降钙素原联合中性粒细胞/淋巴细胞比值在COPD急性加重期合并细菌感染的诊断价值

Clinical Value of Procalcitonin and Neutrophil-lymphocyte Ratio in Diagnosis of Bacterial Infection in Patients with Acute Exacerbations of COPD

目的:探讨降钙素原联合中性粒细胞/淋巴细胞比值在COPD急性加重期细菌感染的诊断价值。方法:选取80例COPD急性加重期患者为研究对象,以2017年GOLD报告中关于存在细菌感染的诊断标准为金标准,分为细菌感染组49例(61.25%)和非细菌感染组31例(38.75%),分别检测两组PCT及NLR值,比较两组PCT与NLR值差异,并通过ROC曲线分析PCT与NLR单独和联合对COPD急性加重期患者细菌感染的诊断价值。结果:细菌感染组PCT及NLR值明显高于非细菌感染组,比较差异有统计学意义(P均<0.05);通过ROC曲线分析,PCT的AUC面积为0.922,截断值为0.55 ng/mL,灵敏度为0.816,特异度为0.903;NLR的AUC面积为0.762,截断值为3.45,灵敏度为0.694,特异度为0.774;NLR联合PCT串联特异度最高为98%,NLR联合PCT并联灵敏度最高为94%。结论:PCT对AECOPD患者合并细菌感染的诊断价值较高,且其并联NLR时漏诊率较低,串联NLR时误诊率较低。

Objective:To explore the clinical value of procalcitonin(PCT) and neutrophil-lymphocyteratio(NLR) in diagnosis of bacterial infection in patients with acute exacerbations of COPD.Method:Eighty patients with acute exacerbation of COPD were enrolled in the study.The diagnostic criteria for the presence of bacterial infection in the 2017 GOLD report were based on the gold standard.The patients were divided into the bacterial infection group of 49 cases(61.25%) and the non-bacterial infection group of 31 cases(38.75%).The PCT and NLR values of the two groups were detected respectively.The differences of PCT and NLR values between the two groups were compared.The value of single PCT, NLR, or their combination in diagnosis of the bacterial infection in the patients with acute exacerbations of COPD were evaluated by means of ROC curve analysis. Result:The levels of PCT and NLR in the bacterial group were higher than those of the non-bacterial infection group, the difference was statistically significant(P<0.05).By ROC curve analysis,the AUC of PCT was 0.922,the cutoff value was 0.55 ng/mL,the sensitivity was 0.816,the specificity was 0.903.The AUC of NLR was 0.762,the cutoff value was 3.45,the sensitivity was 0.694, and the specificity was 0.774.The specificity of PCT combined with NLR in serial is up to 98%, and the sensitivity of PCT combined NLR in parallel is up to 94%. Conclusion:PCT has a higher diagnostic value for AECOPD patients with bacterial infection,the rate of missed diagnosis is lower when the NLR is combined in parallel,and the rate of misdiagnosis is lower when the NLR is combined in series.