SLE患者外周血中性粒细胞CD64指数在鉴别并发细菌感染与疾病活动期的临床价值

Clinical Value of Peripheral Blood Neutrophil CD64 Index in Identifying SLE Complicated with Bacterial Infection and Active SLE

目的探讨中性粒细胞CD64表达在鉴别系统性红斑狼疮(systemic lupus erythematosus,SLE)并发细菌感染与SLE活动期的临床价值。方法随机选取2017年1~5月期间南京总医院就诊的健康体检者30例,SLE患者34例[其中SLE疾病并发细菌感染组12例(其中并发肺炎3例,其他部位细菌感染9例),按SLE疾病活动指数(systemic lupus erythematosus disease activity-index,SLE-DAI)分为SLE活动组12例(SLE-DAI≥9分)和SLE稳定期组10例(SLE-DAI<9分)]。各组分别进行血细胞计数,C反应蛋白(CRP)和红细胞沉降率(ESR)的检测;用流式细胞术检测外周血中性粒细胞CD64的平均荧光强度(mean fluorescence intensity,MFI),并计算出CD64指数(CD64I)及最佳临界值。筛选出诊断SLE并发细菌感染的差异指标,绘制受试者工作特征曲线(receiver operating characteristic,ROC),对CD64I联合其他指标判断SLE并发细菌感染的敏感度及特异度进行比较。结果 SLE并发细菌感染组CD64I(0.47±0.40)明显高于SLE活动期组(0.17±0.13)、稳定期组(0.14±0.09)及健康对照组(0.12±0.64)(均P<0.05);ROC曲线分析结果显示:CD64I判断SLE并发细菌感染的敏感度及特异度分别为81.8%和80.0%。结论与3个炎性指标相比,中性粒细胞CD64I对判断SLE并发细菌感染具有更高的准确度,有望用于SLE活动期患者与并发细菌感染者的鉴别。

Objective To investigate the clinical value of neutrophil CD64 expression in the differential diagnosis of systemic lupus erythematosus （SLE） and combined bacterial infection. Methods According to the SLE disease activity index （SLE- DAD ,12 patients （SLE-DAI≥9） and 10 patients with stable SLE （SLE-DAI〈9） were divided into SLE activity group. 12 cases of SLE complicated bacterial infection and 30 cases of healthy control were followed-up from Nanjing General Hospital during the period from January to May 2017. Each group was tested for WBC,C-reactive protein （CRP） and erythrocyte sed imentation rate （ESR）. The mean fluorescence intensity （MFI） of neutrophils CD64 was measured by flow cytometry. The CD64 index （CD64 I） and the optimal cut off value were calculated. The sensitivity and specificity of the CD64 I combined with other indicators in the differential diagnosis of SLE infection were compared by mapping the receiver operating charac teristic （ROC） curve. Results The CD64 I （0.47±0.40） in SLE combined bacterial infection group was significantly higher than that in active group （0.17±0.13）,stable group （0.14±0.09） and healthy control group （0.12±0.64） （P〈0.05）. The sensitivity and the specificity of CD64 index was 81.8% and 80.0% ,respectively. Conclusion Compared with the three inflammatory indexes,the CD64 I of neutrophils had higher accuracy in the diagnosis of SLE complicated bacterial infection, which can be used as the differential diagnosis marker both active and complicated infection SLE.