| Chronic obstructive pulmonary disease(COPD)is a common disease that is characterized by persistent airflow limitation.The morbidity and mortality of COPD are both high,as well as the high cost of medical treatment.Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is an important clinical course,and it is one of the main causes of hospitalization and death for the patients with COPD.Respiratory tract infection is a leading cause of acute exacerbation of COPD.It is difficult to conduct the targeted anti-infective therapy for the patients of AECOPD because of the limitations of the microbial culture,such as unqualified of examined samples,delaying feedback of results and so on.In the study,we tested and analyzed the serum procalcitonin(PCT),interleukin(IL)-6,IL-32α and the sputum culture in the patients of AECOPD with infection,so as to estimate the organisms,and to guide the reasonable application of antimicrobials as early as possible.Objective: To investigate the clinical significance of the serum PCT,IL-6 and IL-32α in AECOPD with infection due to different microbial pathogens.Methods: A total of 90 study subjects were selected from the patients of AECOPD with infection in the Intensive Care Unit of our hospital from December 2015 to January 2017.The serum concentrations of PCT,IL-6 and IL-32α were detected within 24 hours after admission.And the sputum samples were also collected within 24 hours after admission.According to the results of sputum culture,they were classified into gram-negative bacterial infection group,gram-positive bacterial infection group and fungal infection group.The continuous variables were expressed as mean with standard deviation if they were normally distributed,and the intergroup differences were assessed by ANOVA and SNK-q test.While the abnormally distributed data were expressed as median(quartiles)and the intergroup differences were assessed by rank sum test.The receiver operating characteristic(ROC)curves of PCT,IL-6 and IL-32α were used to identify the gram-negative bacterial infection/gram-positive bacterial infection,gram-negative bacterial infection/ fungal infection,gram-positive bacterial infection/fungal infection,so as to assess their auxiliary diagnostic value.A P-value <0.05 was considered to be statistically significant.Results: 1 A total of 90 patients of AECOPD were selected,including 49 patients with gram-negative bacteria infection(54.4%),18 patients with gram-positive bacterial infection(20.0%)and 23 patients with fungal infection(25.6%).2 Compare the levels of inflammatory cytokines in the patients of AECOPD with infection due to gram-positive bacteria,gram-negative bacteria or fungus.2.1 The levels of serum PCT were significantly different between gramnegative bacterial infection group and gram-positive bacterial infection group or the fungal infection group(P<0.05),whereas the significant difference between gram-positive bacterial infection group and fungal infection group was not observed(P>0.05).2.2 The levels of serum IL-6 were significantly different between each of the two groups among the three groups(P<0.05).2.3 The levels of serum IL-32α were significantly different between gramnegative bacterial infection group and gram-positive bacterial infection group or the fungal infection group(P<0.05),whereas the significant difference between gram-positive bacterial infection group and fungal infection group was not observed(P>0.05).3 The ROC curves of serum PCT,IL-6 and IL-32α for distinguishing AECOPD with gram-negative bacterial infection from gram-positive bacterial infection showed that the area under the curve(AUC)of PCT+ IL-6+IL-32α was 0.887,the sensitivity was 93.9% and the specificity was 83.3%.The ROC curves of serum PCT,IL-6 and IL-32α for distinguishing AECOPD with gram-negative bacterial infection from fungal infection showed that the AUC of PCT+IL-6+IL-32α was 0.875,the sensitivity was 83.7% and the specificity was 82.6%.The ROC curves of serum PCT,IL-6 and IL-32α for distinguishing AECOPD with fungal infection from gram-positive bacterial infection showed the AUCIL-6 was 0.686,the sensitivity was 69.6% and the specificity was 72.8% when the serum IL-6 cut-off value was 144.435pg/ml.The AUC of PCT+IL-6+IL-32α was 0.679,the sensitivity was 60.9% and the specificity was 88.9%.Conclusions: Early combined detection of serum PCT,IL-6 and IL-32α could distinguish AECOPD with gram-negative bacterial infection from gram-positive bacterial infection or fungal infection.Both the sensitivity and specificity were higher,and it was of great clinical significance in patients of AECOPD with gram-negative bacterial infection.When the three markers were used together to distinguish AECOPD with fungal infection from gram-positive bacterial infection,the specificity was higher but the sensitivity was lower. |
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