CD64指数、sTREM-1、CD54水平对社区获得性肺炎患儿病情评估的价值

The value of CD64 index, sTREM-1 and CD54 levels in the assessment of children with community acquired pneumonia

目的分析CD64指数、可溶性髓系细胞触发受体1(soluble myeloid cells trigger receptor-1,s TREM-1)、CD54水平对社区获得性肺炎(community acquired pneumonia,CAP)患儿诊断及治疗的指导意义。方法选取2014年5月至2016年5月于本院诊断并治疗的377例CAP患儿为研究对象。将入选患儿按照感染病原体类型分为细菌组、支原体组及病毒组,将细菌组患儿按病情轻重分为轻症组和重症组。选取同期30例健康体检儿童纳入对照组。分别于所有患儿入院后第1天及健康体检儿童体检当日,采用酶联免疫吸附测定检测其血清s TREM-1和CD54水平,采用流式细胞术测定血清CD64指数。结果与对照组相比,细菌组患儿CD64指数和血清s TREM-1水平均显著升高(P<0.05);支原体组患儿CD64指数显著升高(P<0.05);所有CAP患儿血清CD54水平均显著高于对照组(P<0.05),其中病毒组升高最显著,与细菌组和支原体组相比均有显著差异(t=26.451,P=0.024;t=28.302,P=0.022)。持续监测结果显示,随着CAP患儿病情的好转,其血清CD64指数、s TREM-1及CD54水平均显著降低,与治疗前相比均有显著差异(P<0.05)。细菌感染患儿中,重症组CD64指数、s TREM-1、CD54水平均显著高于轻症组(P<0.05)。结论 CD64指数、s TREM-1及CD54水平能够为CAP患儿的鉴别诊断和病情评估提供指导,为临床合理用药提供参考依据。

ObjectiveTo study the significance of CD64 index, soluble myeloid cells trigger receptor-1 （sTREM-1） and CD54 levels in the diagnosis and treatment of children with community acquired pneumonia （CAP）. Method377 cases of CAP children diagnosed and treated in our hospital from May 2014 to May 2016 were selected as the subjects. According to the type of infection pathogen, they were divided into bacteria-infected group, mycoplasma-infected group and virus-infected group. The bacteria-infected group was divided into mild group and severe group according to the severity of the disease. 30 healthy children during the same period were selected as control group. STREM-1 level, CD54 level and CD64 index of the selected CAP children were detected the first day after admission, respectively, those indexs of health checkup children were detected on physical examination day. ResultThe CD64 index and sTREM-1 level of bacteria-infected group were significantly increased in comparison with control group （P 〈0.05）. In the mycoplasma-infected group, the CD64 index significantly increased （P 〈 0.05）. CD54 levels increased in all of the three infection groups but was more significant in the virus-infected group （P 〈 0.05）. There were significant differences compared with the bacteria-infected group and the mycoplasma-infected group （t = 26.451, P = 0.024; t = 28.302, P = 0.022）. According to the results of consecutive detection, CD64 index, sTREM-1, CD54 levels declined in accordance with the alleviation of the disease （P〈 0.05）. On the other side, CD64 index, sTREM-1, CD54 levels were significantly higher in mild group than severe group （P〈0.05）. Conclusion The level of CD64 index, sTREM-1 and CD54 can provide guidance for the differential diagnosis and disease evaluation of children with CAP, and provide reference for clinical rational use of drugs.