医学检验与临床
醫學檢驗與臨床
의학검험여림상
Medical Laboratory Science and Clinics
2015年
4期
56-60
,共5页
李念顺%时荣海%王小丽%吕江峰%范常珍
李唸順%時榮海%王小麗%呂江峰%範常珍
리념순%시영해%왕소려%려강봉%범상진
C反应蛋白%肺疾病,慢性阻塞性%细菌感染%急性加重%抗生素
C反應蛋白%肺疾病,慢性阻塞性%細菌感染%急性加重%抗生素
C반응단백%폐질병,만성조새성%세균감염%급성가중%항생소
C-reactive protein%Pulmonary disease,chronic obstructive%Bacterial infection%Acute exacerbation%Antibiotics
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。
目的：探討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反應蛋白（C-reactive protein,CRP）水平變化及指導抗生素使用的臨床價值。方法：採用散射比濁法測定86例AECOPD患者治療前、後血清CPR水平及誘導痰細菌定量培養，以痰中潛在病原菌（PPM）濃度≥107cfu/mL作為AECOPD細菌感染診斷標準，將86例患者分為有細菌感染組48例和無細菌感染組38例。根據治療策略將48例有細菌感染組隨機分成CRP組(n=24)和常規治療組(n=24)，CRP組根據鑑測血清CRP水平指導抗生素的使用,常規治療組根據臨床經驗使用抗生素，觀察住院時間、治療效果等指標。結果：①急性加重期，有細菌感染組CRP水平[39.13（17.32,55.09）mg/L]顯著高于無細菌感染組[3.25（0.98,5.33）mg/L]及穩定期[4.72（2.68,5.05）mg/L]（P=0.000，0.001）；穩定期，兩組CRP水平[4.72（2.68,5.05）mg/L]與[3.34（1.09,5.16）mg/L]相噹（P=0.538）；無細菌感染組急性加重期CRP水平[4.25（1.98,5.33）mg/L]與穩定期[3.34（1.08,5.16）mg/L]比較無顯著變化（P=0.316）。②86例AECOPD患者中61例痰培養齣PPM，其中48例痰中PPM≥107cfu /mL，經抗感染治療後穩定期時仍有18例痰中可培養齣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]，與治療前比較均顯著下降（P=0.001，0.003）。③ CRP組的抗生素使用天數多分佈在8~10d,而常規治療組大部分在2週甚至更長,差異有顯著性(P<0.01),兩組患者住院天數和二重感染髮生例數相比差異均具有顯著性(P<0.01)，兩組臨床有效率、功能狀態評分、加重例數差異均無顯著性( P>0.05)。結論：AECOPD患者血清CRP水平升高可能與細菌感染有關，動態鑑測其水平變化，可以指導抗生素的閤理使用，降低二重感染機會。
목적：탐토만성조새성폐질병급성가중기（acute exacerbation of chronic obstructive pulmonary disease AECOPD）환자혈청C반응단백（C-reactive protein,CRP）수평변화급지도항생소사용적림상개치。방법：채용산사비탁법측정86례AECOPD환자치료전、후혈청CPR수평급유도담세균정량배양，이담중잠재병원균（PPM）농도≥107cfu/mL작위AECOPD세균감염진단표준，장86례환자분위유세균감염조48례화무세균감염조38례。근거치료책략장48례유세균감염조수궤분성CRP조(n=24)화상규치료조(n=24)，CRP조근거감측혈청CRP수평지도항생소적사용,상규치료조근거림상경험사용항생소，관찰주원시간、치료효과등지표。결과：①급성가중기，유세균감염조CRP수평[39.13（17.32,55.09）mg/L]현저고우무세균감염조[3.25（0.98,5.33）mg/L]급은정기[4.72（2.68,5.05）mg/L]（P=0.000，0.001）；은정기，량조CRP수평[4.72（2.68,5.05）mg/L]여[3.34（1.09,5.16）mg/L]상당（P=0.538）；무세균감염조급성가중기CRP수평[4.25（1.98,5.33）mg/L]여은정기[3.34（1.08,5.16）mg/L]비교무현저변화（P=0.316）。②86례AECOPD환자중61례담배양출PPM，기중48례담중PPM≥107cfu /mL，경항감염치료후은정기시잉유18례담중가배양출PPM<107cfu/mL[1.7×106(6.5×105,4.6×106) cfu/mL],동보CRP수평균<6mg/L[3.05（1.39,5.08）mg/L]，여치료전비교균현저하강（P=0.001，0.003）。③ CRP조적항생소사용천수다분포재8~10d,이상규치료조대부분재2주심지경장,차이유현저성(P<0.01),량조환자주원천수화이중감염발생례수상비차이균구유현저성(P<0.01)，량조림상유효솔、공능상태평분、가중례수차이균무현저성( P>0.05)。결론：AECOPD환자혈청CRP수평승고가능여세균감염유관，동태감측기수평변화，가이지도항생소적합리사용，강저이중감염궤회。
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.
