三种感染标记物在新生儿早发感染诊断中的比较

Comparison of Three Infection Markers for Diagnosis of Early Onset Infection in Newborn Infants

目的使用前瞻性方法,评估中性白细胞表面抗原CD64、单核细胞表面抗原人类白细胞相关抗原DR(HLA-DR)和C反应蛋白(CRP)对诊断新生儿早发型细菌感染的作用。方法生后72h内临床怀疑细菌感染的足月新生儿288例,非感染新生儿10例为对照组,在0及24h取血,用流式细胞仪定量测定CD64和HLA-DR表达量,用酶联免疫吸附试验(ELISA)测定CRP水平。行一系列细菌感染筛查,收集人口学数据和相关临床资料。比较CD64、HLA-DR及CRP诊断新生儿早发感染的灵敏度、特异性、阳性和阴性预告值。结果确定感染组93例,非感染组195例。感染组CD64表达量在0、24h均显著高于非感染和对照组(Pa<0.0005)。其最佳截断值为6136个荧光抗体分子/细胞,在24h具有非常高的灵敏度(94%)和阴性预告值(96%)。感染、非感染和对照组HLA-DR表达量无显著性差异,无法得到最佳截断值。CRP特异性与CD64相似,但灵敏度较低,ROC曲线下面积也小于CD64。结论中性白细胞表面抗原CD64是诊断足月新生儿早发型感染的灵敏指标,单核细胞表面抗原HLA-DR不能区分感染和非感染患儿。

Objective To evaluate utilities of neutrophil CD64, monocyte human leukocyte antigen （HLA） - DR and C - reactive protein （CRP） for diagnosis of early onset bacterial infection in newborn infants. Methods A total of 288 term newborns whom infection was suspected within 72 h of age were enrolled in the study. Another 10 infants without infection were severed as control group. Neutrophil CD64, monoctye HLA - DR and CRP were measured quantitatively at the time of sepsis evaluation （0 h） and 24 h after wards. The demographic and clinical data were documented. Receiver operation characteristic curves （ ROC curve） of three markers at different time point were constructed. Sensitivity, specificity, positive predict value （PPV） and negative predict value （NPV） of different marker were calculated according to the optimal cutoff value. Results Ninty - three infants were found to be clinically infected. One hundred and ninty - five infants were not infected. The expression of CD64 significantly increased in infection group than that of non - infection and control group not only at 0 h but also at 24 h （ Pa 〈 0.000 5）. CD64 had high sensitivity of 94% and specificity of 96% by using 6 136 PE/cell as the optimal cutoff value. There were no statistical difference of HLA - DR among the infected, non - infected and control groups. And it was very difficult to determine an optimal cutoff value. Although CRP had the same specificity as CD64, but there was relative low sensitivity. And the area under the curve of CRP was less than that of CD64. Conclusions Neutrophil CD64 is a sensitive marker for early onset clinical infection in term newborns. Its diagnostic utilities is better than those of CRP. Monocyte HLA - DR is less useful in the same purpose.