AECOPD合并感染患者PCT、hs-CRP、CD64指数及PA变化情况及临床意义探讨  

Changes of PCT,hs-CRP,CD64 index,PA and their clinical significance in AECOPD patients with infection

作　　者：彭定辉[1] 刘静 PENG Dinghui;LIU Jing(Department of Clinical Laboratory ,Zhongnan Hospital of Wuhan Uniersity ,Wugan , Hubei 430071 ,China;Ittspection Center of Beijing Boren Hospital ,Beijing 100000 ,China)

机构地区：[1]武汉大学中南医院检验科,武汉430071 [2]北京博仁医院检验中心,北京100000

出　　处：《国际检验医学杂志》2018年第19期2408-2412,2416,共6页International Journal of Laboratory Medicine

摘　　要：目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、CD64指数、前清蛋白(PA)水平变化情况,为临床诊断和预后判断提供依据。方法选取武汉大学中南医院2015年10月至2016年10月收治的100例慢性阻塞性肺疾病(COPD)患者,其中50例AECOPD患者设为急性组,50例缓解期COPD患者设为缓解组,并选取同期该院50例体检健康者作为对照组。比较各组患者入院时血清PCT、hs-CRP、CD64指数、PA水平,并比较急性组感染者和未感染者血清PCT、hs-CRP、CD64指数、PA水平,以及感染者不同肺功能分级间血清PCT、hs-CRP、CD64指数、PA水平,采用ROC曲线比较治疗前和治疗7d后血清PCT、hs-CRP、CD64指数、PA水平灵敏度和特异度,比较急性组不同致病菌感染患者血清PCT、hs-CRP、CD64指数、PA水平。结果入院时急性组、缓解组、对照组患者血清PCT、hsCRP、CD64指数均逐渐下降,PA水平逐渐升高,差异有统计学意义(P<0.05)。急性组感染者血清PCT、hsCRP、CD64指数均高于非感染者,PA水平低于非感染者,差异有统计学意义(P<0.05)。急性组GOLD分级Ⅰ、Ⅱ、Ⅲ级者血清PCT、hs-CRP、CD64指数均逐渐升高,PA水平逐渐降低,差异有统计学意义(P<0.05)。ROC曲线表明,治疗前和治疗7d后血清PCT、CD64指数诊断的灵敏度和特异度均大于85%,且ROC曲线下面积均大于0.7。细菌组患者血清PCT、hs-CRP、CD64指数均低于混合组、病毒组患者,PA水平低于混合组、病毒组患者;混合组患者血清PCT、hs-CRP、CD64指数均低于病毒组患者,PA水平低于病毒组患者,差异有统计学意义(P<0.05)。结论 AECOPD合并不同感染者血清PCT、hs-CRP、CD64指数、PA水平不同,血清PCT、CD64指数对AECOPD患者临床诊断和病情评估具有一定的指导价值。Objective To discuss the change of the serum levels of procalcitonin （PCT）,high-sensitivity C reaction protein （hs-CRP）,CD64 index and pre-albumin （PA） in chronic obstructive pulmonary disease with acute exacerbation （AECOPD）patients, excepting to provide the basis for clinical diagnosis and prognosis judgment. Methods A total of 100 patients with AECOPD in Zhongnan Hospital of Wuhan University from October 2015 to October 2016, which were selected as our objects, were divided into two groups： the acute group （n= 50） with AECOPD, and the remission group （n= 50） in the remission stage of COPD. 50 healthy persons who were given physical examination in our hospital during the same period were selected as control group. The serum levels of PCT,hs-CRP,CD64 index and PA of the three groups on admission were detected and compared. The serum levels of PCT,hs-CRP, CD64 index and PA between infectious patients and non-in fectious patients,between I stage, Ⅱ stage and Ⅲ stage of GOLD class in the acute group were compared. The susceptibility of PCT, hs-CRP, CD64 index and PA in pre-therapy and 7 days after therapy were deter- mined by receiver operator characteristic curve （ROC）. The serum levels of PCT,hs-CRP,CD64 index and PA in patients with acute infection of different pathogenic bacteria were compared. Results At the time of admis sion, the serum levels of PCT, hs-CRP, CD64 index was gradually decreased from the acute group to the remis sion group to the control group, and PA levels in these three groups were gradually increased, the difference was statistically significant（P〈0.05）. In the acute group,the serum levels of PCT,hs-CRP,CD64 index in in fectious patients were remarkably higher then these in non-infectious patients,and PA levels were lower, the difference was statistically significant（P〈0. 05 ）. In the acute group,the serum levels of PCT,hs-CRP,CD64 index from I stage to 1I stage to M stage of GOLD class were gradually elevated, and PA levels in these three stage

关 键 词：慢性阻塞性肺疾病急性加重期 感染 降钙素原 超敏C-反应蛋白 CD6 4指数 

分 类 号：R563.9[医药卫生—呼吸系统]