降钙素原测定在慢性阻塞性肺疾病急性加重期的临床意义

Clinical significance of procalcitonin determination in acute exacerbation of chronic obstructive pulmonary disease

目的探讨降钙素原(PCT)在慢性阻塞性肺疾病急性加重期(AECOPD)病程中的临床意义。方法以48例痰菌培养阳性AECOPD患者为细菌感染组,48例痰菌培养阴性AECOPD患者为非细菌感染组,2个组分别检测PCT,细菌感染组在治疗后3、5及7 d分别再检测1次PCT。结果细菌感染组PCT水平明显高于非细菌感染组(P<0.01);细菌感染组治疗后3、5及7 d PCT浓度均明显持续下降,与治疗前差异均有统计学意义(P<0.01);细菌感染组PCT在治疗后3 d就显示与治疗前有显著差异(P<0.01),红细胞沉降率(ESR)、白细胞(WBC)计数、中性粒细胞计数(NC)等指标则在治疗后5 d才显著下降;细菌感染组有2例患者PCT水平持续增高,治疗无效,死亡,非细菌感染组患者均好转出院。结论 PCT是反映AECOPD患者肺部感染的敏感指标,也是反映AECOPD患者感染细菌是否被清除的最常用指标,可敏感地反映AECOPD患者治疗过程中炎症程度的变化,较好地考核抗菌治疗效果。

Objective To investigate the clinical significance of procalcitonin（PCT） in acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods A total of 48 sputum culture positive patients with AECOPD were enrolled as bacterial infection group,and 48 sputum culture negative patients with AECOPD were enrolled as non-bacterial infection group. The PCT was determined,and PCT was determined again in bacterial infection group after treatment for 3,5 and 7 d. Results The level of PCT in bacterial infection group was significantly higher than that in non-bacterial infection group（P〈0.01）. In bacterial infection group after treatment for 3,5 and 7 d,PCT levels decreased significantly with statistical significance compared with that before treatment（P〈0.01）. The bacterial infection group after treatment for 3 d showed significant difference for PCT compared with that before treatment（P〈0.01）. Erythrocyte sedimentation rate（ESR）,white blood cell（WBC）,neutrophil count（NC）and other indicators decreased significantly after treatment for 5 d. In bacterial infection group,2 patients had a continuous increasing of PCT and then died,and non-bacterial infection group all cured. Conclusions PCT is a sensitive index for pulmonary infection in patients with AECOPD,and it also reflects whether infection bacterium is removed or not. It is sensitive to reflect the changes of inflammation degrees and the effect of antimicrobial treatment in the treatment of patients with AECOPD.