CRP、PCT、WBC、Neu%及EsR對(duì)慢性阻塞性肺疾病急性加重期細(xì)菌感染的診斷價(jià)值

付云杰

[摘要] 目的 探討血清中C反應(yīng)蛋白（C-reactiveprotein，CRP）、降鈣素原（procalcitioIlin，PCT）、白細(xì)胞總數(shù)（leukocyte count，WBC）、中性粒細(xì)胞百分比（neutrophilic granulocyte，Neu%）及血沉（erythrocyte sedimentation rate，ESR）水平在慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）細(xì)菌感染患者中的臨床價(jià)值。 方法 選取2015年1月～2017年6月間于我院呼吸科診治的AECOPD患者36例，其中感染組20例，非感染組16例，檢測(cè)治療前后血清中CRP、PCT、WBC、Neu%及ESR水平，分析其與AECOPD細(xì)菌感染的關(guān)系。 結(jié)果 感染組與非感染組AECOPD患者治療前CRP、PCT、WBC、Neu%水平組間差異有統(tǒng)計(jì)學(xué)意義（P<0.05），ESR水平組間無差異（P>0.05）；感染組患者治療前后CRP、PCT、WBC水平差異有統(tǒng)計(jì)學(xué)意義（P<0.05），而Neu%和ESR水平差異無統(tǒng)計(jì)學(xué)意義（P>0.05）；AECOPD患者治療前后CRP、PCT、WBC、Neu%及ESR水平差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。 結(jié)論 CRP、PCT、WBC、Neu%及ESR聯(lián)合檢測(cè)是判斷AECOPD患者是否合并細(xì)菌感染的有效指標(biāo)，同時(shí)也為AECOPD患者的治療和預(yù)后評(píng)估提供了臨床指導(dǎo)。

[關(guān)鍵詞] 慢性阻塞性肺病；細(xì)菌感染；降鈣素原；C反應(yīng)蛋白

[中圖分類號(hào)] R563 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-9701（2017）36-0023-03

[Abstract] Objective To investigate the clinical value of levels of serum C-reactive protein（CRP）， procalcitiorium（PCT）， leukocyte count（WBC）， neutrophilic granulocyte（Neu%） and erythrocyte sedimentation rate（ESR） in the patients with bacterial infection of acute exacerbations of chronic obstructive pulmonary disease（AECOPD）. Methods 36 AECOPD patients who were diagnosed and treated in the department of respiratory medicine in our hospital from January 2015 to June 2017 were selected. Among them， 20 cases were in infection group， and 16 cases were in non-infection group. The levels of serum CRP， PCT， WBC， Neu% and ESR were measured before and after treatment， and its relationship with AECOPD bacterial infection was analyzed. Results The levels of CRP， PCT， WBC and Neu% in AECOPD patients before and after treatment were statistically significantly different between the infection group and non-infection group（P<0.05）. There was no difference in ESR level between two groups（P>0.05）； there were statistically significant difference in levels of CRP， PCT and WBC before and after treatment in infection group（P<0.05）， and there was no statistically significant difference in levels of Neu% and ESR between two groups（P>0.05）； there was statistically significant difference in levels of CRP， PCT， WBC， Neu% and ESR before and after treatment in AECOPD patients（P<0.05）. Conclusion The combined detection of CRP， PCT， WBC， Neu% and ESR is an effective index for judging the bacterial infection in patients with AECOPD. It also provides clinical guidance for the treatment and prognosis evaluation of patients with AECOPD.

[Key words] Chronic obstructive pulmonary disease（COPD）； Bacterial infection；Procalcitiorium （PCT）； C-reactive protein（CRP）

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）是一種具有氣流阻塞特征的慢性支氣管炎和（或）肺氣腫，可進(jìn)一步發(fā)展為肺心病和呼吸衰竭的常見慢性疾病[1]。與有害氣體及有害顆粒的異常炎癥反應(yīng)有關(guān)，致殘率和病死率很高，全球40歲以上人群發(fā)病率已高達(dá)9%～10%[2]。慢性阻塞性肺病的確切病因不清楚，起病緩慢、病程較長(zhǎng)是其主要特點(diǎn)，急性加重期患者主要表現(xiàn)為咳嗽、氣短或呼吸困難，痰液量增多，疾病進(jìn)展嚴(yán)重者可導(dǎo)致死亡[3]。盡早診斷減少急性發(fā)作次數(shù)對(duì)COPD的預(yù)后有重要影響。細(xì)菌或病毒感染、過敏等因素都是引起COPD急性發(fā)作的重要原因，臨床多數(shù)又以細(xì)菌感染為主，診斷是否細(xì)菌感染臨床以往采用白細(xì)胞總數(shù)、中性粒細(xì)胞百分比及血沉等常規(guī)指標(biāo)進(jìn)行判斷[4]，而這些指標(biāo)特異性較差，導(dǎo)致臨床判斷AECOPD患者是否細(xì)菌感染只能靠臨床經(jīng)驗(yàn)，臨床抗菌治療中一部分患者可能是非細(xì)菌性的。……