社区获得性肺炎患者中性粒细胞CD64的表达及其意义

CD64 expression on neutrophils and its clinical significance in patients with community-acquired pneumonia

目的研究社区获得性肺炎(CAP)患者外周血中性粒细胞CD64的表达及其临床意义。方法选择51例CAP患者、33例疑似CAP患者和32例健康对照人群,采用流式细胞术检测外周血中性粒细胞CD64表达情况,采用受试者工作曲线分析法判断CD64表达对CAP的诊断价值,比较病情严重程度[以肺炎严重度指数(PSI)评分反映]不同的CAP患者CD64的表达差异。结果 CAP患者外周血中性粒细胞CD64的表达率为8.35%±2.28%,显著高于健康对照(0.51%±0.29%)和疑似CAP患者(5.66%±2.10%)。受试者工作曲线分析结果表明,中性粒细胞CD64表达用于CAP诊断的曲线下面积为0.81(95%CI 0.71～0.90),联合CD64表达、C反应蛋白、白细胞计数和中性粒细胞百分比可显著提高CAP的诊断敏感性(平行诊断试验)或特异性(系列诊断试验)。随PSI评分升高,CAP患者的中性粒细胞CD64表达也呈上升趋势。结论检测中性粒细胞CD64的表达有助于CAP诊断的确立,并可为CAP患者的病情分级提供参考。

Objective To investigate the CD64 expression on neutrophils and its clinical significance in patients with community-acquired pneumonia（CAP）.Methods Fifty one CAP patients,33 suspected to have CAP patients,who were suffering from other lung diseases（including pulmonary tuberculosis,lung cancer,eosinophilic lung disease and pulmonary edema）,and 32 healthy individuals were enrolled as control in present study.CD64 expression on the neutrophils were quantitatively detected by flow cytometry on admission,and the significance of CD64 expression for diagnosis of CAP was assessed by receiver operating characteristics（ROC） analysis.The difference of CD64 expression levels among patients with varying severity of CAP,expressed with Pneumonia Severity Index（PSI） score,was compared.Results The expression level of CD64 in neutrophil was 8.35%±2.28% in CAP patients,higher than that in CAP suspicious patients（5.66%±2.10%） and healthy controls（0.51%±0.29%）.In receiver operating characteristics analysis,the area under the curve of neutrophil CD64 expression was 0.81（95%CI 0.71-0.90）,and a comprehensive analysis of CD64 expression,white blood cell counts,C reactive protein and neutrophil percentage might obviously enhance the sensitivity in parallel test or specificity in series test of CAP diagnosis.In addition,a positive correlative tendency was found between the expressive level of CD64 on neutrophil and the PSI scores of CAP patients.Conclusion The expression of CD64 on neutrophils may be helpful for the differential diagnosis of CAP suspicious patients,and it may also provide a reference for stratification of CAP severity.