血浆氨基酸水平及CD64感染指数鉴别AECOPD重症患者合并细菌感染的临床价值

Clinical value of plasma amino acids and CD64 infection index in distinguishing patients with severe AECOPD complicated with bacterial infection

目的探究慢性阻塞性肺疾病急性加重(AECOPD)重症患者合并细菌感染后,血浆氨基酸水平及CD64感染指数变化。方法回顾性分析2022年1-12月广州医科大学附属第一医院收治的75例AECOPD重症患者的临床资料,根据患者是否合并细菌感染分为感染组(n=41)及未感染组(n=34),比较感染组与未感染组患者血浆必需氨基酸、非必需氨基酸水平差异,使用受试者工作特征(ROC)曲线分析差异有统计学意义的氨基酸种类对AECOPD重症患者合并细菌感染的诊断效能。比较两组患者炎症指标[CD64感染指数、可溶性髓系细胞触发受体-1(sTREM-1)、C反应蛋白(CRP)]水平差异,ROC曲线分析CD64感染指数、sTREM-1、CRP对AECOPD重症患者合并细菌感染的诊断效能。结果感染组患者苏氨酸、精氨酸、甘氨酸、天冬酰胺、瓜氨酸、谷氨酸、组氨酸、蛋氨酸、丝氨酸水平均高于未感染组,差异均有统计学意义(t=3.363、2.730、5.923、3.191、5.823、6.356、2.374、5.011、6.352,P均<0.05)。ROC曲线显示,谷氨酸、丝氨酸、甘氨酸、瓜氨酸、蛋氨酸、精氨酸、苏氨酸、组氨酸、天冬酰胺对AECOPD重症患者合并细菌感染的诊断效能曲线下面积(AUC)分别为0.875、0.848、0.840、0.828、0.802、0.761、0.670、0.638、0.602,差异有统计学意义(P<0.05);感染组患者CD64感染指数、sTREM-1、CRP水平均高于未感染组,差异均有统计学意义(t=11.855、6.826、3.166,P均<0.05);ROC曲线显示,CD64感染指数、sTREM-1、CRP对AECOPD重症患者合并细菌感染的诊断效能AUC分别为0.977、0.798、0.693,差异有统计学意义(P<0.05)。结论部分氨基酸、CD64感染指数、sTREM-1、CRP在AECOPD重症发生细菌感染后会发生显著变化,且具有一定辅助诊断细菌感染的价值。

Objective To explore the changes of plasma amino acids and CD64 infection index in patients with severe acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with bacterial infection. Methods The clinical data of 75 patients with severe AECOPD who were treated in the First Affiliated Hospital of Guangzhou Medical University from January 2022 to December 2022 were retrospectively analyzed. According to whether the patients were complicated with bacterial infection, they were divided into infection group(n=41) and non-infection group(n=34). The differences in the levels of plasma essential amino acids and non-essential amino acids were compared between infection group and non-infection group. Receiver operating characteristic(ROC) curve was used to analyze the diagnostic efficiency of amino acid types with significant differences on bacterial infection in patients with severe AECOPD. The differences in inflammatory indicators [CD64 infection index, soluble triggering receptor expressed on myeloid cells-1(sTREM-1), Creactive protein(CRP)] of the two groups were compared. ROC curve was applied to analyze the diagnostic efficiency of CD64 infection index, sTREM-1 and CRP on bacterial infection in patients with severe AECOPD. Results The levels of threonine, arginine, glycine, asparagine, citrulline, glutamic acid, histidine, methionine and serine in infection group were higher than those in non-infection group,the differences were statistically significant(t=3.363, 2.730, 5.923, 3.191, 5.823, 6.356, 2.374, 5.011, 6.352;all P<0.05). ROC curve showed that the area under the curve(AUC) of glutamic acid, serine, glycine, citrulline, methionine, arginine, threonine, histidine and asparagine in the diagnosis of bacterial infection in patients with severe AECOPD were 0.875, 0.848, 0.840, 0.828, 0.802, 0.761, 0.670, 0.638 and 0.602, respectively(P<0.05). The CD64 infection index, sTREM-1 and CRP in infection group were higher than those in noninfection group,the differences were statistically significant(t=11.855,6.826,3.166;all P<0.05). ROC curve revealed that the AUCs of CD64 infection index, sTREM-1 and CRP in diagnosing bacterial infection in patients with severe AECOPD were 0.977, 0.798 and 0.693, respectively(P<0.05). Conclusion Some amino acids, CD64 infection index, sTREM-1and CRP had significant changes after bacterial infection in patients with severe AECOPD, and they had certain auxiliary value in the diagnosis of bacterial infection.