| Chronic obstructive pulmonary disease(COPD)is a common and frequently-occurring disease of the respiratory system,and its condition is repeatedly acutely aggravated.Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD)is an important factor in the death of patients with COPD and is also the cause of high medical costs in patients with COPD.It is currently believed that 80% of AECOPD is caused by lower respiratory tract infections,of which about 50% are caused by bacterial infections.However,at present,antibiotic use is more than 70% in the treatment of AECOPD.Excessive use of antibiotics leads to double infection,waste of resources,and aggravate the burden on patients.It is currently necessary to find a rapid and specific inflammatory indicator to guide antibiotic treatment in patients with AECOPD.Studies have shown that the n CD64 index is a biomarker for determining bacterial infections and can be used to guide antibiotic use.This study analyzed the clinical significance of the n CD64 index in AECOPD patients by comparing the n CD64 index with Anthonisen typing standard recommended by the guidelines,in order to enable clinicians to identify the start time of antibiotic use and the duration of antibiotic use in AECOPD patients as early as possible.Objective: To investigate the guiding significance of neutrophil CD64 index in the application of antibiotics in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods: AECOPD patients who met the inclusion criteria and admitted to our department from January 2017 to October 2017 were enrolled in the study.The selected 120 patients were randomly divided into two groups using the digital table method: the n CD64 guided-treatment group(experimental group)and the conventional treatment group(control group),60 cases in each group.The levels of the n CD64 index were measured within 2 hours,4 days and 8 days after admission,respectively.On the basis of treatment,the two groups were routinely given oxygen therapy,spasmolysis,antiasthmatic,expectorant and other conventional treatments after admission.The control group used antibiotics according to the Anthonisen classification criteria,and the antibiotics were stopped after 48 hours of clinical stabilization.The experimental group decided whether to use antibiotics according to the n CD64 index level of AECOPD patients within 2h after admission.the n CD64 index levels were rechecked on day 4 and day 8.If the n CD64 index was > 3,antibiotics were continued or started;Instead,stopped using antibiotics.SPSS24.0 software was used for data collation and the counting data were expressed by percentage and were processed by the chi-square test.If the measurement data satisfied the normal distribution,it was expressed by mean ± standard deviation by one-way ANOVA and t-test.The skewness distribution data was expressed by the median.If P was less than 0.05,the difference was considered statistically significant.Results: 1.On the 4th and 8th day after treatment,the n CD64 index of the experimental group and the control group were significantly lower than that at admission,while the n CD64 index of the experimental group was lower than that of the control group on the 4th and 8th day after treatment,which was statistically significant(P < 0.05).2.The duration of antibiotics in the nCD64 guided-treatment group(experimental group)and the conventional treatment group(control group)were(6.49±1.60)vs(10.38±1.62)(P<0.05),and hospitalization time were(7.48±1.33)vs(11.86±2.51)(P<0.05),meanantibiotic cost were(1356±180)vs(2670±230)(P<0.05),respectively,which was statistically significant(P < 0.05).3.The clinical effective rates of the n CD64 guided-treatment group(experimental group)and the conventional treatment group(control group)were(54/60)vs(52/60),the time to the next acute exacerbation were(64.3± 3.5)vs(63.3± 2.8),the number of acute exacerbations were(2.4± 0.5)vs(2.5± 0.8),the number of hospitalizations were(2.7 ±0.6)vs(2.8± 0.9),and the pulmonary function FEV1 changes were(18.6(-60.2~132.4))vs(20.3(-70.3~102.6)),respectively,which was statistically significant(P > 0.05).Conclusion: The n CD64 index can guide antibiotic use in patients with AECOPD. |
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