新生儿感染时CD分子变化及临床意义

The change and clinical significance of the molecule CD in the newborns with infection.

目的探讨不同胎龄新生儿感染时T、B、NK细胞及中性粒细胞表面CD分子变化及临床意义。方法2004年2～6月复旦大学儿科医院用流式细胞仪检测34例早产儿及33例足月儿CD表达。结果(1)足月感染组CD3[(76.89±2.52)%]高于足月非感染组[(64.40±5.69)%],早产非感染组[(80.93±9.13)%]高于足月非感染组;早产非感染组CD4[(61.20±2.21)%]高于足月非感染组[(47.60±4.27)%],早产感染组[(53.63±3.23)%]低于早产非感染组;CD8各组间无统计学差异性。(2)CD19各组间无统计学差异性。(3)足月感染组CD56CD16[(5.88±0.62)%]低于非感染组[(13.00±5.31)%],足月非感染组高于早产非感染组[(6.13±1.25)%]。(4)足月感染组CD64[(5056.92±1255.58)分子/单位]高于足月非感染组[(2112.60±1157.21)分子/单位],早产感染组[(4619.67±1395.99)分子/单位]高于早产非感染组[(2407.45±1247.16)分子/单位]。(5)败血症、肺炎及其它感染组CD64高于非感染组。以CD64大于3000分子/单位为阳性,CD64诊断感染灵敏度为79.6%,特异度为75.1%;以CD64大于2000分子/单位为阳性,CD64诊断感染灵敏度为88.9%,特异度为60%;CRP诊断感染灵敏度为65.3%,特异度为86%。结论早产儿细胞表面CD3、CD4、CD16CD56变化不同于足月儿,可能与早产儿免疫功能低下有关;CD64可能会成为一种新型感染诊断指标。

Objective To evaluate the change and the clinical significance of the cell CD on the surface of T,B,NK and Neutrophils cells.Methods From Feb. to June 2004,50 preterms and 49 terms with infection or non-infection were sturied.The level of peripherical blood CD_3,CD_4,CD_8,CD_ 19 ,CD_ 16 CD_ 56 and CD_ 64 were measured by flow cytometry.Results ① The level of CD_3 in terms(76.89±2.52)% with infection was higher than that in terms without infection(64.40±5.69)%.The level of CD_3 in preterms without infection(80.93±9.13)%was significantly higher than that in terms without infection.The level of CD_4 in preterms without infection(61.20±2.21)% was significantly higher than that in terms without infection(47.60±4.27)%.The level CD_4 in preterms with infection (53.63±3.23)% was significantly lower than that in preterms without infection ;The level of CD_8 was not different in all groups.②The level of CD_ 19 has no difference in all groups.③The level of CD_ 56 CD_ 16 in terms with infection(5.88±0.62)% was significantly lower than that in terms without infection(13.00±5.31)%,the level of CD_ 56 CD_ 16 in terms without infection was significantly higher than that in preterms without infection(6.13±1.25)%.④ The level of CD_ 64 in terms with infecton (5056.92±1255.58)Molecule/Unit was higher than that in terms without infection (2112.60±1157.21)M/U.The level of CD_ 64 (4619.67±1395.99)M/U in preterms with infection was significantly higher than that in the preterms without infection(2407.45±1247.16)M/U.⑤The level of CD_ 64 in patients with sepsis,pneumonia and other infections were higher than that in those patients without infection.If the positive standard of CD_ 64 was over 3000 M/U,then the sensitivity was 79.6% and the specificity was 75.1%.If the positive standard of CD_ 64 was over 2000 M/U,then the sensitivity was 88.9% and the specificity was 60%.The sensitivity of CRP was 65.3% and the specificity was 86%.Conclusion The level of CD_3、CD_4、CD_ 16 CD_ 56 in preterms with or without infection differs from those in terms,which is probably due to the low immunity function of preterms.CD_ 64 may be a kind of new diagnosis guideline.