慢阻肺急性加重期患者痰色与感染指标相关性研究

Clinical research of sputum color and infection indicators in AECOPD

目的探讨慢阻肺急性加重患者入院自发痰的痰色与感染指标的相关性,帮助患者评估病情,加强自我管理。方法收集慢阻肺急性加重期患者尚未使用抗生素的自发痰,检测痰和血中性粒细胞比例、C-反应蛋白(CRP)、CD64感染指数及降钙素原(PCT)。同时采用Bronko Test比色卡对痰色进行分级,从1至5共分五级,痰色由白色至黄绿色。根据痰色级别将患者分为两组,1-2级为粘液痰组,3-5级为脓性痰组。数据采用SPSS.22软件、Spearman等级相关性检验;组间非正态分布采用Mann-Whitney秩和检验方法,P<0.05有统计学意义。结果共收集患者48例,粘液痰组10例(21%)、脓性痰组38例(79%)。痰中性粒细胞比例与痰色级呈正相关(r=0.43,P=0.006)。脓性痰组痰中性粒细胞比例中位数显著高于粘液痰组(P=0.004);脓性痰组血中性粒细胞比例中位数高于粘液痰组(P=0.043);两组间CRP、PCT和CD64无明显差异。结论慢阻肺急性加重患者痰色与痰中性粒细胞比例关系密切;脓性痰组与粘液痰组相比,痰及血中性粒细胞比例显著增高。痰色是临床评估感染简单而有效的方法之一。

Objective To investigate the relationship of spontaneous sputum color and infection indicators in AECOPD patients, in order to assess disease and strengthen self-management.Methods Spontaneous sputum of AECOPD patients untreated with antibiotics was collected to detect neutrophil ratio, blood neutrophil ratio, C-reactive protein, CD64 infection indicators and procalcitonin.The sputum color grading from 1-5 was divided into five and sputum color from white to yellow-green by Bronko Test colorimetric card.According to the Sputum color they were divided into two groups, the mucus group of stage 1-2 and the purulent group of stage 3-5.The correlation was analyzed by SPSS.22 and Spearman.Non-normal distribution was analyzed by Mann-Whitney rank sum test method, and P〈0.05 was statistically significant.Results A total of 48 AECOPD patients enrolled, and 10 cases of mucus sputum （21%） and 38 cases of purulent sputum （79%） were collected.The proportion of sputum neutrophil ratio was positively correlated with sputum color （r=0.43, P=0.006）.Compared with the purulent sputum, sputum neutrophil ratio was significantly increased in the mucus sputum group （P=0.004）.Compared with the purulent sputum, blood neutrophil ratio was increased in the mucus sputum group （P=0.043）.The levels of CRP, PCT and CD64 showed no significant difference between the two groups.Conclusion The sputum color in AECOPD is closely related with the proportion of sputum neutrophils ratio.Compared with mucus sputum, the blood and sputum neutrophil ratio increases significantly in purulent sputum.Sputum color is one of the simple and effective method to assess infection.