CD64、血清降钙素原及C-反应蛋白在尿源性脓毒血症早期诊断中的意义

Significance of CD64,serum procalcitonin and C-reactive protein in early diagnosis of urinary sepsis

目的探讨CD64、PCT及CRP在尿脓毒血症诊断中的作用,为临床早期诊断提供理论依据。方法收集本院泌尿外科2015年1月-2017年3月收治的尿脓毒血症患者46例,普通尿路感染患者48例,同期健康体检者30例,比较3组研究对象中性粒细胞膜表面CD64表达、血清PCT及CRP含量,并应用ROC确定CD64指数、PCT及CRP单独及联合评价对尿脓毒血症的诊断价值。结果脓毒血症组CD64指数、PCT和CRP均明显高于尿路感染组及对照组,差异均有统计学意义(H值分别为36.35、44.97、29.59,P<0.01)。当以CD64荧光指数5.676为截断值,其曲线下面积为0.956 5,此时CD64荧光指数鉴别尿脓毒血症与普通尿路感染的灵敏度和特异度分别为95.65%和93.33%,其诊断效率均优于血清CRP、PCT单独应用;而当联合应用3项检测指标时,诊断灵敏度为93.48%,特异度为96.67%,在保证灵敏度前提下,特异度有较大提升。结论联合应用CD64指数、PCT和CRP可以提高尿脓毒血症早期诊断的效率,达到早期诊断早期治疗的目的。

Objective To investigate the role of CD64,PCT and CRP in the diagnosis of urinary sepsis,ao as to provide theoretical basis for clinical early diagnosis. Methods 46 patients with urinary sepsis were enrolled in this study during January 2015-March 2017,48 cases with common urinary tract infection and 30 cases of healthy physical examination in the same period were also enrolled. The expression of CD64 in the membrane surface of neutrophils,the content of serum PCT and CRP were compared among the 3 groups. ROC was used to determine the value of single or joint detection of CD64 index,PCT and CRP in the diagnosis of urinary sepsis. Results CD64 index,PCT and CRP of sepsis group were significantly higher than those of urinary tract infection group and control group,and the differences were statistically significant（ H = 36. 35,H = 44. 97,H = 29. 59,P〈0. 01）.When CD64 fluorescence index was 5. 676 for the cut-off value,the area under the curve was 0. 956 5,the sensitivity and specificity of CD64 fluorescence index in detecting urinary sepsis and urinary tract infection were 95. 65% and 93. 33%,respectively.The diagnostic efficiency was better than that of serum CRP and PCT alone. When the combined application of three test indicators,the diagnostic sensitivity was 93. 48%,the specificity was 96. 67%,under the premise of ensuring the sensitivity,the specificity has greatly improved. Conclusion Combined use of CD64 index,PCT and CRP can improve the early diagnosis efficacy of urinary sepsis and achieve the purpose of early diagnosis and early treatment.