Application of procalcitonin and C-reactive protein detection in acute exacerbation of chronic obstructive pulmonary disease and its guiding value in the use of antimicrobial agents / 中国基层医药

ABSTRACT

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.