C反应蛋白测定在慢性阻塞性肺疾病急性加重期临床应用研究

摘要

目的：探讨慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease AECOPD）患者血清C反应蛋白（C-reactive protein,CRP）水平变化及指导抗生素使用的临床价值。方法：采用散射比浊法测定86例AECOPD患者治疗前、后血清CPR水平及诱导痰细菌定量培养，以痰中潜在病原菌（PPM）浓度≥107cfu/mL作为AECOPD细菌感染诊断标准，将86例患者分为有细菌感染组48例和无细菌感染组38例。根据治疗策略将48例有细菌感染组随机分成CRP组(n=24)和常规治疗组(n=24)，CRP组根据监测血清CRP水平指导抗生素的使用,常规治疗组根据临床经验使用抗生素，观察住院时间、治疗效果等指标。结果：①急性加重期，有细菌感染组CRP水平[39.13（17.32,55.09）mg/L]显著高于无细菌感染组[3.25（0.98,5.33）mg/L]及稳定期[4.72（2.68,5.05）mg/L]（P=0.000，0.001）；稳定期，两组CRP水平[4.72（2.68,5.05）mg/L]与[3.34（1.09,5.16）mg/L]相当（P=0.538）；无细菌感染组急性加重期CRP水平[4.25（1.98,5.33）mg/L]与稳定期[3.34（1.08,5.16）mg/L]比较无显著变化（P=0.316）。②86例AECOPD患者中61例痰培养出PPM，其中48例痰中PPM≥107cfu /mL，经抗感染治疗后稳定期时仍有18例痰中可培养出PPM<107cfu/mL[1.7×106(6.5×105,4.6×106) cfu/mL],同步CRP水平均<6mg/L[3.05（1.39,5.08）mg/L]，与治疗前比较均显著下降（P=0.001，0.003）。③ CRP组的抗生素使用天数多分布在8~10d,而常规治疗组大部分在2周甚至更长,差异有显著性(P<0.01),两组患者住院天数和二重感染发生例数相比差异均具有显著性(P<0.01)，两组临床有效率、功能状态评分、加重例数差异均无显著性( P>0.05)。结论：AECOPD患者血清CRP水平升高可能与细菌感染有关，动态监测其水平变化，可以指导抗生素的合理使用，降低二重感染机会。%Objective:To investigate the changes and clinical value to guide antibiotic therapy of serum C-reactive protein (CRP) in the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients. Methods:We have evaluated serum CRP measurement in 86 patients with AECOPD before and after treatment by immune turbidimetric test quantitative sputum culture was performed too. With potential pathogens in thesputum bacteria (PPM) concentration ≥107cfu/mL as the criteria for the diagnosis of AECOPD infection,86 patients were divided into the two groups, one has 48 cases with bacterial infection and another has 38 cases with non bacterial infections.48 cases of bacterial infection group were randomly divided into CRP group (n=24) and conventional treatment group (n=24), CRP group guides the use of antibiotic based on the monitor of serum CRP level, conventional treatment group use antibiotic according to the clinical experience, observer the hospitalization time and treatment effects.Results:①In acute exacerbation, the CRP level of the bacterial infection group was significantly higher than that of non bacterial infection group and that of itself (P=0.000, 0.001) in stable prtiod;in stable period, CRP level of two groups is almost the same(P=0.538);CRP level has no significant change between acute exacerbation and stable period for non bacterial infection group(P=0.316).②In 86 cases of AECOPD patients, 61 cases sputum culture PPM, including 48 cases of sputum PPM≥107cfu/mL, in stable period after anti infection treatment there were still 18 cases in the sputum culture PPM<107cfu/mL, compared with before treatment, the difference was significant(P=0.001). ③In CRP group, the antibiotics use varies from 8 ~ 10 days, and almost of the conventional treatment group were 2 weeks or even longer, there was a significant difference (P<0.01), the differences were significant (P<0.01) between two groups of patients in hospitalized days and double infection number, no significant difference(P>0.05) between two groups in clinical efficiency, performance status score and aggravated cases. Conclusions:The increase of serum CRP level in patients with AECOPD may be associated with bacterial infection, dynamically monitor the change of its level, guide the rational use of antibiotics, reduce the opportunities of double infection.