慢性阻塞性肺病急性加重期痰细菌学与hsCRP水平的关系
发布时间：2018-10-11 11:12
【摘要】：目的:通过检测慢性阻塞性肺疾病(COPD)急性加重期患者痰细菌学状况、血清超敏C-反应蛋白(hsCRP)水平以及治疗前和治疗后患者的痰细菌学状况、血清hsCRP水平,探讨COPD急性加重期痰细菌学与hsCRP水平的关系。方法:选择2015年10月至2016年10月就诊于弋矶山医院呼吸内科的80例COPD急性加重期患者为观察组,选择同时间段于我院查体中心查体的80例健康人为对照组。分别对观察组和对照组进行痰细菌学培养和菌株鉴定,分别测定观察组和对照组的血清hsCRP水平、外周血白细胞数和中性粒细胞比值,并进行统计分析。结果:⑴观察组COPD急性加重期患者的血清hsCRP水平为(60.87±52.12)mg/L,对照组健康人的血清hsCRP水平为(5.63±3.12)mg/L,观察组COPD急性加重期患者的血清hsCRP水平与对照组相比,差异具有统计学意义(P0.05)。观察组COPD急性加重期患者的外周血白细胞数和中性粒细胞比值分别为(10.13±4.47)×109/L和(78.46±14.21)%,观察组COPD急性加重期患者的外周血白细胞数和中性粒细胞比值分别为(6.25±1.39)×109/L和(51.33±9.61)%,两组相比,差异具有统计学意义(P0.05)。⑵血清hsCRP水平、外周血白细胞数和中性粒细胞比值对COPD急性加重期患者的诊断灵敏度分别为82.50%、46.25%和55.00%,说明与外周血白细胞数和中性粒细胞比值相比,血清hsCRP水平具有更高的灵敏性,且差异具有统计学意义(P0.05)。⑶观察组COPD急性加重期患者痰细菌培养出革兰氏阴性菌(G-菌)(34±6)株,革兰氏阳性菌(G+菌)(16±5)株,对照组健康人痰细菌培养出G-菌(3±1)株,G+菌(2±1)株,两组相比差异具有统计学意义(P0.05)。⑷观察组COPD急性加重期患者经抗菌药物治疗后,其血清hsCRP水平为(25.37±16.58)mg/L,与治疗前相比,差异具有统计学意义(P0.05);其痰细菌培养出革兰氏阴性菌(15±4)株,革兰氏阳性菌(9±5)株,与治疗前相比差异具有统计学意义(P0.05)。⑸利用观察组COPD急性加重期患者的血清hsCRP水平和痰细菌培养情况绘制接受者操作特征曲线(ROC),并计算曲线下面积,发现当COPD急性加重期患者的血清hsCRP水平超过28.65 mg/L时,提示有细菌感染,且血清hsCRP水平越高,细菌感染越严重。结论:⑴血清hsCRP水平可作为COPD急性加重期患者的诊断指标,其诊断灵敏度高于外周血白细胞数和中性粒细胞比值。⑵血清hsCRP水平可为抗菌药对COPD急性加重期患者临床疗效的评估提供依据。⑶血清hsCRP参与COPD急性加重期的严重过程,能够反映COPD急性加重期的细菌感染情况,可作为COPD急性加重期患者细菌感染情况的指标。
[Abstract]:Objective: to detect the bacteriological status of sputum, the level of serum hypersensitive C-reactive protein (hsCRP), the bacteriological status of sputum before and after treatment, and the level of serum hsCRP in patients with chronic obstructive pulmonary disease (COPD) in acute exacerbation stage. To investigate the relationship between sputum bacteriology and hsCRP level in acute exacerbation of COPD. Methods: from October 2015 to October 2016, 80 patients with acute exacerbation of COPD were selected as observation group and 80 healthy persons as control group. The sputum bacteriological culture and strain identification were carried out in the observation group and the control group respectively. The serum hsCRP level, the white blood cell count and the neutrophil ratio were measured respectively in the observation group and the control group, and the statistical analysis was carried out. Results: 1 the serum hsCRP level of the patients with acute exacerbation of COPD in the observation group was (60.87 卤52.12). The serum hsCRP level of the healthy persons in the control group was (5.63 卤3.12) the level of serum hsCRP in the mg/L, group was significantly higher than that in the control group (P0.05). The peripheral blood leukocyte count and neutrophil ratio in patients with acute exacerbation of COPD were (10.13 卤4.47) 脳 10 9 / L and (78.46 卤14.21)%, respectively, compared with (6.25 卤1.39) 脳 109 / L and (51.33 卤9.61)% in patients with acute exacerbation of COPD, respectively. The difference was statistically significant (P0.05). 2 the diagnostic sensitivity of peripheral blood leukocyte count and neutrophil ratio in patients with acute exacerbation of COPD were 82.50% and 55.00%, respectively. The serum hsCRP level was more sensitive, and the difference was statistically significant (P0.05). 3 in the observation group, Gram-negative bacteria (G-bacteria) and Gram-positive bacteria (G-bacteria) were cultured in sputum of patients with acute exacerbation of COPD (16 卤5). There were (3 卤1) and (2 卤1) strains of G bacteria in sputum bacteria in control group, the difference was statistically significant (P0.05). 4 the serum hsCRP level of patients with acute exacerbation of COPD in observation group was (25.37 卤16.58) mg/L, compared with that before treatment. The difference was statistically significant (P0.05), and the sputum bacteria were cultured from Gram-negative bacteria (15 卤4), Gram-positive bacteria (9 卤5), Gram-negative bacteria (9 卤5), Gram-positive bacteria (9 卤5), Compared with before treatment, the difference was statistically significant (P0.05). 5 the level of serum hsCRP and sputum bacterial culture in the observation group were used to draw the operating characteristic curve (ROC),) of the recipient and calculate the area under the curve by using the level of serum hsCRP and the culture of sputum bacteria in the patients with acute exacerbation of COPD. It was found that when the serum hsCRP level of patients with acute exacerbation of COPD exceeded 28.65 mg/L, it was suggested that there was bacterial infection, and the higher the serum hsCRP level was, the more serious the bacterial infection was. Conclusion: 1 Serum hsCRP level can be used as a diagnostic index in patients with acute exacerbation of COPD. The diagnostic sensitivity was higher than that of peripheral blood leukocyte count and neutrophil ratio. 2 the level of serum hsCRP could provide a basis for evaluating the clinical efficacy of antimicrobial agents in patients with acute exacerbation of COPD. 3 Serum hsCRP was involved in the severe process of acute exacerbation of COPD. It can reflect the bacterial infection in acute exacerbation of COPD and can be used as an indicator of bacterial infection in patients with acute exacerbation of COPD.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9
