摘要
目的探讨联合检测血清中性粒细胞CD64与C反应蛋白(CRP)对烧伤脓毒症患者的早期诊断价值。方法采用前瞻性研究,选择烧伤住院患者76例,依据烧伤脓毒症诊断标准分为脓毒症组27例,局部感染组31例,非细菌感染对照组18例,入院后24~48 h内均以流式细胞术检测外周静脉血中性粒细胞CD64,蛋白分析仪检测CRP,五分类血液分析仪检测外周血白细胞计数(WBC)、中性粒细胞比率(N),并进行微生物培养,脓毒症组经常规抗感染治疗7 d和14 d后复查各指标。结果脓毒症组CD64及CRP均高于局部感染组和对照组(P<0.01),局部感染组CD64和CRP均高于对照组(P<0.01),CD64与CRP呈正相关;脓毒症组治疗7 d后CD64和CRP下降,但与治疗前相比差异无统计学意义;治疗14 d后CD64和CRP下降明显,与治疗前相比差异有统计学意义,但仍然高于对照组(P<0.01)。检测CD64联合CRP、CD64、CRP、WBC、N、ROC曲线下面积分别为0.952、0.923、0.904、0.756、0.728。结论中性粒细胞CD64对烧伤脓毒症有良好的早期诊断价值,其表达在革兰阳性菌和革兰阴性菌中无明显差异,联合检测CD64与CRP可以提高诊断率。
Objective To investigate the utility of combined test of neutrophil CD64 and C-reactive protein（CRP）for early diag- nosis of burn sepsis. Methods A prospective study was conducted in 76 hospitalized burn patients,including three groups：burn sepsis（n = 27）,local infection（n = 31 ） and controls without bacterial infection （n = 18） based on their diagnosis. Blood samples were collected within 24-48 h after hospital admission for analysis of neutrophil CD64,CRP, white blood cell count （WBC）, neutrophils percentage （N） by flow cytometry, and bacterial culture. These parameters were re-evaluated for the patients in sepsis group 7 and 14 days after antibiotic therapy. Results Neutrophil CD64, CRP, WBC and N were significantly higher in sepsis patients than the corresponding values in the patients with local infection or control patients （P^0. 01 ）. Neutrophil CD64 and CRP in the patients with local infection were significantly higher than those in the control patients without bacterial infection （P% 0.01）. Neutrophil CD64 was positively correlated to CRP. Neutrophil CD64 and CRP decreased 7 days after an- tibiotic therapy, but the difference was not statistically significant compared to the pretreatment levels. Neutrophil CD64 and CRP decreased significantly 14 days after antibiotic therapy compared to the pretreatment levels （P% 0.01）, but still higher than the levels in the control group. The receiver operating characteristic （ROC） curve of CD64 ＋ CRP combined test,CD64,CRP, WBC, N for detecting bacterial infection showed an area under curve （AUC） of 0. 952, 0. 923, 0. 904, 0. 756 and 0. 728, respectively. Conclusions Neutrophil CD64 is useful in early diagnosis of burn sepsis. The expression of neutrophil CD64 does not have significant difference betweengram positive and gram negative bacterial infections. Combined test of neutrophil CD64 and CRP can improve the efficiency for diagnosis of burn sepsis.
出处
《中国感染与化疗杂志》
CAS
北大核心
2014年第2期89-93,共5页
Chinese Journal of Infection and Chemotherapy
基金
广西医疗卫生重点科研项目(重2012071)
