慢性阻塞性肺疾病急性加重期HBP和CD64表达与不同细菌感染的关系  

The correlations between the expression of HBP and CD64 and different bacterial infections in the acute exacerbation of chronic obstructive pulmonary disease

作　　者：张春云[1] 何耀军[1] 江雁琼[2] 

机构地区：[1]广州医科大学附属第五医院呼吸内科,广东广州510700 [2]广州医科大学附属第五医院检验科,广东广州510700

出　　处：《广东医学》2017年第12期1842-1844,1848,共4页Guangdong Medical Journal

基　　金：广东省医学科学技术研究基金项目(编号:A2015359)

摘　　要：目的通过观察慢性阻塞性肺疾病急性加重期(AECOPD)患者不同细菌感染时肝素结合蛋白(HBP)和CD64血浆水平,探讨HBP和CD64表达与细菌感染的关系;测定细菌感染时肌钙蛋白(cTnI)的血清水平,分析HBP与心肌损伤的相关性。方法根据标本中下呼吸道细菌浓度>107cfu/mL作为细菌感染的诊断标准,将AECOPD患者分为细菌感染组[100例,分革兰阳性菌感染组(41例)和革兰阴性菌感染组(59例)]、非细菌感染组(80例)及健康志愿者(健康对照组80例)。各组分别用流式细胞术检测外周血白细胞CD64的平均荧光强度(MFI),并换算成CD64指数,酶联免疫吸附试验测定血浆HBP水平,自动免疫荧光法测定cTnI水平。评价HBP与CD64对AECOPD细菌感染的诊断价值,并分析HBP与cTnI的相关性。结果细菌感染组HBP和CD64水平明显高于非细菌感染组[HBP:(86.8±27.39)ng/mL vs(29.35±7.54)ng/mL;CD64指数:6.28±2.23 vs 0.69±0.19]和健康对照组[HBP:(16.08±4.45)ng/mL,CD64指数:0.47±0.12](F=960.97,P<0.01;F=108.43,P<0.01)。非细菌感染组与健康对照组HBP水平差异无统计学意义(P>0.05),但CD64水平差异有统计学意义(P<0.05)。革兰阳性菌感染组HBP水平显著高于革兰阴性菌感染组[HBP:(95.88±11.61)ng/mL vs(74.32±17.84)ng/mL](t=6.795,P<0.01)。细菌感染组HBP的血浆水平与cTnI呈正相关(r=0.904)。结论 HBP与CD64可以作为AECOPD患者细菌感染的诊断指标。依据HBP血浆水平能初步判断AECOPD患者细菌感染的种类以及感染对心脏功能的影响,对指导临床用药意义重大。Objective To observe the levels of heparin -binding protein （HBP） and CD64 in the acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with different bacterial infections, and to investigate the correlations between them and the bacterial infection, also the correlation between HBP and eTnI. Methods The level of HBP in AECOPD patients with bacterial infection （ n = 100 ） and non - bacterial infection （ n = 80 ）, and in 80 healthy persons was determined by ELISA method, as the index of CD64 was determined by flow cytometry. The level of cTnI was determined by automatic immunoassay in bacterial infection cases. Bacterial infection was defined as patients with bacteria concentration exceeded 107cfu/mL. Results The levels of HBP and CD64 in the bacterial infection group were significantly higher than those with non - bacterial infection [ HBP ： （ 86. 8 ± 27.39 ） ng/mL vs. （29. 35 ± 7.54） ng/mL ; CD64 ： 6. 28±2.23 vs. 0.69 ±0.19] and health group [HBP： （16.08 ±4.45）ng/mL; CD64 index 0.47 ±0.12] （F= 960. 97, P 〈0. 01 ; F = 108.43, P =0. 01 ）. And there was no significant difference in the level of HBP between non - bacterial infection and health group （ P 〉 0. 05 ） , but the difference in the level of CD64 between the two groups was significant （ P 〈 0. 05 ）. The level of HBP in gram positive bacterial infection was significantly higher than that in grain negative bacterial infection [ （95.88 ± 11.61 ） ng/mL vs. （74. 32 ± 17.84） ng/mL] （ t = 6. 795, P 〈 0. 01 ）. The plasma level of HBP in bacterial infection was significantly positively correlated with cTnl （ r = 0. 904）. Conclusion HBP and CD64 ean be used as indicators for the diagnosis of bacterial infection in patients with AECOPD. We ean determine the type of baeterial infection and the effeet of infection on eardiac function in patients with AECOPD according to the plasma level of HBP.

关 键 词：慢性阻塞性肺病 HBP CD64 细菌感染 

分 类 号：R563[医药卫生—呼吸系统]