新生儿败血症中性粒细胞CD64、CD11b的表达及临床意义

Expression of peripheral blood neutrophil CD64 and CD11b in neonatal septicemia

目的探讨中性粒细胞CD64、CD11b对新生儿败血症早期诊断、判断病情、分析预后的实用价值。方法败血症组36例和非感染组22例均在入院初及恢复期采空腹静脉血,应用流式细胞术测定中性粒细胞CD64、CD11b,同时行外周血C反应蛋白(CRP)测定,败血症组在入院接受抗生素治疗前做血培养,对照组一次性采血测定CD64、CD11b和CRP。结果败血症组CD64水平为(60.4±22.7)MFI,明显高于非感染组的(27.9±4.9)MFI和对照组的(23.1±5.1)MFI(均P<0.01);败血症组CD11b水平为(1 645.1±463.7)MFI,明显高于非感染组的(1101.5±333.8)MFI和对照组的(1 041.5±260.3)MFI(均P<0.01);败血症组恢复期CD64、CD11b水平明显有下降(均P<0.01);以CD64≥35MFI、CD11b≥1 300MFI、CRP≥8 mg/L为阳性标准,三指标对诊断败血症的敏感度分别为95.7%、82.6%、69.6%,特异度分别为95.8%、79.2%、75.0%;CD64与CRP呈正相关(r=0.428,P<0.01),与CRP无相关性(r=0.214,P>0.05)。结论中性粒细胞CD64、CD11b可作为新生儿败血症早期诊断、判断病情的可靠指标。

Objective To evaluate the diagnostic utilities of two neutrophil antigens（CD64 and CD11b） for early identification of neonatal sepsis related to bacterial infection. Methods The group of sepsis consisted of 36 newborns, the group of noninfection consisted of 22 newborns and the control group included 26 healthy newborns. The blood samples were obtained from the subjects just into hospital and recovery stage in the group of sepsis and noninfection, and were collected only once in the control. In sepsis group, samples were also taken for bacterial culture before treatment. CD64 and CDllb were quantified with the whole blood flow cytometry and direct immunofluorescence technique. Also C-reactive protein（CRP） was mearured. Results The expression of CD64 in neonates with sepsis was （60.4±22.7）MFI, which was significantly higher than that in the group of noninfection （27.9±4.9） MFI and the control （23.1±5.1） MFI（ P〈0.01） ,respectively. The expression of CDllb in neonates with sepsis was （1 645.1± 463.7） MFI, Which was significantly higher than that in the group of noninfection （1 101.5±333.8） MFI and the control（1 041±260.3） MFI（ P〈0 . 01） ,respectively. In the group of sepsis,the expression of CD64 and CDllb during the beginning stage was higher than during recovery stage distinctly （ P〈0.01）. These markers are considered positive if CD64≥35MFI,CD11b≥1 300MFI,CRP≥8 mg/L. Their sensitivity was 95.7% ,82.6% and 69.6%. Their specificity was 95.8%,79.2% and 75.0%. CD64 was in direct proportion to CRP（r =0.428, P〈0.01）. No correlation was found between CD11b and CRP（ r =0. 214, P〉0.05）. Conclusion CD64 and CD11b are the credible markers in the early diagnosis of neonatal sepsis,and they may play important role in the treatment of neonatal sepsis.