Pizzini Alex, Lunger Fabian, Sahanic Amra, Nemati Nada, Fuchs Dietmar, Weiss Günter, Kurz Katharina, Bellmann-Weiler Rosa
a Department of Internal Medicine VI, Infectious Diseases, Immunology, Pneumology, Rheumatology , University of Innsbruck , Innsbruck , Austria.
b Department of Gynecologic Endocrinology and Reproductive Medicine , Medical University of Innsbruck , Innsbruck , Austria.
COPD. 2017 Jun;14(3):298-303. doi: 10.1080/15412555.2016.1266317. Epub 2017 Feb 28.
Acute exacerbations and community-acquired pneumonia (CAP) are severe complications in patients with chronic obstructive pulmonary disease (COPD). In this study, we analyzed inflammatory parameters in serum including C-reactive protein (CRP), procalcitonin (PCT), and serum neopterin (NPT) to determine their potential to differentiate between patients with CAP+COPD and with acute exacerbations of COPD (AECOPD) without pneumonia. 102 (39 women and 63 men) patients were included in this retrospective study, of whom 48 presented with CAP without underlying COPD, 20 with CAP+COPD and 34 with AECOPD. CRP, PCT, and blood counts were determined by routine automated tests, and NPT concentrations were determined by ELISA. The ratios of CRP to NPT levels were calculated. Upon patient admission, CRP, PCT, and NPT levels were significantly higher in patients with CAP compared to those in AECOPD patients. CRP/NPT ratio was lower in AECOPD compared to CAP (+/-COPD) patients. Positive correlations were found between duration of hospitalization and CRP levels and the CRP/NPT ratio at study entry. Patients who were readmitted within 30 days tended to have higher NPT levels at initial presentation. Patients under ongoing corticosteroid treatment presented with lower inflammatory parameters. The CRP/NPT-ratio was suited well to discriminate between AECOPD and CAP on the basis of COPD, a CRP/NPT cutoff of 0.346 provided a sensitivity of 65% and a specificity of 79%. The combinatory use of inflammatory patterns might help to differentiate patients with AECOPD from those with CAP on the basis of COPD.
急性加重和社区获得性肺炎（CAP）是慢性阻塞性肺疾病（COPD）患者的严重并发症。在本研究中，我们分析了血清中的炎症参数，包括C反应蛋白（CRP）、降钙素原（PCT）和血清新蝶呤（NPT），以确定它们在区分CAP合并COPD患者与无肺炎的COPD急性加重（AECOPD）患者方面的潜力。102例患者（39例女性和63例男性）纳入了这项回顾性研究，其中48例患有无基础COPD的CAP，20例患有CAP合并COPD，34例患有AECOPD。CRP、PCT和血细胞计数通过常规自动化检测确定，NPT浓度通过ELISA测定。计算CRP与NPT水平的比值。患者入院时，CAP患者的CRP、PCT和NPT水平显著高于AECOPD患者。与CAP（±COPD）患者相比，AECOPD患者的CRP/NPT比值更低。住院时间与CRP水平以及研究开始时的CRP/NPT比值之间存在正相关。在30天内再次入院的患者在初次就诊时往往具有较高的NPT水平。正在接受皮质类固醇治疗的患者炎症参数较低。CRP/NPT比值非常适合于在COPD的基础上区分AECOPD和CAP，CRP/NPT临界值为0.346时，敏感性为65%，特异性为79%。炎症模式的联合使用可能有助于在COPD的基础上区分AECOPD患者和CAP患者。
