【摘要】：目的:通過檢測慢性阻塞性肺疾病(COPD)急性加重期患者痰細菌學狀況、血清超敏C-反應(yīng)蛋白(hsCRP)水平以及治療前和治療后患者的痰細菌學狀況、血清hsCRP水平,探討COPD急性加重期痰細菌學與hsCRP水平的關(guān)系。方法:選擇2015年10月至2016年10月就診于弋磯山醫(yī)院呼吸內(nèi)科的80例COPD急性加重期患者為觀察組,選擇同時間段于我院查體中心查體的80例健康人為對照組。分別對觀察組和對照組進行痰細菌學培養(yǎng)和菌株鑒定,分別測定觀察組和對照組的血清hsCRP水平、外周血白細胞數(shù)和中性粒細胞比值,并進行統(tǒng)計分析。結(jié)果:⑴觀察組COPD急性加重期患者的血清hsCRP水平為(60.87±52.12)mg/L,對照組健康人的血清hsCRP水平為(5.63±3.12)mg/L,觀察組COPD急性加重期患者的血清hsCRP水平與對照組相比,差異具有統(tǒng)計學意義(P0.05)。觀察組COPD急性加重期患者的外周血白細胞數(shù)和中性粒細胞比值分別為(10.13±4.47)×109/L和(78.46±14.21)%,觀察組COPD急性加重期患者的外周血白細胞數(shù)和中性粒細胞比值分別為(6.25±1.39)×109/L和(51.33±9.61)%,兩組相比,差異具有統(tǒng)計學意義(P0.05)。⑵血清hsCRP水平、外周血白細胞數(shù)和中性粒細胞比值對COPD急性加重期患者的診斷靈敏度分別為82.50%、46.25%和55.00%,說明與外周血白細胞數(shù)和中性粒細胞比值相比,血清hsCRP水平具有更高的靈敏性,且差異具有統(tǒng)計學意義(P0.05)。⑶觀察組COPD急性加重期患者痰細菌培養(yǎng)出革蘭氏陰性菌(G-菌)(34±6)株,革蘭氏陽性菌(G+菌)(16±5)株,對照組健康人痰細菌培養(yǎng)出G-菌(3±1)株,G+菌(2±1)株,兩組相比差異具有統(tǒng)計學意義(P0.05)。⑷觀察組COPD急性加重期患者經(jīng)抗菌藥物治療后,其血清hsCRP水平為(25.37±16.58)mg/L,與治療前相比,差異具有統(tǒng)計學意義(P0.05);其痰細菌培養(yǎng)出革蘭氏陰性菌(15±4)株,革蘭氏陽性菌(9±5)株,與治療前相比差異具有統(tǒng)計學意義(P0.05)。⑸利用觀察組COPD急性加重期患者的血清hsCRP水平和痰細菌培養(yǎng)情況繪制接受者操作特征曲線(ROC),并計算曲線下面積,發(fā)現(xiàn)當COPD急性加重期患者的血清hsCRP水平超過28.65 mg/L時,提示有細菌感染,且血清hsCRP水平越高,細菌感染越嚴重。結(jié)論:⑴血清hsCRP水平可作為COPD急性加重期患者的診斷指標,其診斷靈敏度高于外周血白細胞數(shù)和中性粒細胞比值。⑵血清hsCRP水平可為抗菌藥對COPD急性加重期患者臨床療效的評估提供依據(jù)。⑶血清hsCRP參與COPD急性加重期的嚴重過程,能夠反映COPD急性加重期的細菌感染情況,可作為COPD急性加重期患者細菌感染情況的指標。
[Abstract]:Objective: to detect the bacteriological status of sputum, the level of serum hypersensitive C-reactive protein (hsCRP), the bacteriological status of sputum before and after treatment, and the level of serum hsCRP in patients with chronic obstructive pulmonary disease (COPD) in acute exacerbation stage. To investigate the relationship between sputum bacteriology and hsCRP level in acute exacerbation of COPD. Methods: from October 2015 to October 2016, 80 patients with acute exacerbation of COPD were selected as observation group and 80 healthy persons as control group. The sputum bacteriological culture and strain identification were carried out in the observation group and the control group respectively. The serum hsCRP level, the white blood cell count and the neutrophil ratio were measured respectively in the observation group and the control group, and the statistical analysis was carried out. Results: 1 the serum hsCRP level of the patients with acute exacerbation of COPD in the observation group was (60.87 鹵52.12). The serum hsCRP level of the healthy persons in the control group was (5.63 鹵3.12) the level of serum hsCRP in the mg/L, group was significantly higher than that in the control group (P0.05). The peripheral blood leukocyte count and neutrophil ratio in patients with acute exacerbation of COPD were (10.13 鹵4.47) 脳 10 9 / L and (78.46 鹵14.21)%, respectively, compared with (6.25 鹵1.39) 脳 109 / L and (51.33 鹵9.61)% in patients with acute exacerbation of COPD, respectively. The difference was statistically significant (P0.05). 2 the diagnostic sensitivity of peripheral blood leukocyte count and neutrophil ratio in patients with acute exacerbation of COPD were 82.50% and 55.00%, respectively. The serum hsCRP level was more sensitive, and the difference was statistically significant (P0.05). 3 in the observation group, Gram-negative bacteria (G-bacteria) and Gram-positive bacteria (G-bacteria) were cultured in sputum of patients with acute exacerbation of COPD (16 鹵5). There were (3 鹵1) and (2 鹵1) strains of G bacteria in sputum bacteria in control group, the difference was statistically significant (P0.05). 4 the serum hsCRP level of patients with acute exacerbation of COPD in observation group was (25.37 鹵16.58) mg/L, compared with that before treatment. The difference was statistically significant (P0.05), and the sputum bacteria were cultured from Gram-negative bacteria (15 鹵4), Gram-positive bacteria (9 鹵5), Gram-negative bacteria (9 鹵5), Gram-positive bacteria (9 鹵5), Compared with before treatment, the difference was statistically significant (P0.05). 5 the level of serum hsCRP and sputum bacterial culture in the observation group were used to draw the operating characteristic curve (ROC),) of the recipient and calculate the area under the curve by using the level of serum hsCRP and the culture of sputum bacteria in the patients with acute exacerbation of COPD. It was found that when the serum hsCRP level of patients with acute exacerbation of COPD exceeded 28.65 mg/L, it was suggested that there was bacterial infection, and the higher the serum hsCRP level was, the more serious the bacterial infection was. Conclusion: 1 Serum hsCRP level can be used as a diagnostic index in patients with acute exacerbation of COPD. The diagnostic sensitivity was higher than that of peripheral blood leukocyte count and neutrophil ratio. 2 the level of serum hsCRP could provide a basis for evaluating the clinical efficacy of antimicrobial agents in patients with acute exacerbation of COPD. 3 Serum hsCRP was involved in the severe process of acute exacerbation of COPD. It can reflect the bacterial infection in acute exacerbation of COPD and can be used as an indicator of bacterial infection in patients with acute exacerbation of COPD.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R563.9

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