烧伤感染患者外周血CD64、C-反应蛋白的表达及其临床意义

Expression and significance of peripheral blood CD64 and C-reactive protein in burn infection

目的探讨外周血中性粒细胞表面CD64及C-反应蛋白(CRP)的表达水平,以利于对烧伤感染患者早期诊断及评价临床疗效。方法选择根据病史、症状、体征而诊断明确的烧伤住院患者111例,分为脓毒症组(36例),局部感染组(39例),对照组(36例)。各组患者在入院后24～48h内取外周静脉血2ml,采用流式细胞仪检测中性粒细胞CD64的表达水平,同时检测外周血CRP、白细胞计数及中性粒细胞的百分比。脓毒症组在恢复期(治疗1周后)复查。结果脓毒症组CD64、CRP表达显著高于局部感染组和对照组(P<0.01),局部感染组与对照组比较差别有统计学意义(P<0.01)。以CD64≥43.20%、CRP≥91.85mg/L、白细胞计数≥11.05×109/L和中性粒细胞百分比≥71.50%为阳性标准,4种指标的敏感性分别为88.90%、86.10%、83.30%、88.90%,特异性分别为88.00%、88.00%、70.60%、77.30%。脓毒症组+局部感染组CD64与CRP呈正相关(r=0.458,P<0.01)、与WBC、Neu%无相关性(r=0.175、0.218,P>0.05),脓毒症组在恢复期CD64及CRP表达水平下降,与初期比较差别有统计学意义(P<0.01),但未降至正常水平,与对照组治疗初期比较差别有统计学意义(t=14.19、8.75,P<0.01)。结论应用流式细胞仪测定中性粒细胞表面CD64的表达水平及CRP的检测,可作为早期诊断烧伤感染严重程度的敏感指标,观察其治疗前后水平变化,对判断感染程度、治疗效果的评价具有临床应用价值。

Objective To investigate the value of the peripheral blood neutrophil CD64 and C-reactive protein(CRP) expression in the early diagnosis burn infection and the clinical efficacy. Methods Choossing 111 severity patients who were diagnosised clear by the history,symptoms and signs, were divided into pyaemia group(n=36),local infection group(n=39)and control group(n=36). The peripheral blood samples of 2ml were taken from patients of each group within 24~48h of admission.The levels of peripheral blood neutrophil CD64 were measured by flow cytometry,which were measured again during the recovery period(after treatment 1 week)for pyaemia group. Also CRP,WBC,Neu% were measured. Results The expression of CD64 and CRP in pyaemia group were significantly higher than that in the group of local infection and the control(P<0.01). There also was statistically significant between local infection and the control group(P<0.01). These markers were considered positive when CD64≥43.20%,CRP≥91.85mg/L,WBC≥11.05×109/L and Neu%≥71.50%.Their sensitivity were 88.90%、86.10%、83.30% and 88.90% .Their specificity were 88.00%、88.00%、70.60 % and 77.30%. CD64 was in direct proportion to CRP(r=0.458,P<0.01)in the pyaemia group and local infection group. No correlation was found between WBC and Neu%(r=0.175、0.218,P >0.05). The value of CD64 and CRP in pyaemia group decreased obviously in recovery stage,which still higher than the control group treatment before(t=14.19、8.75,P<0.01). Conclusion The expression of peripheral blood neutrophil CD64 and CRP were measured by flow cytometry can be used as one of the laboratory index for early diagnosis of burn infection. There is clinical value in judging the degree of infection,evaluation of before and after treatment by observation of their levels.