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Objective To explore the application of procalcitonin (PCT) and C-reactive protein (CRP) detection in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and its guiding value in the use of antimicrobial agents.Methods From June 2014 to June 2018,82 patients with AECOPD treated in the Third People's Hospital of Yuyao were selected.According to the difference of PCT and CRP levels at admission,the patients were divided into three groups:A,B and C group.A group (n =17):the serum PCT level was less than 0.10μg/L,treated with phlegm and asthma relief and symptomatic therapy without antibiotic therapy.B group (n =33):the serum PCT level was 0.10-0.25 μg/L,B group was not treated with antibiotics,if the level of PCT≥0.25 μg/L on the next day or the amplitude of increase ＞ 30％,the treatment method was the same as that in C group.C group (n =32):the serum PCT level was more than 0.25 μg/L,C group was given expectoration and asthma relief,symptomatic treatment and antibiotics.The clinical data,laboratory test indicators and clinical efficacy of the three groups were compared.Results There were no statistically significant differences in the general clinical data of the three groups (all P ＞0.05).The incidence of fever in the three groups were 2 cases (11.76％),16 cases (50.00％) and 19 cases (57.58％),respectively;expiratory dyspnea in the three groups were 6 cases (35.29％),25 cases (78.13％),31 cases (93.94％),respectively;wheezing rale in the three groups were 4 cases (23.53％),26 cases (81.25％),33 cases (100.00％),respectively;wet sound in the three groups were 12 cases (70.59％),27 cases (84.37％),33 cases (100.00％),respectively,the differences of the above indicators among the three groups were statistically significant(x2 =15.827,24.361,30.284,18.644,all P ＜ 0.05).The percentages of sputum positive patients in the three groups were 4 cases (23.53 ％),10 cases (31.25 ％) and 23 cases (69.69％),respectively;the percentages of sputum culture positive patients were 5 cases (29.41％),24 cases (75.00％),28 cases (84.85 ％),respectively,the differences of the above indicators among the three groups were statistically significant (x2 =16.871,24.644,all P ＜ 0.05).The WBC counts of the three groups were (4.27 ± 1.92) × 109/L,(8.64 ± 3.77) × 109/L,(18.06 ±4.87) × 109/L,respectively;the ratios of neutrophils were (54.12 ± 3.48),(82.19 ±5.67),(90.07 ± 9.33),respectively;the levels of PCT of the three groups were (0.09 ±0.08) μg/L,(0.21 ±0.12) μg/L,(0.74 ±0.33) μg/L,respectively,there were significant differences in WBC count,ratio of neutrophils and PCT among the three groups (F =14.827,25.825,19.873,all P ＜ 0.05).The level of CRP among the three groups had no statistically significant difference (P ＞ 0.05).Patients in A group were not treated with antimicrobial agents and their clinical symptoms were improved.Fourteen patients without antimicrobial agents and 18 patients with improved clinical symptoms were treated with antimicrobial agents in B group.In C group,20 patients with symptoms improved after treatment with antimicrobial agents,12 patients with replacement of antimicrobial treatment regimen and 1 patient died.Conclusion PCT and CRP can be used as an index to evaluate the severity of AECOPD and a reference tool for the use or replacement of antimicrobial agents.
