目的 研究降钙素原(PCT)和炎症因子(hs-CRP、TNF-α、IL-1β、IL-6和IL-8)在COPD急性加重期病原鉴别诊断中的价值。方法 选择稳定期COPD(SSCOPD组)、急性加重期(AECOPD组)和正常健康人(CON组)为研究对象,检测并比较三组研究对象PCT和炎症因子差异。比较AECOPD组不同感染病原中PCT和炎症因子差异。采用Logistic单因素分析AECOPD组不同感染病原的影响因素。结果 AECOPD组COPD患者感染病原中革兰阴性菌42.8%、革兰阳性菌36.0%、真菌10.0%和病毒16.8%。AECOPD组COPD患者血清PCT、hs-CRP、TNF-α、IL-1β、IL-6和IL-8均显著高于SSCOPD组和CON组正常健康人(均P<0.001)。AECOPD组中细菌感染COPD患者PCT、hs-CRP、TNF-α、IL-1β、IL-6和IL-8均显著高于真菌感染和病毒感染COPD患者(均P<0.001),真菌感染与病毒感染COPD患者PCT和炎症因子均无统计学差异(均P>0.05)。COPD急性加重期PCT、hs-CRP、TNF-α、IL-1β、IL-6和IL-8为细菌感染的影响因素,真菌感染和病毒感染与PCT、hs-CRP、TNF-α、IL-1β、IL-6和IL-8无关。结论 COPD急性加重期病原主要为细菌,PCT、hs-CRP、TNF-α、IL-1β、IL-6和IL-8在细菌感染、真菌感染和病毒感染鉴别诊断中具有重要价值。

Objective To study procalcitonin and inflammatory factors’ differential diagnosis value of pathogen in acute exacerbation of COPD. Methods Patients with COPD and healthy people were enrolled for study. The differences of procalcitonin and inflammatory factors were compared. The risk factors for pathogen in acute exacerbation of COPD were analyzed with Logistic regression. The differences of procalcitonin and inflammatory factors between bacterial infection and nonbacterial infection were compared. Results The procalcitonin, hs-CRP, TNF-α, IL-1β, IL-6 and IL-8 in patients with acute exacerbation of COPD were significantly higher than in COPD and healthy people (All P<0.05). The procalcitonin, hs-CRP, TNF-α, IL-1β, IL-6 and IL-8 in patients with bacterial infection were significantly higher than in patients with fungal and viral infections (All P<0.05). Conclusion Bacteria are the main pathogens in acute exacerbation of COPD. The procalcitonin and inflammatory factors have differential diagnosis value of pathogen in acute exacerbation of COPD.