CD64指数 降钙素原和血清淀粉样蛋白A在学龄前儿童早期细菌感染性腹泻中的临床应用价值

Analyzed of the clinical application value of CD64 index procalcitonin and serum amyloid A in preschool children with early bacterial infectious diarrhea

目的探讨外周血中性粒细胞CD64指数、降钙素原(PCT)和血清淀粉样蛋白A(SAA)在学龄前儿童早期细菌感染性腹泻中的临床应用价值。方法选取2015年7月至2016年10月就诊于福建省泉州市儿童医院的203例学龄前腹泻患儿,依据感染的病原体不同分为细菌性腹泻组(97例)、病毒性腹泻组(106例),选取同期健康体检儿童作为对照组(60名)。采用流式细胞术检测CD64指数,酶联免疫荧光法(ELFA)和胶体金法测定PCT和SAA水平,比较分析各组患儿3项指标水平变化及对细菌性腹泻的诊断效率。结果细菌性腹泻组治疗前CD64、PCT和SAA水平显著高于病毒性腹泻组及健康对照组(P<0.05),治疗前后三者水平差异有统计学意义(P<0.05),诊断细菌性腹泻CD64和PCT的阳性率、敏感度、特异度、阳性预测值和阴性预测值均>90.0%,SAA的阳性率、敏感度和阴性预测值>90.0%,但特异度和阳性预测值欠佳,分别为75.5%和78.5%。细菌性腹泻治疗前CD64与PCT水平呈正相关(r=0.796,P<0.01)。结论联合检测CD64、PCT和SAA对学龄前儿童细菌性腹泻的早期诊断、病情监测、预后判断和疗效评价具有一定的临床应用价值。

Objective To investigate the clinical value of peripheral blood neutrophil CD64 index, procalcitonin （PCT） and serum amyloid A （SAA） in preschool children with early bacterial infectious diarrhea. Methods Two hundred and three cases of preschool children with diarrhea in children＇s hospital of Quanzhou were selected, from July 2015 to October 2016, according to the pathogen of infection, groups were divided into the bacterial diarrhea group （97 cases） and viral diarrhea group （106 cases）, healthy children were selected as control group （60 cases）. Flow cytometry was used to detect the CD64 index, enzyme linked immunosorbent assay （ELFA） and colloidal gold assay for the determination of PCT and SAA levels, to compare and analyze the changes of 3 indexes in each group and the diagnostic efficiency of bacterial diarrhea. Results The levels of CD64, PCT and SAA in the treatment of bacterial diarrhea group were significantly higher than those in viral diarrhea group and healthy control group （P〈0.05）, the difference of the three levels before and after treatment was significant （P〈0.05）, the positive rate, sensitivity, specificity, positive predictive value and negative predictive value of CD64 and PCT in the diagnosis of bacterial diarrhea were all 〉90.0% ; positive rate,sensitivity and negative predictive value of SAA 〉90.0% ,but the specificity and positive predictive value were not very well, respectively 75.5% and 78.5%. Before treatment, the levels of CD64 and PCT were positively correlated with bacterial diarrhea （r=-0.796,P〈0.01）. Conclusion Combined detection of CD64, PCT and SAA in the early diagnosis of bacterial diarrhea in preschool children with the early diagnosis, has certain clinical application value to disease monitoring, prognosis judgment and evaluation of curative effect.