降钙素原对老年慢性阻塞性肺疾病急性加重合并肺炎的预测价值

Predictive value of procalcitonin on acute exacerbation of chronic obstructive pulmonary disease combined with pneumonia in the elderly patients

目的探讨降钙素原（PCT）在预测老年慢性阻塞性肺疾病急性加重（AECOPD）合并肺炎患者中的价值。方法选取2012年10月至2014年5月住院的160例老年AECOPD患者,根据影像学结果分为单纯AECOPD组73例,AECOPD合并肺炎组87例,记录2组间性别、年龄、吸烟情况、既往咳痰喘病史、此次急性加重病程、入院前抗生素应用时间、吸烟指数等一般情况,入院24 h内测定PCT、C-反应蛋白（CRP）、白细胞计数（WBC）及中性粒细胞百分比（NE%）并进行比较。对2组间差异有统计学意义的指标进行Logistic回归分析。对Logistic回归有意义的指标绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）。结果2组间既往咳痰喘病史、PCT、CRP、WBC、NE%差异有统计学意义（P〈0.05）。对上述5项指标行Logistic回归分析,发现仅PCT（P=0.002）有预测意义。PCT预测老年AECOPD患者合并肺炎的ROC曲线下面积为0.878（95%CI：0.823-0.933）。根据ROC曲线选取最佳截点为0.075 ng/ml,预测老年AECOPD患者合并肺炎的灵敏度为83.9%,特异度为79.5%。结论血清PCT可以作为判断老年AECOPD患者是否合并肺炎的辅助检查指标。

Objective To explore the predictive value of procalcitonin（PCT） on acute exacerbation of chronic obstructive pulmonary disease（AECOPD） combined with a concomitant pneumonia in the elderly patients.Methods 160 elderly AECOPD patients,hospitalized from October 2012 to May 2014,were divided into AECOPD group（73 patients）and AECOPD combined with pneumonia group（87 patients） according to result of imaging data.Gender,age,smoking status,history of coughing,acute exacerbation course,application of antibiotics prior to admission time,smoking index were recorded.The serum levels of PCT,C-reactive protein（CRP）,white blood cell（WBC）,and neutrophil percentage（NE%） were measured within 24 hours after admission and compared between two groups.Logistic regression,the receiver-operating characteristic（ROC） cun＇e and the area under the cun＇e（AUC） were analyzed for statistically significant indicators between two groups.Results The history of coughing,PCT,CRP,WBC,and NE%levels in AECOPD combined with pneumonia group were significantly higher than AECOPD group（P〈0.05）.Logistic regression showed that only PCT was a significant predictor of pneumonia（P = 0.002）.The AUC of PCT predicting the combination of pneumonia in elderly patients with AECOPD was 0.878（95%CI：0.823-0.933）.Using a cut-off point of 0.075 ng/ml for PCT,the sensitivitiy and specificitiy for pneumonia in elderly patients with AECOPD were 83.9%and 79.5%respectively.Conclusions Serum procalcitonin measurements in elderly patients with AECOPD plays a role in the diagnosis of pneumonia.