摘要
目的:探讨中性粒细胞CD64指数在恶性血液病伴肺部感染中的临床价值。方法:采用队列研究方法,回顾性分析就诊于苏州大学附属第三医院的恶性血液病伴肺部感染患者(125例)的临床资料,将患者诊疗过程划分为未发生感染阶段(T1)、出现感染症状并使用抗菌药物前(T2)、抗感染治疗1周后(T3)、停用抗菌药物后(T4)4个阶段,比较CD64指数、C反应蛋白(CRP)、血细胞计数和免疫细胞水平在感染发生前后(T1 vs T2)的差异,探寻CD64指数与其他指标间的相关性;观察有统计学差异的指标在病程中的变化趋势,并比较CD64指数和CRP的诊断效能;回访存活患者出院30 d内是否发生再感染,比较再感染和未再感染患者出院前(T4)各指标的复查结果,寻找再感染的危险因素。结果:患者发生感染前后,CD64指数、CRP、CD14^(+)HLA-DR^(+)、CD4^(+)和淋巴细胞计数存在明显差异(均P<0.05),CD64指数与CD14^(+)HLA-DR^(+)之间存在负相关(r=-0.395,P<0.001),与CD3^(+)之间存在负相关(r=-0.187,P=0.047),与淋巴细胞计数之间存在负相关(r=-0.230,P=0.006),与CRP之间存在正相关(r=0.313,P<0.001)。CD64指数的曲线下面积为0.790(95%CI:0.711-0.868),敏感性为59.6%,特异性为89.2%,cut-off值为0.488;CRP的曲线下面积为0.754(95%CI:0.667-0.841),敏感性为72.7%,特异性为73.0%,cut-off值为0.457;CD64指数联合CRP的曲线下面积为0.835(95%CI:0.762-0.907),敏感性为74.7%,特异性为78.4%,cut-off值为0.531。发生再感染的患者与未再感染患者在出院前的复查指标中仅有CD14^(+)HLA-DR^(+)(F=8.524,P=0.004)和CD64指数(F=9.993,P=0.002)比较存在差异。CD64指数升高为患者出院后30 d内再感染发生的独立危险因素(HR=1.790,95%CI:1.343-2.386,P<0.001)。结论:CD64指数在恶性血液病伴肺部感染的患者中具有诊断价值,其特异性高于CRP,联合使用两个指标可提高诊断敏感性。CD64指数对感染治疗结束后30 d内再感染具有预测价值。
Objective: To investigate the clinical value of neutrophil CD64 index in hematological malignancies with pulmonary infection. Methods: The cohort study method was used to retrospectively analyze the clinical data of 125patients with hematological malignancies and pulmonary infections who were treated in The Third Affiliated Hospital of Soochow University. All the patients were divided into four stages according to the diagnosis and treatment process: noninfected stage(T1), the symptoms of infection had appeared before using antibiotics(T2), one week after anti-infective treatment(T3), and after stopping antibiotics(T4). CD64 index, C-reactive protein(CRP), blood cell count, and immune cell level were compared before and after infection(T1 vs T2), the correlation between CD64 index and other indicators were explored, the change trends of the significantly different indicators in the course of the disease were observed, and the diagnostic efficacy of CD64 index and CRP were compared. The surviving patients were followed up for whether reinfection occurred within 30 days after discharge, and the re-examination results of indices before discharge(in stage of T4) between reinfected and non-reinfected patients were compared to find the risk factors of reinfection. Results: Before and after infection, the CD64 index, CRP, CD14^(+)HLA-DR, CD4, and lymphocyte counts were significantly different(all P<0.05). There was a negative correlation of CD64 index with CD14^(+)HLA-DR^(+)(r=-0.395, P<0.001), a negative correlation with CD3^(+)(r=-0.1.87, P=0.047), and a negative correlation with lymphocyte count(r=-0.230, P=0.006),while a positive correlation with CRP(r=0.313, P<0.001). The area under the curve of CD64 index, CRP, and CD64 index combined with CRP was 0.790(95%CI: 0.711-0.868), 0.754(95%CI: 0.667-0.841), and 0.835(95%CI: 0.762-0.907),respectively;the sensitivity was 59.6%, 72.7%, and 74.7%, the specificity was 89.2%, 73.0%, and 78.4%, and the cutoff value was 0.488, 0.457, and 0.531, respectively. There were only two
作者
徐茵
董伟民
林艳
郭嫣婷
刘佳
徐婷
顾伟英
XU Yin;DONG Wei-Min;LIN Yan;GUO Yan-Ting;LIU Jia;XU Ting;GU Wei-Ying(Department of Hematolog,The Third Affiliated Hospital of Soochow University,Changzhou 213003,Jiangsu Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2022年第5期1601-1606,共6页
Journal of Experimental Hematology
基金
江苏现代医院管理研究(JSY-3-2019-107)。
