儿童细菌感染性疾病中性粒细胞自然活化及临床意义

Spontaneous activity and clinical significance of neutrophils in children with bacterial infectious diseases.

目的 使用流式细胞仪(FCM)检测细菌感染患儿中性粒细胞(PMNs)活化状态,评价其临床意义。方法 对上海复旦大学附属儿科医院2 0 0 3年2月至2 0 0 4年8月4 2例临床诊断为细菌感染患儿和随机抽取的2 7例正常对照儿童,抽取周围静脉血0 . 5mL ,佛波脂(phorbolmyristateacetate ,PMA)刺激以排除PMNs功能缺陷。FCM检测PMNs无其他刺激物时自然活化比例,对细菌培养(血、痰、中段尿)阳性病例和细菌培养阴性但是临床特征符合细菌感染及抗生素治疗有效的病例分别与对照组比较FCM实验室指标(PMNs活化率和平均荧光强度)。结果 4 2例临床诊断为细菌感染的患儿中,细菌培养阳性2 6例(6 1 .9% ) ,细菌培养阴性但是临床特征符合细菌感染及抗生素治疗有效者16例。PMNs活化率和平均荧光强度在细菌培养阳性患儿[(33. 33±2 3 .0 3) % ,6 . 5 0±4. 82 ]、细菌培养阴性患儿[(2 3. 10±2 1 .6 8) % ,4 . 74±2 .2 8]均高于正常对照[(8 .0 2±8 .0 1) % ,3 .18±1 .0 5 ],具有统计学意义(P <0 0 5 )。血培养阳性的全身感染PMNs活化率最高,中段尿培养及痰培养阳性者PMNs活化率与正常对照相比也增高,但低于血培养阳性者。4 2例感染组患儿PMNs活化增加占78 .6 % ,C反应蛋白(CRP)增高仅占31%。结论 细菌感染患儿PMNs明显活化。?

Objective Flow cytometry was used to detect the activity of neutrophils in children with bacterial infection and its clinical significance was evaluated.Methods 0.5mL venous blood were drawn from peripheral vein of clinical confirmed bacterial infectious patients and age-matched normal controls.Flow cytometry (FCM) was employed to detect respiratory burst of polymorphonuclear neutrophils (PMNs),and to exclude the functional defect of PMNs by PMA stimulation.The ratio of spontaneous activity of PMNs without stimulants was determined in both infectious and control groups.Results The 42 bacterial infectious cases clinically diagnosed including bacteria culture (blood、sputum、middle piece urine) positive (26 cases,61.9%),bacteria culture negative (16 cases,38.1%)and 27 normal controls were analyzed.The statistical significance ( P <0.05, P <0.05) appeared in both PMNs spontaneous ratio[(29.43±22.82)%,(8.01±8.10)%]and mean fluorescence intense (MFI)(5.83±4.10,3.18±1.05) between infectious and control groups.The ratio of PMNs activity was distinguishingly higher in patients with positive blood culture,and also increased in patients with positive results of midstream urine culture and sputum culture.In the 42 patients,the ratio of PMNs spontaneous activity and positive of CRP(13 cases)were 78.6% and 31% respectively.Conclusion PMNs are obviously activated in children with bacteria infection.FCM could rapidly and accurately detect the PMNs spontaneous activity,contributing to the diagnosis of bacterial infectious diseases.