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Objective@#To explore the application of procalcitonin (PCT) and C-reactive protein(CRP) detection in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and its guiding value in the use of antimicrobial agents.@*Methods@#From June 2014 to June 2018, 82 patients with AECOPD treated in the Third People's Hospital of Yuyao were selected.According to the difference of PCT and CRP levels at admission, the patients were divided into three groups: A, B and C group.A group (n=17): the serum PCT level was less than 0.10μg/L, treated with phlegm and asthma relief and symptomatic therapy without antibiotic therapy.B group (n=33): the serum PCT level was 0.10-0.25 μg/L, B group was not treated with antibiotics, if the level of PCT≥0.25 μg/L on the next day or the amplitude of increase≥30%, the treatment method was the same as that in C group.C group (n=32): the serum PCT level was more than 0.25 μg/L, C group was given expectoration and asthma relief, symptomatic treatment and antibiotics.The clinical data, laboratory test indicators and clinical efficacy of the three groups were compared.@*Results@#There were no statistically significant differences in the general clinical data of the three groups (all P>0.05). The incidence of fever in the three groups were 2 cases (11.76%), 16 cases (50.00%) and 19 cases (57.58%), respectively; expiratory dyspnea in the three groups were 6 cases (35.29%), 25 cases (78.13%), 31 cases (93.94%), respectively; wheezing rale in the three groups were 4 cases (23.53%), 26 cases (81.25%), 33 cases (100.00%), respectively; wet sound in the three groups were 12 cases (70.59%), 27 cases (84.37%), 33 cases (100.00%), respectively, the differences of the above indicators among the three groups were statistically significant(χ2=15.827, 24.361, 30.284, 18.644, all P<0.05). The percentages of sputum positive patients in the three groups were 4 cases (23.53%), 10 cases (31.25%) and 23 cases (69.69%), respectively; the percentages of sputum culture positive patients were 5 cases (29.41%), 24 cases (75.00%), 28 cases (84.85%), respectively, the differences of the above indicators among the three groups were statistically significant(χ2=16.871, 24.644, all P<0.05). The WBC counts of the three groups were (4.27±1.92)×109/L, (8.64±3.77)×109/L, (18.06±4.87)×109/L, respectively; the ratios of neutrophils were (54.12±3.48), (82.19±5.67), (90.07±9.33) , respectively; the levels of PCT of the three groups were (0.09±0.08) μg/L, (0.21±0.12) μg/L, (0.74±0.33) μg/L, respectively, there were significant differences in WBC count, ratio of neutrophils and PCT among the three groups (F=14.827, 25.825, 19.873, all P<0.05). The level of CRP among the three groups had no statistically significant difference (P>0.05). Patients in A group were not treated with antimicrobial agents and their clinical symptoms were improved.Fourteen patients without antimicrobial agents and 18 patients with improved clinical symptoms were treated with antimicrobial agents in B group.In C group, 20 patients with symptoms improved after treatment with antimicrobial agents, 12 patients with replacement of antimicrobial treatment regimen and 1 patient died.@*Conclusion@#PCT and CRP can be used as an index to evaluate the severity of AECOPD and a reference tool for the use or replacement of antimicrobial agents.
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Objective To observe and compare the clinical effect of aerosol inhaled and systemic glucocorticoid treatment and its influence on the expression of procalcitonin ( PCT) and hyper-sensitive C reactive protein ( hs-CRP) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods 146 elderly patients with AECOPD were enrolled prospectively.The patients were divided in three groups randomly, including inhalation group (48 cases referred as 2 mg of budesonide nebulization every 8 hours with therapeutic course of 5 days), intravenous group (50 cases referred as 40 mg methylprednisolone intravenous injection once daily with therapeutic course of 5 days), and control group (48 cases with no glucocorticoid ) .All the patients were treated with routine oxygen therapy, anti-inflammation, bronchodilators (β2 receptor agonist and doxofylline) and mucolytics, and so on.The levels of serum PCT and hs-CRP were detected before and after five days treatment, and also the clinical parameters such as symptoms, blood gas analysis, lung function, hospital days, fasting blood glucose and adverse reaction were simultaneously recorded. Results The general clinical data demonstrated no significant difference among the groups.Compared with the control group, the total effective rate, improvement rate of lung function (FEV1%pred and FEV1/FVC) and of blood gas parameters (pH value, PaO2 and PaCO2) in the inhalation group and intravenous group were higher, with shorter hospital days(P<0.05), while with no obvious difference between the two group.The levels of the serum PCT and hs-CRP were decreased in the patients enrolled after treatment, compared with the prior treatment (P<0.05).Compared with the control group, the levels of serum PCT and hs-CRP in the inhalation group and intravenous group decreased significantly, while with no obvious difference between the two groups.The levels of fasting blood glucose in the intravenous group were the highest;compared with the control group, the adverse effect incidence of the inhalation and intravenous groups were higher obviously, with the most obvious in the intravenous group ( P<0.05 ). Conclusion Application of glucocorticoid is benefit to improving the clinical symptom and lung function, and to rectifying hypoxemia and to shortening hospital days.The aerosol inhaled and systemic glucocorticoid application shows equivalent clinical efficiency on anti-airway inflammation.The glucocorticoid inhalation has fewer adverse effects and is recommended to treat the elderly patients with AECOPD .