| Objective: This experiment was mainly aimed at investigating the diagnostic value of CD64 combined PCT for pulmonary tuberculosis and pulmonary tuberculosis complicated with bacterial pulmonary infections. Pulmonary tuberculosis and bacterial pneumonia are respiratory diseases that commonly and frequently occur. Typical pulmonary tuberculosis and bacterial pneumonia are not difficult to diagnose by patient history collection, physical examination and laboratory tests in combination with chest radiographs, chest CT scans and so on. But sometimes it is difficult to distinguish between the two diseases, and often, there is a manifestation- pulmonary infections as a complication based on pulmonary tuberculosis, which lead to certain difficulties in clinical diagnosis and treatment. Particularly, when the radiographic findings of smear-negative pulmonary tuberculosis are atypical, coupled with fever and abnormal elevations in the erythrocyte sedimentation rate, CRP, WBC counts and N%, a final diagnosis is often made according to the status of absorption of lesions which are treated by anti-infective therapy or experimental combination therapy for fighting tuberculosis and infections as well as are then reexamined after a short period of time by chest X-ray and CT. As a result, this will inevitably cause irrational use of antibiotics and anti-tuberculosis drugs, or delay the treatment for the patient condition. Currently, as sensitive index for infectious diseases, CD64 and PCT have been confirmed in many studies. There are more research of PCT on tuberculosis and tuberculosis infection and shows a certain value in the diagnosis of tuberculosis and pulmonary tuberculosis infection. On the other hand, there were fewer reports on the expression level of CD64 in this disease. This experiment was intended to investigate the expression levels of CD64 in patients with pulmonary tuberculosis and those with pulmonary tuberculosis complicated with bacterial pulmonary infections, to compare such levels with the CRP and PCT, and to explore the diagnostic value of CD64 for pulmonary tuberculosis and pulmonary tuberculosis complicated with bacterial pulmonary infections, thereby providing a theoretical basis for early differentiation between pulmonary tuberculosis and bacterial pneumonia as well as for early and rational use of antibiotics to treat pulmonary tuberculosis complicated with infections.Methods: 200 patients were selected, who stayed between Oct 2012 and Oct 2014 in the Department of Tuberculosis and the Department of Respiratory Diseases, Hebei Chest Hospital. Of them, 100 cases suffered from pulmonary tuberculosis, while the remaining 100 cases suffered from pulmonary tuberculosis complicated with bacterial pulmonary infections. 100 healthy volunteers were selected from the Physical Examination Center. The volunteers and patients were assigned to 3 groups(each group included 100 cases): Group I-healthy control group, group II-group with pulmonary tuberculosis, and group III-group with pulmonary tuberculosis complicated with bacterial pulmonary infections.Inclusion criteria:18y<age<80y;meeting the diagnostic criteria for pulmonary tuberculosis,or coexistence of pulmonary tuberculosis and bacterial pulmonary infections. All the patients had negative results of virological tests in the respiratory tracts and tests for atypical pathogens; they all had negative blood cultures; all their sputum smears did not show funguses; their possible extrapulmonary infections were excluded. Diagnostic criteria for pulmonary tuberculosis:Patients met the diagnostic criteria in the 2001 guidelines for diagnosis and treatment of pulmonary tuberculosis formulated by the Tuberculosis Branch of Chinese Medical Association, as well as the anti-tuberculosis therapy was effective. Diagnostic criteria for pulmonary tuberculosis complicated with pulmonary infections: Currently, there is still a lack of uniform clinical diagnostic criteria for pulmonary tuberculosis complicated with bacterial pulmonary infections. In this study, the patients with pulmonary tuberculosis and those with pulmonary tuberculosis complicated with bacterial pulmonary infections were included according to following clinical diagnostic criteria: ①Patients were diagnosed with tuberculosis alone when their clinical symptoms were improved markedly after effective treatment with anti-tuberculosis drugs, they did not need to use antibiotics for treatment, the chest X-ray or CT performed after a short period of time(2-3 weeks) showed that the lesions were not obviously absorbed, as well as lung shadows were partially absorbed after a period(2 months) of intensive treatment; ②patients were diagnosed with pulmonary tuberculosis complicated with bacterial pulmonary infections when their symptoms of infections were not improved markedly after effective treatment with anti-tuberculosis drugs, their fever did not disappear or recurred, purulent sputum was coughed