The neutrophil/lymphocyte ratio is a better addition to C-reactive protein than CD64 index as a marker for infection in COPD.

BACKGROUND: This study investigated the importance of neutrophil/lymphocyte ratio (NLR) and other new inflammatory markers including CD64 expression in patients with chronic obstructive pulmonary disease (COPD) for identifying the severity of inflammation and recognition of acute exacerbation and infection. METHODS: Seventy-two patients with a diagnosis of COPD exacerbation who were admitted to the Department of Internal Medicine B, 13 with stable COPD, and control group of 15 healthy people were enrolled in the study. Complete blood count (CBC), measurement of C-reactive protein (CRP), mean platelet volume (MPV), red blood cell distribution width (RDW) and CD64 expression were determined within 2 hours of hospital admission. RESULTS: NLR and other inflammatory markers, such as RDW, CRP, and CD64 were found to be significantly elevated in exacerbated COPD compared to stable COPD and control participants. There was a significant correlation of NLR with CRP (r=0.309, P<0.001), For an NLR cutoff of 7.3, sensitivity for detecting exacerbation of COPD was 0.768 and specificity was 1-0.269 (AUC=0.793, P=0.001) RDW was significant as NLR. CD64 is statistically significant (P=0.002) the lack of significance was between acute exacerbation of COPD and stable COPD, but indexes were higher in the group of COPD patients with complications. CONCLUSIONS: Elevated NLR can be used as a marker similar to CRP, and RDW, in the determination of increased inflammation in acutely exacerbated COPD. NLR could be beneficial for the early detection of potential acute exacerbations in patients with COPD who have normal levels of traditional markers; CD64 was higher but did not reach statistical significance. MPV was not helpful.

T regulatory cell responses to immunization with a soluble egg antigen in Schistosoma mansoni-infected mice.

The aim of the study is to characterize the phenotypes of CD4(+) CD25(+) T regulatory cells within the liver granulomas and association with both Foxp-3 gene expression and splenic cytokines. Naïve C57BL/6 mice were intravenously injected with multiple doses of the soluble egg antigen (SEA) 7 days before cercarial infection. The immunized and infected control groups were sacrificed 8 and 16 weeks post-infection (PI). Histopathology, parasitological parameters, splenic phenotypes for T regulatory cells, the FOXP-3 expression in hepatic granuloma using real-time PCR, and the associated splenic cytokines were studied. Histopathological examination of the liver revealed remarkable increase in degenerated ova within hepatic granuloma which decreased in diameter at weeks 8 and 16 PI (P<0.01). The percentage of T regulatory cells (CD4(+) CD25(+)) increased significantly (P<0.01) in the immunized group compared to the infected control at weeks 8 and 16 PI. The FOXP-3 expression in hepatic granulomas increased from 10 at week 8 to 30 fold at week 16 PI in the infected control group. However, its expression in the immunized group showed an increase from 30 at week 8 to 70 fold at week 16 PI. The splenic cytokine levels of pro-inflammatory cytokines, IFN-γ, IL-4, and TNF-α, showed significant decreases (P<0.05) compared to the infected control group. In conclusion, the magnitude and phenotype of the egg-induced effects on T helper responses were found to be controlled by a parallel response within the T regulatory population which provides protection in worm parasite-induced immunopathology.