不同病原体致COPD患者急性加重期血清炎症标志物改变及对患者临床转归的影响

Changes of serum inflammatory biomarkers and clinical outcomes of AECOPD caused by different pathogens

目的探讨不同病原体致急性加重期慢性阻塞性肺疾病(AECOPD)患者血清炎症标志物改变及对患者临床转归的影响。方法选取2013年3月至2016年12月在我院收入的AECOPD患者186例。采用电化学发光法测定血清降钙素原(PCT);免疫比浊法测定血清C-反应蛋白(CRP)。运用VITEK 2Compact全自动细菌鉴定仪鉴定细菌;15联呼吸道病毒荧光标记PCR鉴定病毒。ROC分析PCT和CRP的诊断价值。结果 65例(34.9%)患者细菌感染,25例(13.4%)病毒感染,28例(15.1%)细菌与病毒混合感染,68例(36.6%)未感染。四组患者PCT(P=0.035)和CRP(P=0.042)具有统计学意义。患者中57例(30.6%)感染革兰阴性菌,36例(19.4%)感染革兰阳性菌,53例(28.5%)感染病毒,三组患者PCT差异具有统计学意义(P=0.046);PCT辅助诊断AECOPD患者感染具有临床价值(AUC=0.772,P=0.002)。存活患者PCT(P=0.005)和CRP(P=0.010)显著低于死亡患者。结论细菌感染AECOPD患者血清PCT高于病毒感染AECOPD患者;PCT可用于辅助诊断AECOPD感染类型及预测临床转归情况。

Objective To explore the changes of serum inflammatory markers and clinical outcomes of patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）caused by different pathogens.Methods 186 patients with AECOPD were enrolled from March 2013 to December 2016.Serum levels of procalcitonin（PCT）were measured with electrochemiluminescence.Serum C-reactive protein（CRP）was measured with immunoturbidimetry.VITEK 2 Compact automatic bacterial identification instrument was used to identify bacteria.Fluorescent labeling PCR kits for detection of 15 respiratory viruses in combination were used to identify viruses.Results Sixty-five patients（34.9%）were infected by bacteria,25（13.4%）by viruses,28（15.1%）by both bacteria and viruses,while 68（36.6%）had no infections.Serum PCT（P =0.035）and CRP（P =0.042）among four groups had statistically significant differences.Fifty-seven patients（30.6%） were infected by Gram-negative bacteria,36（19.4%）by Gram-positive bacteria,while 53（28.5%）by viruses.Serum PCT（P=0.046）among three groups had statistically significant differences.The diagnosis value of PCT to AECOPD infection was efficient（AUC=0.772,P=0.002）.PCT（P=0.005）and CRP（P=0.010）in survival patients were significantly lower than in those who failed to survive.Conclusion Serum PCT in AECOPD paients with bacterial infection was higher than those with viral infection,therefore,PCT can be used to help diagnose the infection types and predict clinical outcomes of AECOPD patients.