中性粒细胞碱性磷酸酶在急性脑出血患者并发感染中的诊断价值

Detection of membrane neutrophil alkaline phosphatase in diagnosis of infection in patients with acute cerebral hemorrhage

目的探讨中性粒细胞碱性磷酸酶（NAP）在急性脑出血患者合并感染中的应用价值。方法收集2010年1月至2016年7月在南通大学第二附属医院住院的208例急性脑出血患者，按照有无并发感染分为感染组（56例）和无感染组（152例），另外收集30名正常体检者作为健康对照组。收集所有受试者的外周血，检测白细胞（WBC）、中性粒细胞、降钙素原（PCT）和中性粒细胞碱性磷酸酶（NAP）的水平，采用受试者工作特征（ROC）曲线评价NAP、PCT、WBC和中性粒细胞诊断急性脑出血患者并发感染的价值。组间差异的比较用方差分析或t检验，相关性分析采用Pearson检验。结果脑出血感染组和无感染组WBC、中性粒细胞百分比和NAP在入院时的表达均高于健康对照组，差异具有统计学意义（F＝117.64、100.69和425.09，P值均〈0.01）。感染组WBC、PCT和NAP的表达在感染期要高于入院时的水平（t＝3.14、34.30和36.39，P〈0.01），且NAP的表达与PCT呈正相关（r＝0.762, P〈0.05）。NAP和PCT在诊断感染时的ROC曲线下面积分别为0.875和0.884，在取临界值10655.28 AB/c和5.01 mg/L时，敏感性为85.50%和87.66%，特异性为90.50%和90.31%。不同菌群感染中，革兰阳性球菌患者NAP的表达要高于革兰阴性杆菌感染者（t＝6.29，P〈0.01）。结论急性脑出血患者并发感染时NAP的表达显著升高，对临床诊治细菌感染有一定帮助。

Objective To evaluate the detection of membrane neutrophil alkaline phosphatase （NAP） in diagnosis of infection in patients with acute cerebral hemorrhage. Methods A total of 208 patients with acute cerebral hemorrhage, including 152 cases without infection （uninfected group） and 56 cases with infection （ infected group ） , admitted in the Second Affiliated Hospital of Nantong University during January 2010 to July 2016 were enrolled ,30 healthy subjects were also enrolled in the study as control group. The peripheral blood from all subjects were collected, and the counts of white blood cell （ WBC ） , percentage of neutrophil, serum procalcitonin （PCT） and NAP were measured. The value of above 4 indicators in diagnosing infection was determined by receiver operating characteristic （ROC） curves. ANOVA and t test were used to analyze the data, Pearson correlation was performed to analyze the correlation between NAP and PCT in infected group. Results The levels of WBC, percentage of neutrophil and NAP in both infected and uninfected group were higher than those in healthy control group at admission（ F = 117.64,100.69 and 425.09,all P 〈0.01）, and the levels of WBC, PCT and NAP were also higher when infection occurred compared with those at admission in infected group （t =3.14, 34.30 and 36.39,all P 〈0.01 ） . The expression of NAP was positively correlated with PCT in infected group （ r = 0. 762, P 〈 0. 05 ）. ROC curve analysis showed that the areas under the curves of NAP and PCT in diagnosis of infection were 0. 875 and 0. 884, respectively. When 10655. 28 AB/c and 5. 01mg/L were taken as cut-off values, the sensitivities of NAP and PCT in diagnosis of infection were 85.50% and 87.66% ; the specificities were 90. 50% 和 90. 31%, respectively. The level of NAP in infected patients with gram-positive bacterial infections was higher than that in patients with gram-negative bacterial infections （ t = 6.29, P 〈 0.01 ）. Conclusion The expression of NAP in patients with acute cerebral hemorrhage increases when infection occurs, which may be helpful to the clinical diagnosis of bacterial infection.