| ObjectiveTo study the change PCT, CD64 index in AECOPD, and to analyze the sensitivity and specificity of CD64, PCT in diagnosing of bacteria infection in patients with AECOPD, and its clinical value in guiding anti-infective therapy through the determination of serum calcitonin(PCT), CD64 index, and compared with C-reactive protein(CRP) and white blood cells(WBC), neutrophil in patients with chronic obstructive pulmonary disease(COPD), acute exacerbation of COPD(AECOPD) and healthy controls. MethodsCollection of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital,South Hospital respiratory medicine during January 2014-December 2014 inpatient and outpatient, 197 cases of patients with COPD were included and divided into AECOPD group(n=150) and COPD stabilization group(n=47). At the same time, normal medical health personnels were selected as healthy controls(n=35). Flow cytometry test was used to detece the CD64 index, enzyme linked fluorescence analysis(ELFA) to detect serum PCT, hypersensitive immune turbidimetric method to detect the CRP and blood cell analyzer of WBC count, and AECOPD group were sputum bacterial culture and at the same time. AECOPD group were randomly divided into experiential treatment sub-group and CD64-guilding subgroup, 75 cases of each sub-group. Experiential treatment sub-group was treated according to the clinical experience in combination with clinical symptoms and signs to decide whether to give antibiotics, CD64-guilding subgroup was treated according to the CD64 index at admission to decide whether to give antibiotics, if CD64 index less than 4.0 or less, antibiotic treatment was stopped. After treatment for 5 d, 7 d, CD64,PCT were rechecked, blood gas analysis was performed, the clinical curative effect of two groups was compared. All the data was analyzed by SPSS 18.0 software, measurement data was used single factor analysis of variance or t test, enumeration data was used Chi-squared test, correlation analysis was using Perason correlation coefficient r. Results1. CD64 index, PCT, CRP, WBC count, neutrophil percentage in AECOPD group were increased significantly compared with healthy controls(P<0.05), while the indicators of bacterial infection between COPD stabilization group and healthy controls were no significant difference(P>0.05). Compared with COPD stabilization group, CD64 index, PCT and CRP in AECOPD group were significantly increased(P<0.05).2. There was no significant difference on the WBC count, neutrophil percentage, CRP between positive and negative in bacterial culture of sputum(P>0.05),while the CD64 index, PCT in positive sputum bacterial culture was significantly higher than those in negative sputum bacterial culture(P<0.05). There was no significant difference on the level of CRP, count of WBC and neutrophil percentage(P>0.05).3. CD64 index and PCT were positively correlated in AECOPD(r=0.773, P<0.05), CD64 index, PCT have good correlation with CRP, WBC and neutrophil percentage.4. After treatment for 5 days, the CD64 index, PCT in AECOPD patients was all reduced compared with that at admission. the CD64 index, PCT in CD64-guilding subgroup was significantly lower than that in experiential treatment sub-group at 5d, 7d after treatment(P<0.05).5. The time of hospital stay, treatment course of antibiotics therapy in CD64-guilding subgroup was significantly reduced compared with experiential treatment sub-group, and the costs of hospitalization also reduced(P<0.05). There were no statistically significant difference on the improvement rate and recurrence rate between two groups(P>0.05).6. After treatment for 5 days,7days, the levels of p H, Pa CO2, Sa O2 were all improved compared with before treatment, and these indicators in CD64-guilding subgroup were significantly better than those in experiential treatment sub-group(P<0.05). Conclusion1.The CD64 index, PCT in patients with AECOPD shows high expression, significantly higher than that of patients with COPD and healthy controls, and closely related with the severity of disease and activity.2.CD64 index is directly related to bacterial infection, and the application value in diagnosing bacterial infections of AECOPD is similar with PCT, better than inflammatory indexes such as CRP and WBC, and it has advantage of simple and quick detection, stable expression, can be used as a biomarkers of bacterial infections in AECOPD, to improve early detection and treatment rate of AECOPD.3. Anti-infection treatment under the guidance of CD64, combined with the patient’s clinical symptoms and joint detection of PCT and inflammatory indexes such as CRP and WBC at the same time, has important clinical significance in the comprehensive assessment of AECOPD condition, adjustment of treatment plan, optimizing antibiotic use, and improve the clinical curative effect. |
