中性粒细胞CD64指数在鉴别类风湿关节炎合并感染中的应用评价

Usefulness of neutrophil CD64 index as a marker to differentiate between infection and disease flare in patients with rheumatoid arthritis

目的:探讨中性粒细胞CD64指数在鉴别类风湿关节炎(RA)合并感染中的临床价值。方法:收集62例RA患者及30名健康对照者外周血样本,其中RA活动期24例、稳定期20例、合并感染18例。应用流式细胞术检测外周血中性粒细胞CD64指数的表达水平,并分析其与实验室指标的相关性。ROC曲线分析中性粒细胞CD64指数鉴别诊断RA合并感染的敏感性和特异性。结果:RA合并感染组中性粒细胞CD64指数为8.23±3.39,显著高于RA活动期组(2.61±0.94)、RA稳定期组(1.78±0.76)和健康对照组(1.65±0.61),P均<0.001;RA合并感染组中性粒细胞CD64指数与白细胞计数呈正相关(r=0.462,P=0.037);革兰阴性杆菌感染患者中性粒细胞CD64指数为9.06±3.39,虽高于革兰阳性球菌感染者(6.07±2.50),但差异无统计学意义(t=1.782,P=0.094);ROC曲线显示中性粒细胞CD64指数诊断RA合并感染的敏感性和特异性为94.4%和91.7%。结论:中性粒细胞CD64指数可作为鉴别RA合并感染与RA活动期的一个有效指标。

Objective：To investigate usefulness of neutrophil CD64 index as a marker to differentiate between infection and disease flare in patients with rheumatoid arthritis （RA）.Methods：The peripheral blood specimens from 24 RA patients with active stage,20 RA patients with stable stage,1 8 RA patients with infection and 30 healthy controls were collected.Neutrophil CD64 index was quantitatively measured using flow cytometry.The correlation between neutrophil CD64 index and laboratory data in RA patients was analyzed.The sensitivity and specificity of neutrophil CD64 index in diagnosis of RA with infection was cal-culated by receiver operating characteristic curve.Results：Neutrophil CD64 index in RA patients with in-fection （8.23 ±3.39）were significantly higher than active stage RA patients [（2.61 ±0.94）,P 〈0.001 ],stable stage RA patients [（1 .78 ±0.76）,P〈0.001 ]and healthy controls [（1 .65 ±0.61 ）, P〈0.001 ].The expression of neutrophil CD64 index was positively correlated with WBC in RA patients with infection （r=0.462,P=0.037 ）.Although neutrophil CD64 index in infection patients with Gram negative bacilli was higher than Gram positive coccus,there was no statistical difference [（9 .06 ±3 .39 ）vs （6.07 ±2.50）,t=1 .782,P=0.094].The sensitivity and specificity of neutrophil CD64 index in diag-nosis of infection in RA patients was 94.4% and 91 .7%,respectively.Conclusion：Neutrophil CD64 in-dex may be a marker to differentiate between infection and disease flare in patients with RA.