血清降钙素原预测慢性阻塞性肺疾病急性加重期患者院内感染的临床价值

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。

Predictive value of serum procalcitonin on cross infection in patients with acute period of chronic obstructive pulmonary diseases

Objective To assess the predictive value of serum procalcitonin （PCT） on cross infection in patients with acute period of chronic obstructive pulmonary diseases （AECOPD）. Methods Seventy-eight patients with AECOPD from January 2009 to October 2011 were enrolled. Blood specimen was collected from each patient. Bacteriological culture for blood and sputum and chest X-ray were performed. The temperature, lung and sputum changes and cross infection condition of all the patients were monitored, and the levels of PCT, C-creative protein （CRP）, and white blood cell （WBC） count were measured as well. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PCT, CRP, and WBC were calculated and compared. Results Patients with AECOPD, combined with the sepsis or severe sepsis had higher incidence of cross infection. When PCT increased by an average value of 0.12- 0.30 μg/L, the sensitivity, specificity, accuracy, and positive predictive value of cross infection prediction were 86.7%, 66.7%, 82.1%, 89.7%, respectively, which were all better than CRP, WBC count, and temperature. Conclusion With the high sensitivity and specificity, PCT can be used as an early indicator on cross infection prediction in patients with AECOPD.