CAJ | 학술논문

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曲线分析显示院血清CRP/PA跃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。
목적：채용ROC곡선평고혈청C-반응단백(CRP)여전백단백(PA)비치(CRP/PA)대만성조새성폐질병급성가중(AECOPD)합병하호흡도세균감염적조기진단개치。방법선택2013년8월~2014년4월절강성립동덕의원、절강성립동덕의원해염분원화상해시포동신구포남의원호흡내과림상의사합병세균감염적AECOPD환자105례,우입원치료전급치료후체은정기시검측혈청PA화CRP수평,채집담액송세균학배양。근거림상표현화병균배양결과장105례AECOPD환자분위중도감염조(19례)、경도감염조(45례)화비감염조(41례),비교삼조환자치료전후혈청PA화CRP수평적변화,채용ROC곡선평고혈청CRP/PA비치대조기진단AECOPD합병하호흡도세균감염적개치。결과치료전,중도감염조혈청PA수평현저저우경도감염조(P<0.01),경도감염조현저저우비감염조(P<0.01)；중도감염조혈청CRP수평현저고우경도감염조(P<0.01),이경도감염조고우비감염조(P<0.01)。치료후,중도감염조PA수평교치료전현저승고(P<0.01),삼조환자CRP수평균교치료전현저하강(P<0.01),단삼조간CRP수평차이무통계학의의(P>0.05)。 ROC곡선분석현시원혈청CRP/PA약0.1시,예측세균감염적민감성、특이성화곡선하면적위93.4%、88.4%、0.881,균고우PA、CRP급PA연합CRP(P<0.01),Youden지수(0.588)고우PA화PA연합CRP(P<0.01)。결론혈청CRP/PA비치재조기진단AECOPD시부합병하호흡도세균감염방면구유교고적민감도화특이성,유리우지도항생소적사용。
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 obstruc-tive 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 cultiva-tion was taken. According to associated clinical manifes-tations 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 bac-terial 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-in-fection 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 high-er 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.