Probing Clinical Application Of Serum Amyloid A Combinating C-reactive Protein In Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective To probe clinical application of serum amyloid A combinating C-reactive protein in acute exacerbation of chronic obstructive pulmonary disease.Methods Through disease history inquiry,physical examination,chest X-ray and pulmonary function test,we recruited 112 patients admitted to the Department of Respiratory Medicine,the First Affiliated Hospital of Kunming Medical College.Patients with COPD(GOLDⅡ-Ⅳlevel)include fifty six patients of AECOPDⅠlevel and fifty six patients AECOPDⅡ/Ⅲ(according to 2004 year ATS/ERS guide:levelⅠ,treated at home;levelⅡ,requires hospitalization;levelⅢ,leads to respiratory failure.The criteria is regarded golden criteria to decide wether patients require hospitalization.).There are 67 male patients,45 female patients.The concentrations of SAA and CRP in the serum were measured in patients with levelⅠAECOPD both acute exacerbation and stable stage and in twenty healthy volunteers(13 male,7 female);they were also measured in patients with AECOPD of levelⅡ/Ⅲamong acute exacerbation,stage of recovery,stable stage.The concentrations of SAA and CRP in the serum were measured again after twenty-four hours using glucocorticoid.And sputum smear and cluture were done three times at least after hospitalization.A11 AECOPD patients were measured antibody of Mycoplasma pneumoniae.Results The concentration of SAA was significantly higher than that of CRP in patients with AECOPD(P＜0.05).According to the receiver operating characteristic curves(ROC curves) analysis principle,both SAA and CRP modestly distinguished levelⅠAECOPD from stable COPD,as ROC analysis generated AUC values of 0.69 for SAA and 0.63 for CRP;SAA was significantly better at differentiating levelⅡ/ⅢAECOPD from stable COPD with an AUC value of 0.91 versus CRP with an AUC value of 0.80(P＜0.05). The concentrations of SAA and CRP before and after using glucocorticoid are not different in statistics.The concentrations of SAA and CRP in the serum were significantly higher when sputum was purulent or bacteria found. The concentrations of SAA and CRP in group of bacterial infection are higher than those of group of Mycoplasma pneumoniae infection,the concentrations of SAA and CRP in group of Mycoplasma pneumoniae infection are higher than those of group of other incentives(P＜0.05).When SAA and CRP were both higher than normal level,one group used ivtravenous antibiotic about five days and symptom was significantly improved,then altered oral antibiotic using three days and the other group used ivtravenous antibiotic about 10-14 days in hospital.Times of hospitalization and acute exacerbation were not significantly different between the two groups after twelve months follow-up visit (P＞0.05).Wether using antibiotic was not significantly different by twelve months follow-up visit when SAA was high and CRP was normal(P＞0.05).Conclusion SAA is more sensitive inflammation marker than CRP in AECOPD,and is availed to diagnose disease and estimate therapy.Moreover, SAA combinating CRP can profit to direct application of antibiotic.The concentrations of SAA and CRP will not be affected by using glucocorticoid.