血清C反应蛋白与前白蛋白比值对慢性阻塞性肺疾病伴下呼吸道细菌感染的早期诊断价值(1)
[摘要] 目的 采用ROC曲线评估血清C-反应蛋白(CRP)与前白蛋白(PA)比值(CRP/PA)对慢性阻塞性肺疾病急性加重(AECOPD)合并下呼吸道细菌感染的早期诊断价值。 方法 选择2013年8月～2014年4月浙江省立同德医院、浙江省立同德医院海盐分院和上海市浦东新区浦南医院呼吸内科临床疑似合并细菌感染的AECOPD患者105例，于入院治疗前及治疗后达稳定期时检测血清PA和CRP水平，采集痰液送细菌学培养。根据临床表现和病菌培养结果将105例AECOPD患者分为重度感染组(19例)、轻度感染组(45例)和非感染组(41例)，比较三组患者治疗前后血清PA和CRP水平的变化，采用ROC曲线评估血清CRP/PA比值对早期诊断AECOPD合并下呼吸道细菌感染的价值。 结果 治疗前，重度感染组血清PA水平显著低于轻度感染组(P < 0.01)，轻度感染组显著低于非感染组(P < 0.01)；重度感染组血清CRP水平显著高于轻度感染组(P < 0.01)，而轻度感染组高于非感染组(P < 0.01)。治疗后，重度感染组PA水平较治疗前显著升高(P < 0.01)，三组患者CRP水平均较治疗前显著下降(P < 0.01)，但三组间CRP水平差异无统计学意义(P > 0.05)。ROC曲线分析显示：血清CRP/PA>0.1时，预测细菌感染的敏感性、特异性和曲线下面积为93.4 %、88.4%、0.881，均高于PA、CRP及PA联合CRP(P < 0.01)，Youden指数(0.588)高于PA和PA联合CRP(P < 0.01)。 结论 血清CRP/PA比值在早期诊断AECOPD是否合并下呼吸道细菌感染方面具有较高的敏感度和特异性，有利于指导抗生素的使用。
[关键词] 慢性阻塞性肺疾病；前白蛋白；C-反应蛋白；细菌感染；下呼吸道
[中图分类号] R563 [文献标识码] A [文章编号] 1673-7210(2015)08(b)-0097-04
[Abstract] Objective To explore the value of serum C-reactive protein (CRP) and prealbumin (PA) ratio (CRP/PA) in the early diagnosis of lower respiratory tract bacterial infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods From August 2013 to April 2014， in Tongde Hospital of Zhejiang Province， Haiyan Branch of Tongde Hospital of Zhejiang Province and Pu'nan Hospital of Pudong New District， 105 AECOPD patients with suspicion of lower respiratory tract bacterial infection were selected， at the admission day before treatment and after the treatment for stability， serum PA and CRP levels were detected ， and sputum bacterial cultivation was taken. According to associated clinical manifestations and sputum bacterial cultivation results， These patients were divided into severe infection group (19 cases)， mild infection group (45 cases) and non-infection group (41 cases). Receiver operating characteristic curve (ROC) was used to evaluate the value of serum CRP/PA ratio in the early diagnosis of lower respiratory tract bacterial infection in AECOPD patients. Results Before treatment， serum PA level in mild infection group was significantly lower that in severe infection group (P < 0.01)， this in mild infection group was significantly lower than that in non-infection group (P < 0.01)； serum CRP level in severe infection group was higher than that in severe infection group (P < 0.01)， this in mild infection group was significantly higher than that in non-infection group (P < 0.01). After treatment， the PA level in severe infection group significantly increased (P < 0.01)， serum CPR level significantly decreased than (P < 0.01)， but CRP in three groups was compared， the difference was not statistically significant (P > 0.05). ROC curve analysis showed： when serum CRP/PA > 0.1， the sensitivity， specificity and the area under curve (AUC) were 93.4 %， 88.4 %， 0.881 respectively， they were higher than those of PA， CRP and PA tandem/parallel CRP. The Youden index was 0.588， it was higher than those of PA tandem/parallel PA tandem CRP. Conclusion Serum CRP/PA ratio has higher sensitivity and specificity in the early diagnosis of lower respiratory tract bacterial infection in AECOPD patients， it is helpful to guide the administration of antibacterials. (杨秀云等)
[关键词] 慢性阻塞性肺疾病；前白蛋白；C-反应蛋白；细菌感染；下呼吸道
[中图分类号] R563 [文献标识码] A [文章编号] 1673-7210(2015)08(b)-0097-04
[Abstract] Objective To explore the value of serum C-reactive protein (CRP) and prealbumin (PA) ratio (CRP/PA) in the early diagnosis of lower respiratory tract bacterial infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods From August 2013 to April 2014， in Tongde Hospital of Zhejiang Province， Haiyan Branch of Tongde Hospital of Zhejiang Province and Pu'nan Hospital of Pudong New District， 105 AECOPD patients with suspicion of lower respiratory tract bacterial infection were selected， at the admission day before treatment and after the treatment for stability， serum PA and CRP levels were detected ， and sputum bacterial cultivation was taken. According to associated clinical manifestations and sputum bacterial cultivation results， These patients were divided into severe infection group (19 cases)， mild infection group (45 cases) and non-infection group (41 cases). Receiver operating characteristic curve (ROC) was used to evaluate the value of serum CRP/PA ratio in the early diagnosis of lower respiratory tract bacterial infection in AECOPD patients. Results Before treatment， serum PA level in mild infection group was significantly lower that in severe infection group (P < 0.01)， this in mild infection group was significantly lower than that in non-infection group (P < 0.01)； serum CRP level in severe infection group was higher than that in severe infection group (P < 0.01)， this in mild infection group was significantly higher than that in non-infection group (P < 0.01). After treatment， the PA level in severe infection group significantly increased (P < 0.01)， serum CPR level significantly decreased than (P < 0.01)， but CRP in three groups was compared， the difference was not statistically significant (P > 0.05). ROC curve analysis showed： when serum CRP/PA > 0.1， the sensitivity， specificity and the area under curve (AUC) were 93.4 %， 88.4 %， 0.881 respectively， they were higher than those of PA， CRP and PA tandem/parallel CRP. The Youden index was 0.588， it was higher than those of PA tandem/parallel PA tandem CRP. Conclusion Serum CRP/PA ratio has higher sensitivity and specificity in the early diagnosis of lower respiratory tract bacterial infection in AECOPD patients， it is helpful to guide the administration of antibacterials. (杨秀云等)