摘要
目的应用流式细胞术测定外周血粒细胞表面CD64表达强度,明确CD64平均荧光强度指数(CD64指数)在感染性疾病诊断和鉴别诊断中的意义。方法以2009年3月至2010年4月在本院住院的发热患者105例为研究对象,对照组为健康体检者25例,测定C反应蛋白(CRP)及外周血CD64指数并同时进行细菌培养,根据细菌培养等病原学检查,结合患者症状体征、外周血和骨髓细胞学、胸片等检查综合判断,将患者分为感染性疾病组(感染组)91例和发热待查组14例,再根据白细胞分类、病原学及血清学等检查将感染性疾病分为细菌性(75例)、病毒性(8例)和真菌性感染组(8例)。计算25例正常对照组CD64指数、CRP值和CD64指数95%可信区间,与以上各组比较;另将血培养阳性、确诊为败血症的患者(18例)和局部细菌感染患者(57例)进行比较,回顾性分析各组患者之间CD64指数的差异;根据绘制受试者工作特征(ROC)曲线,计算得出CD64指数及CRP最佳临界值,根据最佳截断值确定阳性阈值,从而重新对病例进行归类分析得出最终阳性意义结论。并对14例细菌性感染患者抗生素治疗前后CD64指数也进行了比较;同时对CRP、血培养及CD64指数几个指标的敏感度与特异度进行横向比较。结果细菌性感染组外周血CD64指数(10.49±6.65)明显高于正常对照(2.87±0.73)(P<0.05);败血症患者CD64指数(14.08±6.78)最高,且明显高于局部细菌感染患者(9.75±6.34)(P<0.05);病毒感染组患者CD64指数(2.96±0.78),真菌感染组患者CD64指数(3.66±0.92)明显低于细菌感染组,提示临床患者感染时CD64指数能起到鉴别作用;根据绘制ROC曲线确定了CD64指数和CRP的最佳截断值,根据最佳截断值及95%可信区间确定了CD64指数的阳性阈值,取CD64指数>4.0为弱阳性,CD64指数>9.0为强阳性,重新分组分析后验证了CD64指数在感染性疾病中的意义;14例细菌感染患者抗生素治疗前CD64指数(13.83±5.50)明显高于治疗后(8.44±3.01)(P<0.05),提示动态监测外周血CD64指数有助于治疗效果评价;同时,计算得出外周血CD64指数的敏感度(95.8%)和特异度(89.9%)明显优于C反应蛋白(79.2%,79.6%),血培养的特异度高(100%),但其敏感度(17%)则明显不如以上两者。结论测定外周血粒细胞CD64指数可以帮助早期诊断细菌性感染(尤其是败血症)、判断感染严重程度和评价治疗效果,其敏感度和特异度均明显优于C反应蛋白。
Objective Using flow cytometry to detect circulating granulocytes surface CD64 mean fluorescence intensity index（CD64 index） to define the clinical significance of the determination of neutrophil CD64 index in diagnosis of infectious diseases.Methods 105 patients with fever from March 2009 to April 2010 in our hospital were collected as research subjects,normal control group included 25 subjects from health check,105 subjects with fever were classified into infectious disease（91 cases） and non-infectious disease（14 cases） by clinical manifestation and relative experimental results.Their levels of CD64 index were detected by flow cytometry.The blood culture and the dynamic change of C reactive protein（CRP） were also determined.And according to the leukocyte classification,serology and etiology results,we divided infectious disease into bacterial infection（75 cases）,viral infection（8 cases）and fungal infection（8 cases）.Calculating the CD64 index,CRP and 95% confidence interval of CD64 index in 25 cases of normal controls,comparing with the above groups;Besides,also retrospective analysis was conducted on CD64 index of sepsis（blood culture positive）（18 cases） and local bacterial infection groups（57 cases）.According to the receiver-operating characteristic（ROC） curve,the best critical CD64 index and CRP truncated value were calculated according to the best cutoff value,thus determining positive threshold to classification and analysis of cases of positive significance to final conclusion.Comparison in CD64 index between pre-and post-treatment of antibiotics in 14 cases infectious patients were also made.Meanwhile,we also made horizontal comparison on sensitivity and specificity among CD64 index,CRP and blood culture.Results CD64 index in the bacterial pneumonia group（10.49±6.65） was significantly higher than that in the healthy control group（2.87±0.73）（P0.05）.CD64 index in the sepsis group（14.08±6.78） was significantly higher than that in the local bacterial infection group（9.75±6.34）（P0.05）.CD64 index in the viral infection group and fungal infection group were significantly lower than that in the local bacterial infection group（P0.05）,suggested that the determination of CD64 index may assist in the differential diagnosis for infection patients.According to the ROC curve for the best CD64 index and CRP truncated value,and 95% confidence interal truncated CD64 determined the index of positive threshold,taking CD64 index 4.0 CD64 index for weak positive,9.0 for strong positive,re-grouping analysis verified CD64 index in the significance of infectious diseases.CD64 index in the pre-treatment（13.83±5.50） was higher than that in the post-treatment（8.44±3.01）（P0.05） in 14 cases of infectious patients,suggested that the dynamic monitoring of CD64 index may assist in the treatment evaluation.The sensitivity and specificity of CD64 index were 95.8% and 89.9% respectively,the sensitivity and specificity of CRP value were 79.2% and 79.6% respectively,while those of blood culture value were 100% and 17%,respectively.Conclusion The determination of CD64 index may assist in early diagnosis of bacterial infection,especially sepsis,and judgment of the infectious degree as well as evaluating the treatment for infection patients,its sensitivity and specificity are superior to CPR.
出处
《临床荟萃》
CAS
2011年第5期383-387,共5页
Clinical Focus
