中性粒细胞CD64和血清sTREM-1在老年社区获得性肺炎中的诊断价值探讨

Study of diagnostic value of neutrophil CD64 and sTREM-1 in elderly patients with community-acquired pneumonia

目的:探讨中性粒细胞CD64和s TREM-1在老年社区获得性肺炎(CAP)诊断中的临床价值。方法:将76例老年CAP住院患者按病情严重程度分为重症肺炎组23例(存活15例,死亡8例),普通肺炎组53例;同期进行健康体检老年人45例为对照组。采用流式细胞术检测外周血中性粒细胞CD64的表达,采用双抗体夹心酶联免疫吸附法检测s TREM-1的水平,并应用受试者工作特征曲线(Receiver operating characteristic curve,ROC)分析二者对老年CAP的诊断价值。结果:重症肺炎组、普通肺炎组、对照组CD64中位数水平分别为37.49、18.82、10.63MFI,三组间比较差异有统计学意义(P<0.05);重症肺炎组s TREM-1中位数为75.39 pg/ml,高于普通肺炎组和对照组(分别为65.31、43.96 pg/ml),三组间比较差异均有统计学意义(P<0.05);重症肺炎存活组CD64、s TREM-1随着病情好转逐渐降低至正常水平,而死亡组CD64、s TREM-1随着病情的加重持续升高,且在死亡时达到最高值;二者诊断老年CAP的ROC曲线下面积分别为0.876、0.843,联合二者诊断CAP的ROC曲线下面积为0.917。结论:CD64、s TREM-1可作为老年CAP有价值的诊断指标,动态监测两项指标的水平变化趋势能够反映CAP的病情以及预后。

Objective：To explore the neutrophil CD64 and sTREM-1 in elderly patients with community-acquired pneumonia （ CAP） in the diagnosis of clinical value. Methods： 76 elderly CAP hospitalized patients were divided into severe pneumonia group （n=23） （live in 15 cases,8 deaths）and ordinary pneumonia group（n=53） according to severity;45 patients in the control group compared with healthy older persons. Peripheral blood neutrophil CD64 was measured by automatic flow cytometry,sTREM-1 levels was measured by double-antibody sandwich enzyme-linked immunosorbent assay. The receiver operating characteristic curve （ ROC curve） was used to check diagnostic value of the detection. Results： Median concentrations of CD64 and sTREM-1 in the severe pneumonia group,general pneumonia group and control group were 37. 49,18. 82 and 10. 63 MFI,and 75. 39,65. 31 and 43. 96 pg/ml, respective-ly. Although there was significant differences among the three groups （ P〈0. 05 ）; CD64 and sTREM-1 in Severe pneumonia survival group reduced to a normal level as his condition improved gradually,death group continued to rise as the disease,and peaked at the time of death;the area under the ROC curve of CD64,sTREM-1were respectively 0. 876,0. 843,which was 0. 917 by combination of CD64 and sTREM-1. Conclusion： Both CD64 and sTREM-1 are good markers in the diagnosis value of CAP, the dynamic changes of two may reflect the condition and prognosis of CAP.