Weis Nina, Almdal Thomas
Department of Endocrinology, The Herlev University Hospital, Denmark.
Eur J Intern Med. 2006 Mar;17(2):88-91. doi: 10.1016/j.ejim.2005.09.020.
Far from all patients with exacerbation of chronic obstructive pulmonary disease (COPD) benefit from antibiotic treatment. However, as these patients are often colonized with bacteria, even in a stable phase, there is no reliable method for establishing whether the patients have a significant bacterial infection and would benefit from antibiotic treatment. C-reactive protein (CRP) has proven to be useful as a marker of bacterial infection. The aim of this study was to assess to what degree CRP is elevated in patients with exacerbation of COPD.
A total of 166 consecutive patients admitted to a department of internal medicine at a university hospital in Copenhagen due to exacerbation of COPD were prospectively included in the study. Patients were asked whether they had experienced increased sputum purulence and whether they were on steroid treatment or not. Blood was drawn for determination of white blood cell count and CRP, and a chest X-ray was taken. Patients whose X-rays of the thorax showed changes compatible with pneumonia were considered to have pneumonia of bacterial origin.
Pneumonia was diagnosed in 51 patients. Their median CRP was 97 mg/l (49-145 interquartile range). Among patients without pneumonia, 46% (51/115) had normal CRP values (0-10 mg/l); 64 had no increased sputum purulence and a median CRP of 8 mg/l (2.9-16 mg/l), which is significantly lower than in the 51 patients who reported increased sputum purulence and had a CRP of 45 mg/l (8.5-86 mg/l; p<0.001).
CRP values are normal in nearly 50% of patients admitted due to exacerbation of COPD. In patients who have increased sputum purulence, the pattern of increase in CRP is similar to that seen in patients with pneumonia. This suggests that CRP may be used as a marker of significant bacterial infection. Thus, it may be used when deciding whether or not to start antibiotic treatment. This should be tested in a controlled trial.
并非所有慢性阻塞性肺疾病（COPD）急性加重期患者都能从抗生素治疗中获益。然而，由于这些患者即使在稳定期也常被细菌定植，目前尚无可靠方法来确定患者是否存在严重细菌感染以及是否会从抗生素治疗中获益。C反应蛋白（CRP）已被证明可作为细菌感染的标志物。本研究的目的是评估COPD急性加重期患者的CRP升高程度。
共有166例因COPD急性加重期而入住哥本哈根一家大学医院内科的连续患者被前瞻性纳入本研究。询问患者是否有痰脓性增加以及是否正在接受类固醇治疗。采集血液以测定白细胞计数和CRP，并进行胸部X线检查。胸部X线显示与肺炎相符变化的患者被认为患有细菌性肺炎。
51例患者被诊断为肺炎。他们的CRP中位数为97mg/l（四分位间距49 - 145）。在无肺炎的患者中，46%（51/115）的CRP值正常（0 - 10mg/l）；64例痰脓性未增加，CRP中位数为8mg/l（2.9 - 16mg/l），这显著低于51例报告痰脓性增加且CRP为45mg/l（8.5 - 86mg/l）的患者（p<0.001）。
因COPD急性加重期入院的患者中近50%的CRP值正常。在痰脓性增加的患者中，CRP升高模式与肺炎患者相似。这表明CRP可作为严重细菌感染的标志物。因此，在决定是否开始抗生素治疗时可使用CRP。这应在对照试验中进行验证。
