付云杰

[摘要] 目的 探討血清中C反应蛋白（C-reactiveprotein，CRP）、降钙素原（procalcitioIlin，PCT）、白细胞总数（leukocyte count，WBC）、中性粒细胞百分比（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）细菌感染患者中的临床价值。 方法 选取2015年1月～2017年6月间于我院呼吸科诊治的AECOPD患者36例，其中感染组20例，非感染组16例，检测治疗前后血清中CRP、PCT、WBC、Neu%及ESR水平，分析其与AECOPD细菌感染的关系。 结果 感染组与非感染组AECOPD患者治疗前CRP、PCT、WBC、Neu%水平组间差异有统计学意义（P<0.05），ESR水平组间无差异（P>0.05）；感染组患者治疗前后CRP、PCT、WBC水平差异有统计学意义（P<0.05），而Neu%和ESR水平差异无统计学意义（P>0.05）；AECOPD患者治疗前后CRP、PCT、WBC、Neu%及ESR水平差异有统计学意义（P<0.05）。 结论 CRP、PCT、WBC、Neu%及ESR联合检测是判断AECOPD患者是否合并细菌感染的有效指标，同时也为AECOPD患者的治疗和预后评估提供了临床指导。

[关键词] 慢性阻塞性肺病；细菌感染；降钙素原；C反应蛋白

[中图分类号] R563 [文献标识码] A [文章编号] 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）是一种具有气流阻塞特征的慢性支气管炎和（或）肺气肿，可进一步发展为肺心病和呼吸衰竭的常见慢性疾病[1]。与有害气体及有害颗粒的异常炎症反应有关，致残率和病死率很高，全球40岁以上人群发病率已高达9%～10%[2]。慢性阻塞性肺病的确切病因不清楚，起病缓慢、病程较长是其主要特点，急性加重期患者主要表现为咳嗽、气短或呼吸困难，痰液量增多，疾病进展严重者可导致死亡[3]。尽早诊断减少急性发作次数对COPD的预后有重要影响。细菌或病毒感染、过敏等因素都是引起COPD急性发作的重要原因，临床多数又以细菌感染为主，诊断是否细菌感染临床以往采用白细胞总数、中性粒细胞百分比及血沉等常规指标进行判断[4]，而这些指标特异性较差，导致临床判断AECOPD患者是否细菌感染只能靠临床经验，临床抗菌治疗中一部分患者可能是非细菌性的。……