中性粒细胞CD64指数指导慢性阻塞性肺疾病急性加重期抗生素应用的探讨
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摘要
目的研究CD64指数在减少慢性阻塞性肺疾病急性加重期(AECOPD)患者抗生素应用中的意义。方法选取2017年1月～10月入住我院的120例AECOPD患者,随机分为对照组和实验组,各60例。对照组根据2016年GOLD指南使用抗生素,实验组根据入院2 h内CD64指数水平来决定是否使用抗生素,在第4天、第8天复测CD64指数水平,若第8天CD64指数≤3,则停用抗生素,相反则继续使用抗生素。比较两组不同时间CD64指数、出院时相关指标(临床有效率、抗生素使用时间、住院时间、平均抗生素花费)、出院后1年内相关指标包括:至下次急性加重时间、随访1年内急性加重次数、住院次数及第一秒用力呼气容积(FEV_1)变化。结果治疗后第4天和第8天,实验组CD64指数水平分别为(1.84±0.65)、(0.86±0.05),对照组CD64指数水平分别为(2.52±0.30)、(1.45±0.03)均较入院时的(3.47±1.00)、(3.04±1.12)降低,且实验组CD64指数在治疗后第4天和第8天均低于对照组,差异有统计学意义(P<0.05);②实验组抗生素使用时间、住院时间、平均抗生素花费均少于对照组,差异有统计学意义(P<0.05);两组的临床有效率、至下次急性加重时间、随访1年内急性加重次数、住院次数及FEV_1变化比较,差异无统计学意义(P>0.05)。结论 CD64指数可有助于决定AECOPD患者是否使用抗生素,对AECOPD患者抗生素的使用有重要的指导意义
Objective To study the significance of CD64 index in reducing antibiotics in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A total of 120 AECOPD patients admitted to our hospital from January to October 2017 were randomly divided into control group and experimental group, 60 cases each. The control group used antibiotics according to the 2016 GOLD guidelines. The experimental group decided whether to use antibiotics according to the CD64 index level within 2 hours after admission. The CD64 index level was retested on the 4th and 8th days. If the CD64 index was ≤3 on the 8th day, Stop using antibiotics and instead continue to use antibiotics. The CD64 index and discharge-related indicators(clinical efficacy, antibiotic use time, hospitalization time, and average antibiotic cost) were compared between the two groups. The relevant indicators within 1 year after discharge included: the time of the next acute exacerbation, and the number of acute exacerbations within 1 year of follow-up. The number of hospitalizations and the forced expiratory volume(FEV_1) in the first second were changed.Results On the 4 th day and the 8 th day after treatment, the CD64 index levels of the experimental group were(1.84 ±0.65) and(0.86 ±0.05),respectively. The CD64 index levels of the control group were(2.52±0.30) and(1.45±0.03), respectively. At the time of admission,(3.47±1.00) and(3.04 ±1.12) were decreased, and the CD64 index of the experimental group was lower than that of the control group on the 4th and 8th day after treatment, the difference was statistically significant(P<0.05);②Experiment The time of antibiotic use, hospitalization time and average antibiotic cost were lower than the control group, the difference was statistically significant(P<0.05); the clinical effective rate of the two groups, the time of the next acute exacerbation, the number of acute exacerbations within 1 year of follow-up, hospitalization,there was no significant difference in the number of times and changes in FEV_1(P>0.05). Conclusion The CD64 index can help determine whether AECOPD patients use antibiotics, which has important guiding significance for the use of antibiotics in AECOPD patients.
Objective To study the significance of CD64 index in reducing antibiotics in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A total of 120 AECOPD patients admitted to our hospital from January to October 2017 were randomly divided into control group and experimental group, 60 cases each. The control group used antibiotics according to the 2016 GOLD guidelines. The experimental group decided whether to use antibiotics according to the CD64 index level within 2 hours after admission. The CD64 index level was retested on the 4th and 8th days. If the CD64 index was ≤3 on the 8th day, Stop using antibiotics and instead continue to use antibiotics. The CD64 index and discharge-related indicators(clinical efficacy, antibiotic use time, hospitalization time, and average antibiotic cost) were compared between the two groups. The relevant indicators within 1 year after discharge included: the time of the next acute exacerbation, and the number of acute exacerbations within 1 year of follow-up. The number of hospitalizations and the forced expiratory volume(FEV_1) in the first second were changed.Results On the 4 th day and the 8 th day after treatment, the CD64 index levels of the experimental group were(1.84 ±0.65) and(0.86 ±0.05),respectively. The CD64 index levels of the control group were(2.52±0.30) and(1.45±0.03), respectively. At the time of admission,(3.47±1.00) and(3.04 ±1.12) were decreased, and the CD64 index of the experimental group was lower than that of the control group on the 4th and 8th day after treatment, the difference was statistically significant(P<0.05);②Experiment The time of antibiotic use, hospitalization time and average antibiotic cost were lower than the control group, the difference was statistically significant(P<0.05); the clinical effective rate of the two groups, the time of the next acute exacerbation, the number of acute exacerbations within 1 year of follow-up, hospitalization,there was no significant difference in the number of times and changes in FEV_1(P>0.05). Conclusion The CD64 index can help determine whether AECOPD patients use antibiotics, which has important guiding significance for the use of antibiotics in AECOPD patients.
