sTREM-1和CD64指数测定在诊断新生儿腹泻中的临床意义

Clinical significance of serum soluble triggering receptor expressed on myeloid cell-1 and neutrophil CD64 in neonatal diarrhea

目的:探讨检测血清可溶性髓样细胞触发受体-1(soluble triggering receptor expressed on myeloid cell 1,sTREM-1)和CD64表达水平在新生儿腹泻早期诊断和疗效判断中的价值.方法:将69例患儿按腹泻的类型分为细菌性腹泻组、病毒性腹泻组和非感染性腹泻组,采用双抗体夹心酶联免疫吸附法(ELISA)测定血清sTREM-1浓度,采用流式细胞技术测定中性粒细胞表面分子CD64的表达,应用受试工作特征曲线(receiver operator characteristic curve,ROC)研究sTREM-1、CD64的诊断效能,并比较每位患儿治疗前后的两指标变化情况.结果:细菌性腹泻组、病毒性腹泻组与非感染腹泻组血清sTREM-1中位数水平分别为75.25、23.25和15.25 pg/mL,三组间比较差异有统计学意义(P<0.05);细菌性腹泻组CD64阳性百分率中位数为69.36 MFI,高于病毒性腹泻组和非感染腹泻组(分别为25.50、21.37MFI),三组间比较差异有统计学意义(P<0.05).治疗后sTREM-1和CRP明显较治疗前下降(P<0.05),病毒性腹泻组与非感染性腹泻组的sTREM-1和CD64比较差异无统计学意义(P>0.05).sTREM-1诊断细菌性腹泻的敏感性90%,特异度82%.CD64诊断细菌性腹泻的敏感度为88%,特异度为93%.结论:sTREM-1、CD64测定有助于细菌性腹泻的早期诊断、鉴别诊断和对抗菌药物疗效的判断.

AIM： To assess the significance of serum soluble triggering receptor expressed on myeloid cell-1 （sTREM-1） and neutrophil CD64 in the differential diagnosis and therapeutic evaluation of neonatal diarrhea. METHODS： This was a prospective observational study. Ninety patients were divided into a bacterial diarrhea group （n = 32）, a viral diarrhea group （n = 32）, and a non-infection diarrhea group （n = 32）. Serum sTREM-1 was measured by double-antibody sandwich enzyme-linked immunosorbent assay （ELISA）. CD64 was measured by automatic flow cytometry. Serum sTREM-1 and CD64 were detected in each child before and after treatment. The diagnostic valueof sTREM-1 and CD64 was assessed by receiver operating characteristic （ROC） curve analysis. RESULTS： Median concentrations of serum sTREM-1 and CD64 in the bacterial, viral infection and non-infection groups were 75.25, 23.25 and 15.25 pg/mL, and 69.36, 25.50 and 21.37 MFI, respectively. After treatment, the level of sTREM-1 in the bacterial diarrhea group was significantly higher than those in the viral diarrhea and non-infection groups （P 〈 0.05）, although there was no statistical difference between the viral diarrhea group and non-infectious diarrhea group （P 〉 0.05）. The sensitivity and specificity of serum sTREM-1 for diagnosis of neonatal diarrhea were 90% and 82%, respectively, while those of serum CD64 were 88% and 93%. CONCLUSION： Serum sTREM-1 and CD64 detection can be used for early diagnosis and differential diagnosis of bacterial diarrhea and for observation of anti-infection effects.