烧伤脓毒症患者外周C-反应蛋白和CD64水平动态变化

Peripheral C-reactive protein and CD64 level dynamic change in patients with burn and sepsis

目的探讨早期烧伤脓毒症患者外周C-反应蛋白(C-reactive protein,CRP)和CD64水平动态变化。方法选择我院烧伤科2013-01至2014-01收治的80例烧伤患者,根据是否诊断烧伤脓毒症分为两组,烧伤脓毒症组40例和对照组40例。两组患者入院后及时给予抗生素抗感染治疗,补液抗休克治疗,创面积极换药,保持水电解质平衡等对症支持治疗。对比烧伤脓毒症组和对照组中性粒细胞CD64及CRP水平以及不同烧伤面积患者中性粒细胞CD64及CRP水平。结果烧伤脓毒症组和对照组中性粒细胞CD64分别为(65.2±18.6)%、(16.8±5.7)%,两组CRP水平为(157±34.8)mg/L、(19.6±2.2)mg/L,差异均有统计学意义(P<0.05);烧伤脓毒症组患者(烧伤面积小于60%)和烧伤脓毒症组患者(烧伤面积大于60%)中性粒细胞CD64及CRP水平分别为(46.8±13.5)%、(135.7±32.8)mg/L;(76.9±24.3)%,(189.6±40.5)mg/L,对比差异有统计学意义(t=8.6、7.9,P<0.05)。在烧伤脓毒症时,中性粒细胞CD64的ROC曲线下面积(AUC)最大,优于CRP(P<0.05)。采用约登指数(正确指数=灵敏度+特异度-1)最大值所对应值,得出有意义指标的最佳截断点(cut-off point),得出对CD64、CRP对诊断烧伤脓毒症的灵敏度、特异度、阳性预测值、阴性预测值,结果显示CD64灵敏度、特异度、阳性预测值、阴性预测值均高于CRP(P<0.05)。结论在烧伤伴脓毒症的细菌感染中,CD64具有较高的特异性,其灵敏度、特异度、阳性预测值、阴性预测值均高于CRP。

Objective To study the peripheral C- reactive protein and CD64 level dynamic change in patients with early burn and sepsis. Methods A total of 80 burn patients were collected in this hospital from 2013 January to 2014 January in burn department. According to the diagnosis, they of burn sepsis were divided into 2 groups, burn sepsis group （40 cases） and control group （40 cases ）. After admission, two groups of patients were promptly given antibiotics to prevent infection, fluid infusion, anti shock, wound dressing changed actively, maintaining water and electrolyte balance for symptomatic and supportive treatment. Comp Neutrophil CD64 and C- reactive protein （CRP） levels in bum sepsis group and control group were compared and neutrophils level and CD64 and C- re- active protein （CRP） level in patients with different burn area. Results In burn sepsis group and control group, neutrophil CD64 and CRP levels were （65.2 ± 18.6）%, （157 ± 34.8 ）mg/L; （16.8 ± 5.7 ）% , （19.6 ±2.2 ）mg/L, the difference was statistically signif- icant （ t = 12.4, 13.8, P 〈 0.05 ）. In bum sepsis group （ patients with burn area of less than 60% ） and burn sepsis patients （ burned area greater than 60% ）, levels of neutrephil CD64 and CRP were （ 46.8 ±13.5 ） %, （ 135.7± 32.8 ） nag/L; （ 76.9 ± 24.3 ） % , （189.6 ± 40.5 ）mg/L, the difference was statistically significant （t = 8.6, 7.9, P 〈 0.05 ）. In burn sepsis, ROC curve area of neu- trophil CD64 （AUC） under the maximum, was better than that of CRP （P 〈 0.05 ）. Using Youden index （ the correct index = sensi- tivity ＋ specificity -1 ） corresponding to the maximum value; the optimum truncation points meaningful index （cut-off point）, draw on the CD64, CRP sensitivity, in the diagnosis of burn sepsis specificity, positive predictive value and negative predictive value ; the re- sults showed that the CD64 sensitivity and specificity and the positive predictive value and negative predictive value were higher than those of CRP （ P 〈 0.05 ）. Conclusions There is a very high specificity of bacterial infection of CD64 on burn with sepsis ;its sensitivity, specificity, positive predictive value, and negative predictive value are higher than CRP.