PCT、CRP 与应用激素后白细胞升高的关系  

Relationship between PCT,CRP and increase of white blood cell after application of glucocorticoid

作　　者：王钧[1] 任瑞华[2] 何红彦[3] 殷智晔[4] 王亮[5] 孙金昊[6] 

机构地区：[1]河北省胸科医院急诊科,石家庄050041 [2]石家庄市第五医院综合内科,050000 [3]河北省胸科医院神经内科,石家庄050041 [4]河北省胸科医院内分泌科,石家庄050041 [5]河北省胸科医院呼吸内科,石家庄050041 [6]河北省胸科医院结核内科,石家庄050041

出　　处：《国际呼吸杂志》2016年第18期1390-1393,共4页International Journal of Respiration

摘　　要：目的：探讨患者应用糖皮质激素后白细胞（WBC）升高是由于感染加重所致的感染性升高,还是糖皮质激素自身所致的非感染性升高。以此来提高感染诊断准确率,减少抗生素的滥用。方法收集2012年3月至2014年5月于我院住院的80例患者,根据其病种及治疗方案分为非感染激素组（n =20）、感染激素组（n =29）、感染非激素组（n =31）,分别在糖皮质激素和/或抗生素治疗前及治疗后第3、5、7天采集静脉血,对其 WBC、C 反应蛋白（CRP）、降钙素原（PCT）、前白蛋白（PA）进行检测,并对感染组治疗前及治疗后第7天进行简化临床肺部感染评分（CPIS）。结果感染激素组与非感染激素组在应用糖皮质激素治疗后3、5、7 d WBC 差异无统计学意义（P 值均〉0.05）；与感染非激素组相比,感染激素组在应用糖皮质激素3、5、7 d 后 WBC 显著升高（P 值均〈0.01）,CRP 显著下降（P 值均〈0.01）,PCT、PA 及 CPIS 差异无统计学意义（P 值均〉0.05）。结论糖皮质激素可升高外周血 WBC,降低 CRP,但对 PCT、PA 及 CPIS 无明显影响,可以以 PCT、PA 及 CPIS 结果为参考了解患者感染控制情况,三者联合可进一步提高感染诊断的准确率、特异度。Objective To discuss the increase of white blood cell （WBC） in patients treated with glucocorticoid is due to the increase of the infection,or the increase of the non-infection to improve the accuracy of diagnosis and reduce the abuse of antibiotics.Methods 80 patients treated in our hospital from March 2012 to May 2014 were recruited in the study.According to the type of disease and therapies, they were divided into glucocorticoid without infection group（n =20）,infection with glucocorticoid group （n =29）,and infection without glucocorticoid group （n = 31）.After treatment with glucocorticoid and （or） antibiotics for 0,3,5,7 d,venous blood samples of patients were collected to determine the concentration of WBC,C-reaction protein （CRP）,procalcitonin （PCT）,prealbumin （PA） count.Clinical pulmonary infection score （CPIS） was measured before and seventh day after treatment in infection group.Results There was no significant difference in WBC concentration in the 3rd,5th and 7th day after treatment with corticosteroids between the glucocorticoid without infection group and the infection with glucocorticoid group （all P 〉0.05）.Compared with the infection without glucocorticoid group,WBC was significantly higher and CRP was significantly decreased in the 3rd,5th and 7th day after treatment with corticosteroids in the infection with glucocorticoid group （all P 〈 0.01）,and there was no significant difference in PCT,PA and CPIS between the two groups （all P 〉0.05）.Conclusions Glucocorticoid can increase venous blood WBC,reduce CRP,but has no significant effection in the PCT,PA and CPIS.PCT, PA and CPIS can be used as references to evaluate the control of infection,the combination of the three indexes can improve the accuracy rate and the specific rate in the diagnosis of infection.

关 键 词：糖皮质激素 白细胞 降钙素原 C 反应蛋白 前白蛋白 简化临床肺部感染评分 

分 类 号：R459.7[医药卫生—急诊医学]