降钙素原、C反应蛋白检测在慢性阻塞性肺疾病急性加重期治疗中的应用价值

Application of procalcitonin and C-reactive protein detection in acute exacerbation of chronic obstructive pulmonary disease and its guiding value in the use of antimicrobial agents

目的探讨降钙素原(PCT)、C反应蛋白(PCR)检测在慢性阻塞性肺疾病急性加重期(AECOPD)中的应用及对抗菌药物使用的指导价值.方法选取2014年6月至2018年6月余姚市第三人民医院收治的AECOPD患者82例为研究对象,根据患者入院时PCT水平分为A、B、C三组.血清PCT水平<0.10μg/L为A组(n=17),给予化痰平喘和对症治疗,不进行抗菌药物治疗;血清PCT水平0.10~0.25 μg/L为B组(n=33),不进行抗菌药物治疗,如隔日PCT水平≥0.25 μg/L或升高幅度>30%时,治疗方法同C组;血清PCT水平>0.25 μg/L时为C组(n=32),给予化痰平喘、对症治疗,同时给予抗菌药物.比较三组患者的临床资料、实验室检测指标及临床疗效.结果三组患者一般临床资料差异均无统计学意义(均P>0.05).三组患者发热分别为2例(11.76%)、16例(50.00%)、19例(57.58%),呼吸困难分别为6例(35.29%)、25例(78.13%)、31例(93.94%),哮鸣音分别为4例(23.53%)、26例(81.25%)、33例(100.00%),湿哕音分别为12例(70.59%)、27例(84.37%)、33例(100.00%),三组间上述指标差异均有统计学意义(x2=15.827、24.361、30.284、18.644,均P<0.05).三组患者血培养阳性患者分别为4例(23.53%)、10例(31.25%)、23例(69.69%),痰培养阳性患者分别为5例(29.41%)、24例(75.00%)、28例(84.85%),三组上述指标差异均有统计学意义(x2=16.871、24.644,均P<0.05).三组患者白细胞(WBC)计数分别为(4.27±1.92)×109/L、(8.64±3.77)×109/L、(18.06±4.87)×109/L;中性白细胞百分比分别为(54.12±3.48)、(82.19±5.67)、(90.07±9.33);PCT水平分别为(0.09±0.08)μg/L、(0.21±0.12)μg/L、(0.74±0.33)μg/L,三组间WBC计数、中性白细胞百分比、PCT水平比较,差异均有统计学意义(F=14.827、25.825、19.873,均P<0.05).三组间CRP水平差异无统计学意义(P>0.05).A组患者未使用抗菌药物治疗且临床症状好转;B组14例未使用抗菌药物且临床症状好转,18例患者加用抗菌药物治疗;C组使用抗菌药物治疗后,20例症状明显好转,12例更换抗菌药物治疗方案,1例死亡.结论 PCT、CRP可以作为AECOPD病情严重程度的评价指标,且可作为抗菌药物使用或更换与否的参考工具.

Objective To explore the application of procalcitonin (PCT) and C-reactive protein (CRP) detection in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and its guiding value in the use of antimicrobial agents.Methods From June 2014 to June 2018,82 patients with AECOPD treated in the Third People's Hospital of Yuyao were selected.According to the difference of PCT and CRP levels at admission,the patients were divided into three groups:A,B and C group.A group (n =17):the serum PCT level was less than 0.10μg/L,treated with phlegm and asthma relief and symptomatic therapy without antibiotic therapy.B group (n =33):the serum PCT level was 0.10-0.25 μg/L,B group was not treated with antibiotics,if the level of PCT≥0.25 μg/L on the next day or the amplitude of increase > 30%,the treatment method was the same as that in C group.C group (n =32):the serum PCT level was more than 0.25 μg/L,C group was given expectoration and asthma relief,symptomatic treatment and antibiotics.The clinical data,laboratory test indicators and clinical efficacy of the three groups were compared.Results There were no statistically significant differences in the general clinical data of the three groups (all P >0.05).The incidence of fever in the three groups were 2 cases (11.76%),16 cases (50.00%) and 19 cases (57.58%),respectively;expiratory dyspnea in the three groups were 6 cases (35.29%),25 cases (78.13%),31 cases (93.94%),respectively;wheezing rale in the three groups were 4 cases (23.53%),26 cases (81.25%),33 cases (100.00%),respectively;wet sound in the three groups were 12 cases (70.59%),27 cases (84.37%),33 cases (100.00%),respectively,the differences of the above indicators among the three groups were statistically significant(x2 =15.827,24.361,30.284,18.644,all P < 0.05).The percentages of sputum positive patients in the three groups were 4 cases (23.53 %),10 cases (31.25 %) and 23 cases (69.69%),respectively;the percentages of sputum culture positive patients were 5 cases (29.41%),24 cases (75.00%),28 cases (84.85 %),respectively,the differences of the above indicators among the three groups were statistically significant (x2 =16.871,24.644,all P < 0.05).The WBC counts of the three groups were (4.27 ± 1.92) × 109/L,(8.64 ± 3.77) × 109/L,(18.06 ±4.87) × 109/L,respectively;the ratios of neutrophils were (54.12 ± 3.48),(82.19 ±5.67),(90.07 ± 9.33),respectively;the levels of PCT of the three groups were (0.09 ±0.08) μg/L,(0.21 ±0.12) μg/L,(0.74 ±0.33) μg/L,respectively,there were significant differences in WBC count,ratio of neutrophils and PCT among the three groups (F =14.827,25.825,19.873,all P < 0.05).The level of CRP among the three groups had no statistically significant difference (P > 0.05).Patients in A group were not treated with antimicrobial agents and their clinical symptoms were improved.Fourteen patients without antimicrobial agents and 18 patients with improved clinical symptoms were treated with antimicrobial agents in B group.In C group,20 patients with symptoms improved after treatment with antimicrobial agents,12 patients with replacement of antimicrobial treatment regimen and 1 patient died.Conclusion PCT and CRP can be used as an index to evaluate the severity of AECOPD and a reference tool for the use or replacement of antimicrobial agents.