白细胞计数、中性粒细胞百分比、降钙素原和C反应蛋白在80岁以上老年感染性患者中的应用评价

Application value of white blood cell,neutrophil percentage,procalcitonin and C-reactive protein in patients aged 80 and over with infectious diseases

目的探讨外周血白细胞计数(WBC)、中性粒细胞百分比(N)、降钙素原(PCT)及C反应蛋白(CRP)水平在≥80岁老年感染性疾病患者中的评估价值。方法对我科2013年1月至2014年12月84例≥80岁老年感染性疾病住院患者进行回顾性分析,对临床资料及实验室检测指标进行分析。结果老年感染性疾病以肺部感染为主,其中慢性阻塞性肺疾病急性加重期(AECOPD)50例(59.5%),细菌性肺炎28例(33.3%),曲霉菌肺炎2例(2.4%);褥疮并感染2例(2.4%),急性化脓性膀胱炎2例(2.4%)。WBC与N对细菌性感染敏感,但受机体免疫状态、合并疾病及应用药物的影响;CRP作为感染炎症指标,敏感性高,但特异性低;PCT在轻度感染及局部感染时无明显升高,对AECOPD与轻症细菌性肺炎敏感性偏低,但不受机体免疫状态及应用糖皮质激素的影响。结论WBC、N、PCT和CRP均有一定的局限性,联合评估可能对于≥80岁老年感染性疾病患者临床意义更大。

Objective To evaluate the clinical value of white blood cell count（WBC）, neutrophil percentage（N）, procalcitonin（PCT） and C-reactive protein（CRP） for infectious diseases in the patients aged 80 and over. Methods The clinical data of 84 patients aged 80 and over with infectious diseases in our department from January 2013 to December 2014 were observed retrospectively. Results Pulmonary infection was the most common infectious disease in elderly pa- tients. Among all the examples, acute exacerbation of chronic obstructive pulmonary disease （AECOPD） accounted for 59. 5% （50 cases）, followed by bacterial pneumonia （33.3%, 28 cases）, aspergillus pneumonia （2. 4%, 2 cases）, pressure ulcers complicated with infection （ 2.4%, 2 cases）, acute suppurative inflammation of bladder （ 2.4%, 2 cases） respetctively. WBC and N were sensitive to bacterial infection, which were influenced by the body＇s immune status, accom- panying diseases and used drug. CRP showed a high sensitivity but low specificity to infection. The level of PCT was not in- creased in mild infections and localized bacterial infections, which showed low sensibility to AECOPD and mild bacterial pneumonia. Conclusions WBC, N, PCT, CRP all have limitations for elderly patients with infectious diseases, combined detection may be helpful.