评估有一定的临床意义。

Objective To investigate the value of systemic inflammation and sputum culture in the diagnosis and treatment of COPD patients. Methods A total of 266 COPD patients were selected as objects,who were divided into stable group and acute exacerbation group. 200 people for health examinations were selected randomly in the control group. The sputum culture was carried out,and the inflammatory indicators including blood neutrophil /lymphocyte ratio ( NLR) ,platelet /lymphocyte ratio (PLR) ,C - reactive protein (CRP) and procalcitonin (PCT) were dynamically monitored before and after treatment. Results Bacterial infection occurred in 62 out of 182 cases in the stable group (34.07%) ,of which 10 cases (5.5%) were simultaneously infected by two bacteria. In the acute exacerbation group,bacterial infection occurred in 40 out of 84 cases (47.62%) ,and 12 of them were simultaneously infected by two bacteria(14.29%) . The levels of inflammatory markers before treatment in the stable group were higher than those in the control group (P<0.05) . After treatment,the levels of NLR,PLR and CRP significantly decreased (P<0.05) . Compared with the control group,the inflammatory indexes of the acute exacerbation group significantly increased (P<0.05) . However,there was no statistical significance on the difference in inflammatory indexes before and after the treatment in the acute exacerbation group (P> 0.05) . Conclusion NLR and PLR can be used as indicators to evaluate the inflammatory response status of COPD,which has clinical significance for the risk stratification and prognosis in patients with COPD.