引文
[1]慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2017年更新版)[J].国际呼吸杂志,2017,37(14):1041-1057.
[2]庞红燕,杨汀,王辰.2016年更新版GOLD慢性阻塞性肺疾病诊断、治疗和预防的全球策略简介[J].中国医学前沿杂志:电子版,2016,8(7):28-32.
[3]Perlat Kapisyzi,Albania,Eduardo A,et al.Global Initiative for Chronic Obstructive Lung Disease(GOLD):Global Strategy for the Diagnosis,Management and Prevention of Chronic Obstructive Pulmonary Disease(2017 REPORT)[EB/OL].http://www.goldcopd.org.2016-11-10.
[4]Lozano R,Naghavi M,Foreman K,et al.Global and regional mortality from 235 causes of death for 20 age groups in 1990and 2010:a systematic analysis for the Global Burden of Disease Study 2010[J].Lancet,2012,380(9859):2095-2128.
[5]Van der Does Y,Rood PP,Haagsma JA,et al.Procalcitoninguided therapy for the initiation of antibiotics in the ED:a systematic review[J].Am J Emerg Med,2016,34(7):1286-1293.
[6]De Jong E,Van Oers JA,Beishuizen A,et al.Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients:a randomised,controlled,openlabel trial[J].Lancet Infect Dis,2016,16(7):819-827.
[7]Schuetz P,Wirz Y,Sager R,et al.Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections[J].Cochrane Database Syst Rev,2017(10):CD007498.
[8]Falsey AR,Becker Kl,Swinburne AJ,et al.Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease:a cautionary note[J].Int JChron Obstruct Pulmon Dis,2012(7):127-135.
[9]Yang AP,Liu J,Yue LH,et al.Neutrophil CD64 combined with PCT,CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis[J].Clin Chem Lab Med,2016,54(2):345-351.
[10]Kipfmueller F,Schneider J,Prusseit J,et al.Role of neutrophil CD64 index as a screening marker for late-onset sepsis in very low birth weight infants[J].PLoS one 2015,10(4):e0124634.
[11]Dai J,Jiang W,Min Z,et al.Neutrophil CD64 as a diagnostic marker for neonatal sepsis:Meta-analysis[J].Adv Clin Exp Med,2017,26(2):327-332.
[12]Fontela PS,O'Donnell S,Papenburg J.Can biomarkers improve the rational use of antibiotics?[J]Curr Opin Infect Dis,2018,31(4):347-352.
[13]García-Salido A,Serrano-González A,Casado-Flores J,et al.CD64 on monocytes and granulocytes in severe acute bronchiolitis:Pilot studyon its usefulness as a bacterial infection biomarker[J].J Leukoc Biol,2018,103(5):965-971.
[14]de Jong E,de Lange DW,Beishuizen A,et al.Neutrophil CD64 expression as a longitudinal biomarker for severe disease and acute infection in critically ill patients[J].Int J Lab Hematol,2016,38(5):576-84.
[15]Burgos J,Los-Arcos I,Alvarez de la Sierra D,et al.Determination of neutrophil CD64 expression as a prognostic biomarker in patients with community-acquired pneumonia[J].Eur J Clin Microbiol Infect Dis,2016,35(9):1411-1416.
[16]陈雪礼,李观华,汤金萍,等.流式细胞术检测中性粒细胞CD64在感染性疾病中的诊断价值[J].国际检验医学杂志,2013,34(22):2999-3000.
[17]Qian W,Huang GZ.Neutrophil CD64 as a Marker of Bacterial Infection in Acute Exacerbations of Chronic Obstructive Pulmonary Disease[J].Immunol Invest,2016,45(6):490-503.
[18]Xu N,Chen J,Chang X,et al.nCD64 index as a prognostic biomarker for mortality in acute exacerbation of chronic obstructive pulmonary disease[J].Ann Saudi Med,2016,36(1):37-41.