up or much sputum was produced, laboratory tests showed a rise in the WBC counts, CRP and PCT, the symptoms were then improved markedly after anti-tuberculosis drugs were combined with antibiotics, as well as lung shadows were better absorbed but not completely after a short period of time.Exclusion criteria: age<18 y, or age >80 y;viral pneumonia or pneumonia due to atypical pathogens; concurrent extrapulmonary infections; using antibiotics outside the hospital; patients with concurrent chronic diseases including hepatitis, autoimmune diseases, underlying lung diseases(such as chronic bronchitis and bronchiectasis), HIV infection and diabetics.Observed indexes: CD64, PCT and CRP in the venous blood drawn within 48 h after the patients were included.Methods:CD64 Index: Application of Flow Cytometer by BD Company in US(BD FACSCalibur) to determine in quantitative the CD64 index.PCT: Roche cobase e601 electrochemical detection.CRP: Roche cobase C501 automatic biochemical analyzer.Results: 1 Comparison of the results of measurement for CD64, PCT and CRP in the three groups 1.1 Comparison of the results of measurement for CD64pulmonary tuberculosis complicated with pulmonary infections group>pulmonary tuberculosis group>healthy control group, and their differences were statistically significant(P<0.05). 1.2 Comparison of the results of measurement for PCTpulmonary tuberculosis complicated with pulmonary infections group>pulmonary tuberculosis group>healthy control group, and their differences were statistically significant(P<0.05). 1.3 Comparison of the results of measurement for CRPpulmonary tuberculosis complicated with pulmonary infections group>pulmonary tuberculosis group>healthy control group, and their differences were statistically significant(P<0.05). 2 ROC curve analysis for CD64, PCT and CRP in the group with pulmonary tuberculosis and the group with pulmonary tuberculosis complicated with pulmonary infectionsROC curves were created by using the data of CD64, PCT and CRP in the healthy control group and the group with pulmonary tuberculosis, and then, the area under the curve(AUC) for PCT(0.884)>the AUC for CD64(0.872)>the AUC for CRP(0.782) was visible. Compared with the standard area of 0.5, each AUC above was statistically significant(P<0.05). Next, the optimal cut-off values for CD64, PCT and CRP in the serum were obtained by calculation. When the critical value of CD64 was taken as 2.56, the sensitivity for diagnosis of pulmonary tuberculosis was 79.0%, and the specificity was 85.0%; when the critical value of PCT was taken as 0.177 ng/ml, the sensitivity was 75.0%, and the specificity was 89.9%; when the critical value of CRP was taken as 10.35 mg/L, the sensitivity was 85.0%, and the specificity was 77.0%. Likewise, additional ROC curves were created by using the data of CD64, PCT and CRP in the group with pulmonary tuberculosis and the group with pulmonary tuberculosis complicated with pulmonary infections, and then, the AUC for CD64(0.971)>the AUC for PCT(0.921)>CRP(0.825) was visible. Compared with the standard area of 0.5, each AUC above was statistically significant(P<0.05). Next, the optimal cut-off values for CD64, PCT and CRP in the serum were obtained by calculation. When the critical value of CD64 was taken as 3.93, the sensitivity for diagnosis of pulmonary tuberculosis complicated with pulmonary infections was 86.2%, and the specificity was 98.3%; when the critical value of PCT was taken as 0.395 ng/ml, the sensitivity was 80.5%, and the specificity was 95.3%; when the critical value of CRP was taken as 26.25 mg/L, the sensitivity was 88.0%, and the specificity was 84.6%. 3 Correlation analysis of CD64, PCT and CRPThe Pearson correlation analysis of CD64, PCT and CRP in the group with pulmonary tuberculosis showed that the CD64 index in such group showed a positive correlation with PCT and CRP(r=0.356, r=0.323, P<0.01); the Pearson correlation analysis of CD64, PCT and CRP in the group with pulmonary tuberculosis complicated with pulmonary infections also showed that the CD64 index in such group showed a positive correlation with PCT and CRP(r=0.541, r=0.437, P<0.01).Conclusion: CD64 was highly expressed in the group with pulmonary tuberculosis and the group with pulmonary tuberculosis complicated with infections, share a better relevance with PCT, and the diagnostic value of CD64 for bacterial infections was similar to that of PCT and superior to that of CRP, therefore, CD64 can serve as an auxiliary tested index for judging possible bacterial infections in patients with pulmonary tuberculosis. In practical clinical work, the patient condition can be judged by dynamic observation of the changes of these inflammatory indexes as well as by comprehensively assessing the status of pulmonary infections, which is of great significance for systematically managing and treating patients with pulmonary tuberculosis complicated with pulmonary infections. |
PDF Full Text Request