外周血中性粒细胞CD4对白血病患者细菌感染的诊断价值

Diagnostic value of neutrophil CD4 in peripheral blood on leukemia patients with bacterial infection

目的探讨外周血中性粒细胞CD4(Neutrophil CD4,nCD4)对白血病患者细菌感染的诊断价值,为临床治疗提供依据。方法选择医院2011年1月-2015年12月白血病患者100例及健康体检者100名为研究对象,将其分为白血病组和对照组,白血病患者根据是否合并临床感染分为感染组与未感染组,细菌感染患者根据血培养结果分为阳性组与阴性组,采用流式细胞术测定nCD4平均荧光强度,电化学发光法测定降钙素原(PCT)水平,免疫比浊法测定C-反应蛋白(CRP)水平。结果白血病感染组与未感染组患者nCD4荧光强度为(183.24±67.35、44.25±25.46)、PCT(10.43±1.21ng/ml、3.25±0.42ng/ml)、CRP(72.35±15.34 mg/l、14.32±3.24mg/l)水平均高于对照组(26.87±12.43、0.42±0.13ng/ml、2.12±0.09mg/l),差异有统计学意义(P<0.05);白血病感染患者中,血培养阳性组nCD4荧光强度(247.76±76.23)高于血培养阴性组(154.24±54.45),差异有统计学意义(P<0.05);nCD4、PCT和CRP诊断白血病细菌感染的灵敏度分别为91.80%、79.80%、82.40%,特异度分别为79.70%、75.80%、77.10%,其中nCD4诊断白血病细菌感染的灵敏度和特异度高于PCT和CRP。结论 nCD4在一定程度上可预测白血病细菌感染,可作为白血病患者细菌感染的诊断指标。

OBJECTIVE To investigate the diagnostic value of neutrophil CD4（nCD4）in peripheral blood on leukemia patients with bacterial infection,so as to provide the assistance for clinical treatment.METHODS A total of 100 leukemia cases and 100 healthy subjects were selected for the study,and were divided into leukemia group and control group.Leukemia patients were divided into leukemia infection group and leukemia uninfected group according to whether had clinical infection,and bacterial infection patients were divided into blood culture positive group and blood culture negative group according to blood culture results.The average fluorescence intensity of nCD4 in peripheral blood was determined by flow cytometry,the level of procalcitonin（PCT）was measured by electrochemiluminescence method,and C-reactive protein（CRP）level was measured by immunoturbidimetry.RESULTS The nCD4 fluorescence intensity（183.24±67.35,44.25±25.46）,PCT level（10.43±1.21ng/ml,3.25± 0.42ng/ml）,and CRP level（72.35±15.34 mg/l,14.32±3.24）in leukemia infection group and leukemia uninfected group were significantly higher than those in control group（26.87±12.43,0.42±0.13ng/ml,and 2.12±0.09mg/l）,and the differences were statistically significant（P〈0.05）.The fluorescence intensity of nCD4 in blood culture positive group was（247.76±76.23）,which was higher than（154.24±54.45）in blood culture negative group,and the difference was statistically significant（P0.05）.The sensitivity of nCD4,PCT and CRP in the diagnosis of leukemia bacterial infection were 91.8%,79.8%,and 82.4%,and the specificity were 79.7%,75.8%,and 77.1%,respectively.The sensitivity and specificity of nCD4 in the diagnosis of leukemia bacterial infection were higher than those of PCT and CRP.CONCLUSION nCD4 can predict leukemia bacterial infection in a certain extent,and can be used as a diagnostic indicator for leukemia patients with bacterial infection.