慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的 血清降钙素原水平的临床研究

田瑞雪，叶青，侯洪艳，张丽萍

（北京市海淀医院/北京大学第三医院海淀院区呼吸科，北京，100080）

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摘要：

目的 探讨慢性阻塞性肺病急性加重期（AECOPD）合并Ⅱ型呼域吸衰竭患者的降钙素（PCT）水平及其临床应用。方法 选择2013 年1 月至2015 年7 月于我院住院的78 例COPD 急性发作合并型Ⅱ呼吸衰竭患者为观察组，同期的89 例COPD急 性发作无Ⅱ型呼吸衰竭为对照组，比较两组患者的血清PCT，C-反应蛋白（CRP）及白细胞计数水平及病死率；依据PCT 水平将 观察组进行分级（≥5 μg/L 组，2~5 μg/L 组，0.5~2 μg/L 组，<0.5 μg/L 组），观察各组的死亡率，抗生素应用时间及住院时间。结果 观察组患者的PCT、CRP 水平及病死率高于对照组（P<0.05）。PCT 水平与抗生素使用时间、住院时间密切相关（r=0.708、0.712，P<0.05）。随着PCT 水平的升高，患者的抗生素应用时间及住院时间延长，PCT 水平≥5 μg/L 组患者的死亡率高于其 他三组抗生素应用时间及住院时间长于其他三组（P<0.05），且2~5 μg/L 组抗生素应用时间及住院时间长于其他两 组（P<0.05）。结论 AECOPD 合并Ⅱ型呼吸衰竭感染程度较未合并呼吸衰竭重，应强化抗生素的使用，而PCT 水平可反映 AECOPD 的病情严重程度。

关键词：降钙素（PCT）；慢性阻塞性肺病急性加重期（AECOPD）；Ⅱ型呼吸衰竭

中图分类号：R563.8文献标志码：A文章编号：2096-1413(2018)06-0026-04

Clinical research of serum procalcitonin in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with typeⅡ respiratory failure
TIAN Rui-xue, YE Qing, HOU Hong-yan, ZHANG Li-ping
(Respiratory Medicine Department, Beijing Haidian Hospital/Beijing Haidian Section of Peking University Third Hospital, Beijing 100080, China)

ABSTRACT: Objective To evaluate the procalcitonin (PCT) level and its clinical application in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with typeⅡrespiratory failure. Methods From January 2013 to July 2015, 78 hospitalized patients with AECOPD complicated with typeⅡrespiratory failure were selected as the observation group, and 89 patients with AECOPD without typeⅡrespiratory failure in the same period were selected as the control group, the serum PCT, C-reactive protein (CRP) and leukocyte counts, mortality were compared between the two groups. The observation group were graded according to the PCT level (≥5 μg/L group, 2-5 μg/L group, 0.5-2 μg/L group, <0.5 μg/L group), and the antibiotic application time, hospital stay and death rate of each group were observed. Results The PCT and CRP levels in the observation group were higher than those in the control group, and the mortality rate was higher than that in the control group (P<0.05). There were closely relation in the PCT levels with antibiotic use time and hospitalization time (r=0.708, 0.712, P<0.05). With the increase of PCT levels, the antibiotic application time and hospitalization time extended, the mortality rate of PCT level ≥5 μg/L was higher than that of other three groups, the antibiotic application time and hospitalization time were longer than the other three groups (P<0.05), and the antibiotic application time and hospitalization time in 2-5 μg/L group were longer than those in the other two groups (P<0.05). Conclusion The patients`` condition in AECOPD with type Ⅱ respiratory failure is poorer than that without respiratory failure, and antibiotics should be strengthened, while PCT levels can reflect the severity of AECOPD.
KEYWORDS: procalcitonin (PCT); acute exacerbation of chronic obstructive pulmonary disease (AECOPD); type Ⅱ respiratory failure

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