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目的评估血清降钙素原(PCT)在慢性阻塞性肺疾病急性加重期(AECOPD)患者预测院内感染的临床价值。方法选取2009年1月至2011年10月收治入院的AECOPD患者78例,行血、痰细菌培养及胸片检查,监测患者体温、肺部体征、痰液性状等的变化及院内感染情况。应用半定量固相免疫法测定PCT水平,同时测定C反应蛋白(CRP)水平及白细胞(WBC)计数。观察各指标预测院内感染的敏感度、特异度、准确度、阳性预测值、阴性预测值。结果脓毒症、严重脓毒症的AECOPD患者在住院期间有较高的院内感染发生率。PCT平均增加值在0.12～0.30μg/L时,预测院内感染的敏感度为86.7%,特异度为66.7%,准确度为82.1%,阳性预测值为89.7%,均高于CRP、WBC、体温。结论血清PCT具有高敏感性和高特异性,可作为早期预测AECOPD患者院内感染的炎性指标。
Objective To evaluate the clinical value of serum procalcitonin (PCT) in predicting nosocomial infections in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods From January 2009 to October 2011, 78 AECOPD patients admitted to hospital were enrolled in this study. Blood and sputum bacterial culture and chest X-ray examination were performed. The changes of body temperature, lung signs and sputum traits and nosocomial infections were monitored. The level of PCT was measured by semi-quantitative solid-phase immunoassay. C-reactive protein (CRP) level and white blood cell count (WBC) were also determined. Observe the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of each index in predicting nosocomial infections. Results AECOPD patients with sepsis and severe sepsis had a higher incidence of nosocomial infections during hospitalization. When the average PCT value was 0.12-0.30μg / L, the sensitivity, specificity and accuracy of predicting the nosocomial infection were 86.7%, 66.7%, 82.1% and 89.7%, respectively, which were higher than those of CRP and WBC . Conclusions Serum PCT is highly sensitive and highly specific and can be used as an early predictor of nosocomial infection in AECOPD patients.