AECOPD合并肺部感染病原学特点及PCT、CD64感染指数、sTREM-1联合检测早期诊断价值分析

Analysis of the pathogenic characteristics of AECOPD complicated with lung infection and the early diagnosis value of combined detection of PCT, CD64 infection index and sTREM-1

【目的】分析慢性阻塞性肺疾病急性加重(AECOPD)患者肺部感染病原菌分布以及与血浆炎症因子的关系。【方法】选取80例AECOPD患者进行病原菌培养及药敏试验;比较感染与未感染患者血浆中降钙素原(PCT)、CD64感染指数以及可溶性髓细胞表达触发受体-1(sTREM-1)水平,并利用受试者工作特征(ROC)曲线评价PCT、CD64感染指数、sTREM-1诊断AECOPD患者合并感染的效能。【结果】80例AECOPD患者有38例(47.50%)患者痰样本中培养出病原菌,共检出病原菌64株,以革兰氏阴性菌为主;革兰氏阴性菌均对阿米卡星、亚胺培南敏感,真菌以白色假丝酵母菌为主,对伏立康唑、卡泊芬等敏感,革兰氏阳性菌对万古霉素、利奈唑胺、替考拉林敏感;入院时,感染组患者血浆中PCT、CD64感染指数、sTREM-1水平均高于非感染组(P<0.05),治疗7 d后,感染组患者血浆PCT、CD64感染指数、sTREM-1水平显著降低(P<0.05),且与非感染组比较无统计学意义(P>0.05);ROC结果显示:血浆中PCT、CD64感染指数、sTREM-1水平诊断AECOPD患者并发感染的曲线下面积(AUC)分别为0.861、0.840、0.904,Cut off值分别为1.075 ng/ml、6.49、6.33 ng/ml。【结论】AECOPD患者肺部感染病原菌以革兰氏阴性菌为主,同时应警惕真菌感染;检测血浆PCT、CD64感染指数、sTREM-1水平有利于合并肺部感染诊断,避免过度治疗。

【Objective】To analyze the distribution of pathogenic bacteria in the lungs of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and its relationship with plasma inflammatory factors.【Methods】A total of 80 patients with AECOPD were selected for pathogen culture and drug susceptibility test;The plasma levels of procalcitonin(PCT)and CD64 infection index in infected and uninfected patients were compared.Soluble myeloid cells express trigger receptor-1(sTREM-1)levels,and use receiver operator characteristic curve(ROC)to evaluate the efficacy of PCT,CD64 infection index,and sTREM-1 in diagnosing co-infection in AECOPD patients.【Results】In 80 AECOPD patients,pathogenic bacteria were cultured in sputum samples of 38 patients(47.50%).64 pathogenic bacteria were detected,mainly Gram-negative bacteria;Gram-negative bacteria were sensitive to amikacin and imipenem.The main fungi are Candida albicans,which are sensitive to voriconazole and caspofene.Gram-positive bacteria are sensitive to vancomycin,linezolid,and teicoplanin;Plasma PCT,CD64 infection index,and sTREM-1 levels in infected patients were high in non-infected patients(P<0.05).After 7 days of treatment,plasma PCT,CD64 infection index,and sTREM-1 levels in infected patients were significantly reduced(P<0.05).Compared with the non-infected group,it was not statistically significant(P>0.05);ROC results showed that the area under curve(AUC)of PCT,CD64 infection index,and sTREM-1 levels in plasma for diagnosis of AECOPD patients with concurrent infection were 0.861,0.840,0.904;Cut off values were 1.075 ng/ml,6.49,and 6.33 ng/ml,respectively.【Conclusion】The main pathogens of lung infection in AECOPD patients are Gram-negative bacteria,and fungal infections should be vigilant.Detection of plasma PCT,CD64 infection index,and sTREM-1 levels is conducive to the diagnosis of combined pulmonary infection and avoid over-treatment.