降鈣素原在慢性阻塞性肺疾病合并重癥肺炎的臨床應(yīng)用及預(yù)后分析

郭俊華　楊誠(chéng)　張偉強(qiáng)

【摘要】 目的：探討降鈣素原（PCT）檢測(cè)在診斷和治療慢性阻塞性肺疾病合并重癥肺炎患者的臨床應(yīng)用與預(yù)后。方法：回顧性選取2015年6月-2016年12月于本院診治的慢性阻塞性肺疾病合并重癥肺炎患者108例作為研究對(duì)象，根據(jù)氣管插管通氣情況分為氣管插管通氣組（n=57）和無(wú)創(chuàng)通氣組（n=51）。入院24 h內(nèi)測(cè)定兩組白細(xì)胞計(jì)數(shù)（WBC）、中性粒細(xì)胞百分比（NE%）、C反應(yīng)蛋白（CRP）、PCT等指標(biāo)數(shù)值進(jìn)行比較，同時(shí)將其陽(yáng)性反應(yīng)率進(jìn)行分析。結(jié)果：氣管插管通氣組入院時(shí)PCT、CRP、WBC水平均明顯高于無(wú)創(chuàng)通氣組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.01）；氣管插管通氣組的患者PCT陽(yáng)性檢出率明顯高于無(wú)創(chuàng)通氣組（P<0.05），兩組患者的CRP和WBC陽(yáng)性反應(yīng)率比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論：慢性阻塞性肺疾病合并重癥肺炎患者進(jìn)行氣管插管后其炎癥指標(biāo)PCT、CRP、WBC檢測(cè)值均明顯高于無(wú)創(chuàng)通氣的患者，感染情況較重，其中PCT指標(biāo)陽(yáng)性表達(dá)率最明顯，能夠作為COPD合并肺炎患者治療和預(yù)后的標(biāo)志指標(biāo)，可為臨床提供有利的依據(jù)。

【關(guān)鍵詞】 降鈣素原； 慢性阻塞性肺疾病； 重癥肺炎； 臨床應(yīng)用； 預(yù)后

Clinical Application and Prognosis Analysis of Procalcitonin in Chronic Obstructive Pulmonary Disease with Severe Pneumonia/GUO Jun-hua，YANG Cheng，ZHANG Wei-qiang.//Medical Innovation of China，2017，14（27）：016-019

【Abstract】 Objective：To investigate the clinical application and prognosis study of procalcitonin（PCT） in the diagnosis and treatment of chronic obstructive pulmonary disease with severe pneumonia.Method：A total of 108 patients with chronic obstructive pulmonary disease complicated with severe pneumonia in our hospital from June 2015 to December 2016 were chosen as the research objects and were divided into tracheal intubation group（n=57） and noninvasive ventilation group（n=51） according to whether the tracheal intubation ventilation.Admitted to hospital within 24 h determination of two groups of white blood cell count （WBC），neutrophil percentage （NE%），C-reactive protein （CRP） and PCT index numerical comparison，the positive reaction rates were also analyzed.Result：The levels of PCT，CRP and WBC of endotracheal intubation group were significantly higher than those of noninvasive ventilation group，the differences were statistically significant（P<0.01）；the positive detection rate of PCT in endotracheal intubation group was significantly higher than that in the non-invasive ventilation group（P<0.05），while the positive response rate between CRP and WBC was not significantly different between the two groups（P>0.05）.Conclusion：In patients with chronic obstructive pulmonary disease complicated with severe pneumonia after endotracheal intubation，the inflammation index PCT，CRP，WBC are significantly higher than the detection value of noninvasive ventilation in patients with infection is heavy，the PCT index of the positive expression rate of the most obvious signs，indicators can be used as COPD with the treatment and prognosis of patients with pneumonia，can provide a favorable basis for clinical.

【Key words】 Procalcitonin； Chronic obstructive pulmonary disease； Severe pneumonia； Clinical application； Prognosisendprint

First-authors address：Meizhou Hospital Affiliated to Zhongshan University，Meizhou 514031，China

doi：10.3969/j.issn.1674-4985.2017.27.005

慢性阻塞性肺疾病（COPD）是一種臨床常見的慢性呼吸系統(tǒng)疾病，主要是以氣流受限為主要特征的肺部疾病，發(fā)病率逐年升高[1]。這種氣流受阻呈進(jìn)行性發(fā)展，不少患者最終發(fā)展為慢性呼吸衰竭及慢性肺源性心臟病，致殘率和死亡率高[2-3]。據(jù)文獻(xiàn)[4]報(bào)道，COPD多由慢性呼吸道疾病如慢性支氣管炎、肺氣腫發(fā)展而來(lái)，吸煙和空氣污染也是促進(jìn)及加重其病程的重要因素，有害氣體及顆粒能引起異常的炎癥反應(yīng)，增加COPD患者出現(xiàn)并發(fā)癥的風(fēng)險(xiǎn)。COPD合并重癥肺炎時(shí)，若在早期發(fā)病時(shí)沒有明確診斷，從而耽誤治療對(duì)患者的生命危害更大，容易在較短的時(shí)間內(nèi)誘發(fā)患者心力衰竭、呼吸衰竭與電解質(zhì)紊亂等疾病而致死[5]。……