降钙素原检测在慢性阻塞性肺疾病急性加重期患者中的临床价值

发布时间：2018-04-17 16:32

本文选题：慢性阻塞性肺疾病 + 慢性阻塞性肺疾病急性加重　；参考：《吉林大学》2017年硕士论文

【摘要】：慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一种可以预防和治疗的疾病,慢性和进行性加重的咳嗽、咳痰和呼吸困难是其典型症状。当COPD急性加重时会出现呼吸道症状的恶化并需要改变常规用药方案,急性加重使患者的症状加重,肺功能恶化,从而影响患者的活动耐量以及生活质量。因感染是AECOPD的最常见诱因,抗感染治疗是目前控制COPD急性加重的最重要措施。降钙素原作为能提示细菌感染的一个标志物越来越受到临床医生的关注与青睐。目的:通过在健康人群、COPD稳定期及AECOPD患者中观察降钙素原的变化情况,进一步深入探讨降钙素原在AECOPD患者中的临床应用价值,为AECOPD患者的及时诊断和治疗提供依据。方法:选取2015年9月至2016年12月于吉林大学第一医院呼吸内科住院并明确诊断为AECOPD的患者75例为AECOPD组,根据痰培养结果分为革兰阴性菌组和革兰阳性菌组;以同时间段内呼吸内科门诊定期随访的75例COPD患者为COPD稳定组;以同时间段内体检中心健康体检患者30例作为正常对照组。分析三组患者中降钙素原及其他炎症因子的变化。结果：1、AECOPD组外周血白细胞、IL-6、CRP、TNF-α、PCT浓度均高于健康对照组、COPD稳定组,有统计学意义(P0.05)。COPD稳定组IL-6、TNF-α浓度高于健康对照组,有统计学意义(P0.05)。COPD稳定组、健康对照组中外周血白细胞、CRP、PCT比较无统计学意义(P0.05)。2、AECOPD组患者外周血白细胞、CRP、IL-6、TNF-α、PCT阳性诊断的灵敏度分别为50.7%、64%、69.3%、74.7%、78.6%,特异性分别为82.7%、77.3%、48%、44%、96%。PCT阳性诊断的灵敏度、特异度高于外周血白细胞、CRP、IL-6、TNF-α。3、AECOPD组痰培养阳性率高于COPD稳定组,差异有统计学意义(P0.05)。4、革兰阴性菌组PCT浓度高于革兰阳性菌组,差异有统计学意义(P0.05)。5、机械通气患者PCT水平高于无机械通气患者,差异有统计学意义(P0.05)。结论:1、AECOPD主要是由感染引起,PCT在AECOPD患者血清中处于高水平,与其他炎性指标相比具有较高的特异性及敏感性,且变化与病情程度关系密切,可作为COPD急性加重患者存在细菌感染及疾病严重程度的判断指标。2、PCT作为判定AECOPD细菌感染的一项炎性指标,在革兰阳性菌与革兰阴性菌之间存在明显不同,对鉴别革兰阳性菌与革兰阴结果:性菌感染有一定提示作用,可为临床医生选择抗生素提供一定的临床依据。
[Abstract]:Chronic obstructive pulmonary disease is a kind of disease that can be prevented and treated. Chronic and progressive cough, expectoration and dyspnea are typical symptoms.The acute exacerbation of COPD will lead to the deterioration of respiratory symptoms and the need to change the routine medication scheme. The acute exacerbation of the symptoms and the deterioration of pulmonary function will affect the patient's activity tolerance and quality of life.As infection is the most common cause of AECOPD, anti-infection therapy is the most important measure to control acute exacerbation of COPD.As a marker of bacterial infection, procalcitonin has attracted more and more attention from clinicians.Objective: to investigate the clinical application value of procalcitonin in patients with AECOPD by observing the changes of procalcitonin in the stable stage of AECOPD and in patients with AECOPD in order to provide the basis for the timely diagnosis and treatment of AECOPD.Methods: from September 2015 to December 2016, 75 patients who were hospitalized in Department of Respiratory, first Hospital of Jilin University and diagnosed as AECOPD were selected as AECOPD group. According to the results of sputum culture, 75 patients were divided into Gram-negative bacteria group and Gram-positive bacteria group.75 patients with COPD were selected as COPD stable group and 30 healthy persons as normal control group.The changes of procalcitonin and other inflammatory factors in the three groups were analyzed.Results the levels of TNF- 伪 PCT in peripheral blood leukocytes of AECOPD group were higher than those in healthy control group, and the levels of IL-6 TNF- 伪 in COPD stable group were significantly higher than those in healthy control group.In the healthy control group, there was no significant difference between the two groups in the diagnosis of CRPn- 伪 -PCT in peripheral blood leukocytes of the patients with AECOPD. The sensitivity of the positive diagnosis was 50.774% 69.3TNF- 伪 and 74.7%, the specificity was 82.77.37.37.37.37.37.37.37.37.3N ~ (48) ~ (48) ~ (44) ~ (96.PCT), and the sensitivity was higher than that in the control group (P < 0.05), and the sensitivity was higher than that in the control group (P < 0.05). The sensitivity of the positive diagnosis of TNF- 伪 was 82.77.37.The positive rate of sputum culture in the group of IL-6 TNF- 伪. 3AECOPD was higher than that in the stable group of COPD, and the difference was statistically significant (P 0.05 路4). The concentration of PCT in Gram-negative bacteria group was higher than that in the group of Gram-positive bacteria.The level of PCT in patients with mechanical ventilation was higher than that in patients without mechanical ventilation, and the difference was statistically significant.Conclusion the serum level of AECOPD patients is higher than that of other inflammatory markers, and the changes are closely related to the severity of the disease.It can be used as an index to judge the severity of bacterial infection and disease in patients with acute exacerbation of COPD. 2PCT can be used as an inflammatory index to judge bacterial infection of AECOPD, and there are obvious differences between Gram-positive bacteria and Gram-negative bacteria.It is helpful to distinguish Gram-positive bacteria from Gram-negative results: sex bacteria infection can provide some clinical basis for clinicians to select antibiotics.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9

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