血清降钙素原对慢性阻塞性肺疾病加重期患者下呼吸道细菌感染的诊断价值  

Value of serum procalcitonin in diagnosing bacterial lower respiratory tract infections in people with exacerbation of Chronic Obstructive Pulmonary Disease

作　　者：常春[1] 姚婉贞[1] 陈亚红[1] 刘振英[1] 张晓伟[1] 

机构地区：[1]北京大学第三医院呼吸内科,北京100083

出　　处：《北京大学学报（医学版）》2006年第4期389-392,共4页Journal of Peking University:Health Sciences

摘　　要：目的：探讨降钙素原（procalcitonin，PCT）这一反映细菌感染的特异指标在慢性阻塞性肺疾病加重（an exacerbation of chronic obstructive pulmonary disease，AECOPD）患者下呼吸道细菌感染诊断中的价值。方法：采用免疫发光法测定45例COPD加重期患者（A组）和25例COPD稳定期患者（B组）的血清PCT水平，并进行诱导痰细菌定量培养。以痰中下呼吸道潜在病原菌浓度≥10^7cfu／mL作为AECOPD下呼吸道细菌感染的诊断标准，将A组患者分为有下呼吸道细菌感染组（A1组）和无下呼吸道细菌感染组（A2组）。结果：A组患者中，有21例（46．7％，21／45）痰培养出下呼吸道潜在病原菌，细菌载量为3．8×10^7（四分位数间距：4．15×10^6,6．4×10^7）cfu／mL。B组患者中，有5例（20％，5／25）痰培养出下呼吸道潜在病原菌，细菌载量为3．5×10^6（四分位数间距：2．4×10^6，7×10^6）cfu／mL。稳定期痰培养阳性率低于加重期，差异有统计学意义（χ^2=4．895，P=0．027），细菌载量亦低于加重期，差异有统计学意义（Z=-2．049，P=0．04）。A1组患者的血清PCT水平明显高于A2组[0．24（四分位数间距：0．17，0．28）μg／L比0．125（四分位数间距：0．10，0．18）μg／L，Z=-3．531，P=0．000]和B组[0．24（四分位数间距：0．17，0．28）μg／L比0．12（四分位数间距：0．10，0．145）μg／L，Z=-4．452，P=0．000]。A2组和B组患者血清PCT水平差异无统计学意义（Z=-1．300，P=0．193）。血清PCT预测AECOPD患者存在下呼吸道细菌感染的ROC曲线下面积0．822（95％CI0．690～0．954，P〈0．01）。根据ROC曲线选取最佳截断点为0．155μg／L，预测AECOPD患者存在下呼吸道细菌感染的灵敏度是93．3％，特异度是60．0％，阳性预测值是53．8％，阴性预测值是94．7％。结论：血清PCT可作为判断AECOPD患者存在下呼吸道细菌感染的辅助检查指标�Objective：To investigate the changes and clinical implications of serum procalcitonin in exacerbation of chronic obstructive pulmonary disease （COPD）. Methods： We have evaluated PCT measurement in 45 patients with an exacerbation of COPD（ group A） and 25 patients with stable COPD（ group B） , quantitative sputum culture was performed, too. PPMs were only regarded as significant if they reached a growth of ≥ 10^7cfu/mL,indicating the presence of bacterial infection. Results：In patients with an exacerbation, 15 patients , sputum yielded a high （ ≥10^7cfu/mL） bacterial load （group A1 ）, 30 patients, sputum yielded a low （ 〈 10^7cfu/mL） bacterial load or a negative bacterial culture（group A2 ）. The levels of procalcitonin in sera from patients of group A1 were significantly higher than those from group A2 and group B [0.24（0.17,0.28） μg/Lvs. 0. 125（0.10,0.18）μg/Lvs.0.12 （0.10,0. 145） μg/L,P = 0.000,0.000]. The levels of procalcitonin in sera from patients of group A2 were similar to those from group B（P〉0.05）. Using a cut-off point of 0.155μg/L for PCT,the sensitivities and specificities for bacterial infection in patients with an exacerbation of COPD were 93.3% and 60% respectively. Conclusion： Serum procalcitonin measurements in patients of an exacerbation of chronic obstructive Dulmonarv disease Dlav a role in the diagnosis of bacterial infection.

关 键 词：降钙素 肺疾病 慢性阻塞性 细菌感染 

分 类 号：R563.04[医药卫生—呼吸系统]