中性粒细胞CD64表达在重症患者感染中的意义

Clinical value of neutrophil CD64 expression in severely ill patients with infection

目的探讨外周血中性粒细胞CD64的表达在重症患者感染诊断及疗效评价中的价值。方法以2013年10月至2014年9月在本院重症监护病房(ICU)住院的感染患者103例为研究对象,对照组为健康体检者25例。根据临床表现和细菌学检测结果,将重症合并感染患者分成细菌感染组(86例)、真菌感染组(9例)和病毒感染组(8例)。应用流式细胞术检测中性粒细胞CD64表达,同时检测外周血C反应蛋白(CRP)及白细胞(WBC)水平,分析各组患者之间这3个指标的差异,并对17例细菌性感染的患者抗生素治疗前后CD64指数进行比较。绘制受试者工作特征(ROC)曲线,计算CD64指数最佳临界值,同时对CRP、WBC及CD64指数的敏感度与特异度进行比较。结果细菌性感染组患者外周血CD64指数(3.416±1.854)明显高于正常对照组(1.351±0.602)、真菌感染组(1.664±0.249)和病毒感染组(1.379±0.071)(P<0.01);败血症组CD64指数(6.081±2.009)最高,且明显高于局部细菌感染组(2.853±1.234)(P<0.01);17例细菌感染患者抗生素治疗后CD64指数(3.946±1.972)明显低于治疗前(5.849±2.185)(P<0.05)。根据ROC曲线得出CD64指数具有较高的特异度(88%)和敏感度(86%),高于白细胞计数(84%,77.9%)和C反应蛋白(76%,83.7%)。结论流式细胞术检测中性粒细胞CD64指数可作为重症患者细菌感染的早期诊断、判断病情和评价治效果的可靠指标。

To investigate the role of peripheral blood neutrophil CD64 expression in diagnosis and treatment evaluation of severely ill patients with infection, total of 103 patients from October 2013 to September 2014 in the ICU of Yijishan Hospital were enrolled, including bacterial infection （86 cases）, fungal infection （9 cases） and viral infection （8 cases）, and 25 healthy persons for control. The expression levels of CD64 were detected by flow cytometry; C-reactive protein （CRP） and white blood cell （WBC） were also determined routinely. CD64 index in the bacterial infection group （3.416±1.854） was significantly higher than that in the healthy control group （1.351±0.602）, fungal infection group （1.664±0.249） and viral infection group （1.379±0.071）（P〈 0.01）, also higher in the sepsis subgroup （6.081±2.009） as compared with the local bacterial infection subgroup （2.853±1.234） （P〈0.01）; CD64 index was lower in patients of post-treatment （3.946±1.972） than that in patients of pre-treatment （5.849±2.185） （P〈0.05）. According to ROC curve, the sensitivity and specificity of CD64 index were 88% and 86% respectively, which were higher than those of WBC （84%, 77.9%） and CRP （76%, 83.7%）. In conclusion, CD64 index determined with flow cytometry may be a reliable marker in early diagnosis and treatment evaluation of severely ill patients with infection.