摘要
目的探讨降钙素原(PCT)在慢性阻塞性肺疾病急性加重(AECOPD)患者下呼吸道感染病原菌种类鉴别及预后评估中的价值。方法本研究为队列研究。采用非随机抽样法,选取重庆市黔江中心医院2018年1月至2020年12月收治的796例感染引起的AECOPD患者,根据诱导痰培养中分离的病原菌种类分组,入院后24 h内检测患者PCT并完成急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分,比较各组间血清PCT水平,采用受试者工作特征(ROC)曲线评估血清PCT水平在鉴别AECOPD患者下呼吸道感染病原菌种类的效能。根据随访情况将患者分为存活组及死亡组,比较2组PCT水平及APACHEⅡ评分是否存在差异,采用Pearson相关性分析及ROC曲线评估血清PCT、APACHEⅡ评分预测患者预后的效能。结果796例感染引起的AECOPD病原菌培养阳性389例。细菌组与真菌组患者血清PCT水平分别为1.80(0.89,3.45)μg/L、0.15(0.06,0.35)μg/L,革兰阴性菌组和革兰阳性菌组PCT水平分别为2.13(1.23,3.98)μg/L、0.77(0.54,1.05)μg/L;而革兰阴性菌中肠杆菌目组、非发酵菌组及其他革兰阴性菌组的PCT水平分别为3.17(1.73,5.81)μg/L、2.23(1.38,3.80)μg/L、1.25(0.86,2.13)μg/L。细菌组患者血清PCT水平高于真菌组(Z=6.19,P<0.05);革兰阴性菌组高于革兰阳性菌组(Z=8.97,P<0.05);肠杆菌目组高于非肠杆菌目组(Z=3.98,P<0.05)。血清PCT判断AECOPD患者下呼吸道感染病原菌种类的ROC曲线,得到的最佳截断值分别为细菌和真菌组0.56μg/L(敏感度为0.88,特异度为0.95);革兰阳性菌和革兰阴性菌组1.13μg/L(敏感度为0.78,特异度为0.83);肠杆菌目组与非肠杆菌目组的最佳截断值为3.89μg/L(敏感度为0.44、特异度为0.81)。死亡组患者入院时APACHEⅡ评分及血清PCT水平均高于存活组,差异均有统计学意义(P值均<0.05)。Pearson相关性分析结果显示PCT与APACHEⅡ评分相关(r=0.62),采用ROC曲线分析PCT、APACHEⅡ评分及二者联合对患者预后的预测价值,PCT曲线下面积为0.70,APACHEⅡ评分曲线下面积为0.76,两者联合曲线下面积为0.78。结论本研究表明,PCT水平可作为鉴别由感染因素引起AECOPD患者病原菌种类的标志物之一,但PCT水平对AECOPD患者预后评估价值较APACHEⅡ评分差,不能单独作为AECOPD患者的预后评价指标,联合使用PCT和APACHEⅡ评分相较于单一使用APACHEⅡ评分对预后评估无显著优势。
Objective To explore the value of procalcitonin(PCT)in the identification of pathogenic bacteria and in prognosis evaluation of lower respiratory tract infection in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods This was a cohort study.Non-random sampling method was used to select 796 patients with infection-induced AECOPD admitted to Chongqing Qianjiang Central Hospital from January 2018 to December 2020.They were grouped according to the types of pathogenic bacteria isolated from induced sputum culture.PCT and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)Scores of patients were completed within 24 h after admission.The efficacy of serum PCT level in identifying pathogens of lower respiratory tract infection in AECOPD patients was evaluated by using receiver operating characteristic(ROC)curve.APACHEⅡscore and PCT level of patients on admission were analyzed,the patients were divided into survival group and death group,and the differences in PCT level and APACHEⅡscore between the two groups were compared.Pearson correlation analysis and ROC curve were used to evaluate the efficacy of serum PCT,APACHEⅡscore,and their combination in predicting patients′prognosis.Results Among 796 cases of AECOPD caused by infection,389 cases were positive in pathogen culture.The serum PCT levels in bacterial and fungal groups were 1.80(0.89,3.45)μg/L and 0.15(0.06,0.35)μg/L,respectivley,in gram-positive group and gram-negative group were 2.13(1.23,3.98)μg/L and 0.77(0.54,1.05)μg/L,respectively.In enterobacteriaceae group,non-fermentative group,and other gram-negative group were 3.17(1.73,5.81)μg/L,2.23(1.38,3.80)μg/L,and 1.25(0.86,2.13)μg/L,respectivley.The serum PCT level in bacterial group was significantly higher than that in fungal group(Z=6.19,P<0.05),was higher in gram-negative group than in gram-positive group(Z=8.97,P<0.05),and was higher in enterobacteriaceae group than in non-enterobacteriaceae group(Z=3.98,P<0.05).ROC curves of serum PCT to determine the pathogen types of lower respiratory tract infection in AECOPD patients were drawn.The optimal cut-off values were 0.56μg/L(sensitivity 0.88,specificity 0.95)for bacteria and fungi,1.13μg/L(sensitivity 0.78,specificity 0.83)for gram-positive and gram-negative group,and 3.89μg/L for non-enterobacteriaceae and enterobacteriaceae group(sensitivity 0.44,specificity 0.81).APACHEⅡscore and serum PCT level in death group were higher than those in survival group at admission,with statistical significance(both P<0.05).Pearson correlation analysis showed that PCT was correlated with APACHEⅡscore(r=0.62).ROC curve was used to analyze the prognostic value of PCT,APACHEⅡscore,and their combination.The area under the curve of PCT,APACHEⅡscore,and their combination was 0.70,0.76 and 0.78,respectively.Conclusions In this study,PCT level can be used as one of the markers to identify pathogenic bacteria in patients with AECOPD caused by infectious factors.However,the prognostic value of PCT is not as good as APACHEⅡscore,so it can not be used as a single prognostic index for patients with AECOPD.There is no statistical significance between the combination of PCT and APACHEⅡscore and APACHEⅡscore alone in the prognosis of AECOPD patients.
作者
冉松
刘园杰
何小阳
田斌
周中丽
梁潇
袁作为
王永红
Ran Song;Liu Yuanjie;He Xiaoyang;Tian Bin;Zhou Zhongli;Liang Xiao;Yuan Zuowei;Wang Yonghong(Department of Laboratory Medicine,Qianjiang Central Hospital of Chongqing,Chongqing 409099,China;Department of Respiratory Medicine,Qianjiang Central Hospital of Chongqing,Chongqing 409099,China;Department of Gastroenterology,Qianjiang Central Hospital of Chongqing,Chongqing 409099,China;Department of Laboratory Medicine,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)
出处
《国际呼吸杂志》
2022年第24期1909-1915,共7页
International Journal of Respiration
基金
国家自然科学基金(81960391)
重庆市科卫联合医学科研项目(2018MSXM104)
黔江区科技局基金(黔科计2019003)。
关键词
肺疾病
慢性阻塞性
降钙素原
急性生理学与慢性健康状况Ⅱ评分
病原菌种类
预后评估
Pulmonary disease,chronic obstructive
Procalcitonin
Acute Physiology and Chronic Health EvaluationⅡScore
Pathogen species
Prognosis assessment
