摘要
目的评价外周血中性粒细胞CD64、CD11b表达在脓毒症患儿早期诊断中的应用价值。方法99例研究对象依据病情不同分为三组：脓毒症组（44例）、非脓毒症感染组（33例）及正常对照组（22例）。采用流式细胞术检测外周血中性粒细胞CD64、CD11b的平均荧光强度（median fluorescence intensity，MFI），同时检测外周血C反应蛋白（C-reactive protein，CRP）水平。结果脓毒症组患儿中性粒细胞CD64、CD11b表达水平及CRP均较非脓毒症感染组及正常对照组高（P均〈0．01）。二元Logistic回归分析，CD64第二分位组发生脓毒症的风险是第一分位组的3．750倍，第三分位组发生脓毒症的风险是第一分位组的4．808倍；CD11b第三分位组发生脓毒症的风险是第一分位组的4．600倍。以ROC曲线确定CD64的最佳截断值为6415MFI，其诊断脓毒症的敏感度和特异度分别为91．7％、72．5％，有较高的诊断价值；以ROC曲线确定CD11b的最佳截断值为1667MFI，诊断脓毒症的敏感度和特异度分别为70．8％、56．9％；CD64联合检测CRP诊断脓毒症的敏感度和特异度为97．9％、84．3％。结论脓毒症患儿外周血中性粒细胞表面标志物CD64、CD11b平均荧光强度表达升高，尤其CD64联合检测CRP诊断脓毒症患儿有更高的敏感度及阴性预测值，减少漏诊率，可以作为脓毒症患儿早期诊断依据，指导临床治疗。
Objective To assess the value of peripheral blood neutrophil CD64 and CDI l b for the early diagnosis of child sepsis. Methods 99 cases of research object were divided into three groups, Group 1 with sepsis （ n = 44）, Group 2 with non - sepsis infection （ n = 33 ）, Group 3 healthy children （ n = 22）. Using flow cytometry to test the median fluorescence intensity （ median fluorescence intensity, MFI） of peripheral blood neutrophil CD64 and CDllb and detecting the level of peripheral blood C -reactive protein （CRP）. Results The expression of CD64, CD11b, CRP were statistically significant in sepsis group with non- sepsis infection group and healthy children （both P 〈 0.01 ）. Two Logistic regression analysis showed that patients in the highest quartile of CD64 had 4. 808 - fold risk of sepsis and those in the second quartiles had 3. 750 times to have sepsis compared with the lowest one. Patients in the highest quartile of CDllb had 4.600- fold risk of sepsis compared with the lowest one. The diagnostic sensitivity and specificity of sepsis were 91.7%, 72.5%, when the optimal cutoff value of CD64 is 6515MFI using ROC curve, which had higher diagnostic value. The diagnostic sensitivity andspecificity of sepsis were 70.8%, 56.9%, when the optimal cutoff value of CDllb is 1667MFI using ROC curve. The diagnostic sensitivity and specificity of sepsis were 97.9% , 84.3% , when combined neutrophil CD64 and CRP. Conclusion The expression of peripheral blood neutrophil CD64 and CD11b increased in children with sepsis. Especially, combination of CD64 and CRP further enhances the sensitivity of the expression and its negative predictive value, which can be used as the early diagnosis of children with sepsis and guide the clinic treatment.
作者
赖乾坤
刘光华
叶红
王世彪
毛晓丹
Lai Qian-kun;Liu Guang-hua;Ye Hong;Wang Shi-biao;Mao Xiao-dan(Department of Pediatrics,Fujian Maternity and Children Health Care Hospital,Fuzhou 350000,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2018年第10期885-889,共5页
Chinese Journal of Critical Care Medicine