[19]Hsu KH,Chan MC,Wang JM,et al.Comparison of Fc gamma receptor expression on neutrophils with procalcitonin for the diagnosis of sepsis in critically Hi patients[J].Respirol,2011,16:152-160.
[20]苏密龙,苏智军,余雪平,等.流式细胞术检测单核细胞、中性粒细胞CD64临床价值研究[J].中国免疫学杂志,2013(29):1072-1076.
[2]庞红燕,杨汀,王辰.2016年更新版GOLD慢性阻塞性肺疾病诊断、治疗和预防的全球策略简介[J].中国医学前沿杂志:电子版,2016,8(7):28-32.
[3]Perlat Kapisyzi,Albania,Eduardo A,et al.Global Initiative for Chronic Obstructive Lung Disease(GOLD):Global Strategy for the Diagnosis,Management and Prevention of Chronic Obstructive Pulmonary Disease(2017 REPORT)[EB/OL].http://www.goldcopd.org.2016-11-10.
[4]Lozano R,Naghavi M,Foreman K,et al.Global and regional mortality from 235 causes of death for 20 age groups in 1990and 2010:a systematic analysis for the Global Burden of Disease Study 2010[J].Lancet,2012,380(9859):2095-2128.
[5]Van der Does Y,Rood PP,Haagsma JA,et al.Procalcitoninguided therapy for the initiation of antibiotics in the ED:a systematic review[J].Am J Emerg Med,2016,34(7):1286-1293.
[6]De Jong E,Van Oers JA,Beishuizen A,et al.Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients:a randomised,controlled,openlabel trial[J].Lancet Infect Dis,2016,16(7):819-827.
[7]Schuetz P,Wirz Y,Sager R,et al.Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections[J].Cochrane Database Syst Rev,2017(10):CD007498.
[8]Falsey AR,Becker Kl,Swinburne AJ,et al.Utility of serum procalcitonin values in patients with acute exacerbations of chronic obstructive pulmonary disease:a cautionary note[J].Int JChron Obstruct Pulmon Dis,2012(7):127-135.
[9]Yang AP,Liu J,Yue LH,et al.Neutrophil CD64 combined with PCT,CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis[J].Clin Chem Lab Med,2016,54(2):345-351.
[10]Kipfmueller F,Schneider J,Prusseit J,et al.Role of neutrophil CD64 index as a screening marker for late-onset sepsis in very low birth weight infants[J].PLoS one 2015,10(4):e0124634.
[11]Dai J,Jiang W,Min Z,et al.Neutrophil CD64 as a diagnostic marker for neonatal sepsis:Meta-analysis[J].Adv Clin Exp Med,2017,26(2):327-332.
[12]Fontela PS,O'Donnell S,Papenburg J.Can biomarkers improve the rational use of antibiotics?[J]Curr Opin Infect Dis,2018,31(4):347-352.
[13]García-Salido A,Serrano-González A,Casado-Flores J,et al.CD64 on monocytes and granulocytes in severe acute bronchiolitis:Pilot studyon its usefulness as a bacterial infection biomarker[J].J Leukoc Biol,2018,103(5):965-971.
[14]de Jong E,de Lange DW,Beishuizen A,et al.Neutrophil CD64 expression as a longitudinal biomarker for severe disease and acute infection in critically ill patients[J].Int J Lab Hematol,2016,38(5):576-84.
[15]Burgos J,Los-Arcos I,Alvarez de la Sierra D,et al.Determination of neutrophil CD64 expression as a prognostic biomarker in patients with community-acquired pneumonia[J].Eur J Clin Microbiol Infect Dis,2016,35(9):1411-1416.
[16]陈雪礼,李观华,汤金萍,等.流式细胞术检测中性粒细胞CD64在感染性疾病中的诊断价值[J].国际检验医学杂志,2013,34(22):2999-3000.
[17]Qian W,Huang GZ.Neutrophil CD64 as a Marker of Bacterial Infection in Acute Exacerbations of Chronic Obstructive Pulmonary Disease[J].Immunol Invest,2016,45(6):490-503.
[18]Xu N,Chen J,Chang X,et al.nCD64 index as a prognostic biomarker for mortality in acute exacerbation of chronic obstructive pulmonary disease[J].Ann Saudi Med,2016,36(1):37-41.
[19]Hsu KH,Chan MC,Wang JM,et al.Comparison of Fc gamma receptor expression on neutrophils with procalcitonin for the diagnosis of sepsis in critically Hi patients[J].Respirol,2011,16:152-160.
[20]苏密龙,苏智军,余雪平,等.流式细胞术检测单核细胞、中性粒细胞CD64临床价值研究[J].中国免疫学杂志,2013(29):1072-1076.