PCT与CRP和CD64指数对细菌感染慢性阻塞性肺疾病急性加重期患者诊断及指导治疗的意义  

Significance of PCT,CRP,and CD64 indexes in diagnosis and treatment of acute exacerbation of chronic obstructive pulmonary disease patients complicated with bacterial infections

作　　者：丁锋[1] 张清会[2] 徐慧[3] 李静[1] 赵登峰[1] 李学兆[4] 许东风[1] 

机构地区：[1]南阳医学高等专科学校第一附属医院呼吸与危重症医学科,河南南阳473058 [2]南阳医学高等专科学校第一附属医院干部病房,河南南阳473058 [3]南阳医学高等专科学校第一附属医院感染控制办公室,河南南阳473058 [4]南阳医学高等专科学校第一附属医院胸外科,河南南阳473058

出　　处：《中华医院感染学杂志》2017年第10期2198-2201,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨降钙素原(PCT)、C-反应蛋白(CRP)、CD64指数对细菌感染慢性阻塞性肺疾病急性加重期(AECOPD)中诊断及指导治疗的意义,以期为AECOPD早期诊断及治疗效果提供数据依据。方法选取医院2013年1月-2016年1月收治AECOPD患者128例为观察组,另收集稳定期慢性阻塞性肺疾病(COPD)患者80例为对照组,观察两组患者入院时CD64、CRP、PCT、WBC水平,观察组不同致病菌指标水平变化,治疗前后各项指标水平变化,并采用ROC曲线观察治疗前后不同时间敏感观察指标特异性及敏感度。结果观察组入院时CD64、CRP、PCT、WBC水平均高于对照组(P<0.05),观察组细菌感染患者各指标水平均高于病毒及混合感染患者(P<0.05),混合感染高于病毒感染(P<0.05),观察组细菌感染患者治疗7d各指标均低于治疗前及治疗3d(P<0.05);ROC曲线显示,治疗前及治疗后不同时间CD64、PCT特异性及敏感度均>85.00%,符合临床需求。结论 CD64、PCT可作为细菌感染AECOPD鉴别及诊断指标,联合CRP诊断,可用于AECOPD指导临床用药及预后预测指标。OBJECTIVE To explore the significance of procalcitonin （PCT）,C-reactive protein （CRP）,and CD64 indexes in diagnosis and treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD） patients complicated with bacterial infections so as to provide guidance for early diagnosis and treatment of AECOPD.METHODS Totally 128 patients with AECOPD who were treated in hospitals from Jan 2013 to Jan 2016 were chosen as the observation group,and 80 patients with stable chronic obstructive pulmonary disease （COPD） were set as the control group.The levels of CD64,CRP,PCT,and WBC of the two groups of patients were observed at the admission to hospital,the changes of the indicators for pathogens were observed,the levels of indexes were studied before and after the treatment.The specificity and sensitivity of the sensitive observation indexes were observed by using ROC curve before and after the treatment for different time periods.RESULTS The levels of CD64,CRP,PCT,and WBC of the observation group were higher than those of the control group at the admission to hospital （P〈0.05）.In the observation group,the levels of indexes of the patients with bacterial infections were higher than those of the patients with viral infections and the patients with mixed infections （P〈0.05）;the levels of indexes of the patients with mixed infections were significantly higher than those of the patients with viral infections （P〈0.05）.In the observation group,the levels of indexes were significantly lower after the treatment for 7 days than before the treatment and after the treatment for 3 days （P〈0.05）.The ROC curve indicated that the sensitivity and specificity of the CD64 and PCT were more than 85.00% before and after the treatment for different time periods,which met the clinical requirements.CONCLUSION CD64 and PCT can be used as the indexes for differential diagnosis of AECOPD complicated with bacterial infections,the combination with CRP may facilitate the clinical use of antibiotics

关 键 词：降钙素原 C-反应蛋白 CD64指数 细菌感染 慢性阻塞性肺疾病急性加重期 

分 类 号：R446[医药卫生—诊断学]