本文编号：2263981
[Abstract]:Objective: to detect the bacteriological status of sputum, the level of serum hypersensitive C-reactive protein (hsCRP), the bacteriological status of sputum before and after treatment, and the level of serum hsCRP in patients with chronic obstructive pulmonary disease (COPD) in acute exacerbation stage. To investigate the relationship between sputum bacteriology and hsCRP level in acute exacerbation of COPD. Methods: from October 2015 to October 2016, 80 patients with acute exacerbation of COPD were selected as observation group and 80 healthy persons as control group. The sputum bacteriological culture and strain identification were carried out in the observation group and the control group respectively. The serum hsCRP level, the white blood cell count and the neutrophil ratio were measured respectively in the observation group and the control group, and the statistical analysis was carried out. Results: 1 the serum hsCRP level of the patients with acute exacerbation of COPD in the observation group was (60.87 卤52.12). The serum hsCRP level of the healthy persons in the control group was (5.63 卤3.12) the level of serum hsCRP in the mg/L, group was significantly higher than that in the control group (P0.05). The peripheral blood leukocyte count and neutrophil ratio in patients with acute exacerbation of COPD were (10.13 卤4.47) 脳 10 9 / L and (78.46 卤14.21)%, respectively, compared with (6.25 卤1.39) 脳 109 / L and (51.33 卤9.61)% in patients with acute exacerbation of COPD, respectively. The difference was statistically significant (P0.05). 2 the diagnostic sensitivity of peripheral blood leukocyte count and neutrophil ratio in patients with acute exacerbation of COPD were 82.50% and 55.00%, respectively. The serum hsCRP level was more sensitive, and the difference was statistically significant (P0.05). 3 in the observation group, Gram-negative bacteria (G-bacteria) and Gram-positive bacteria (G-bacteria) were cultured in sputum of patients with acute exacerbation of COPD (16 卤5). There were (3 卤1) and (2 卤1) strains of G bacteria in sputum bacteria in control group, the difference was statistically significant (P0.05). 4 the serum hsCRP level of patients with acute exacerbation of COPD in observation group was (25.37 卤16.58) mg/L, compared with that before treatment. The difference was statistically significant (P0.05), and the sputum bacteria were cultured from Gram-negative bacteria (15 卤4), Gram-positive bacteria (9 卤5), Gram-negative bacteria (9 卤5), Gram-positive bacteria (9 卤5), Compared with before treatment, the difference was statistically significant (P0.05). 5 the level of serum hsCRP and sputum bacterial culture in the observation group were used to draw the operating characteristic curve (ROC),) of the recipient and calculate the area under the curve by using the level of serum hsCRP and the culture of sputum bacteria in the patients with acute exacerbation of COPD. It was found that when the serum hsCRP level of patients with acute exacerbation of COPD exceeded 28.65 mg/L, it was suggested that there was bacterial infection, and the higher the serum hsCRP level was, the more serious the bacterial infection was. Conclusion: 1 Serum hsCRP level can be used as a diagnostic index in patients with acute exacerbation of COPD. The diagnostic sensitivity was higher than that of peripheral blood leukocyte count and neutrophil ratio. 2 the level of serum hsCRP could provide a basis for evaluating the clinical efficacy of antimicrobial agents in patients with acute exacerbation of COPD. 3 Serum hsCRP was involved in the severe process of acute exacerbation of COPD. It can reflect the bacterial infection in acute exacerbation of COPD and can be used as an indicator of bacterial infection in patients with acute exacerbation of COPD.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9
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