CD_(64)指数联合中性粒细胞绝对值对极低出生体质量儿脓毒血症及坏死性小肠结肠炎的诊断价值研究

Diagnostic Value of CD_(64) Index Combined with Absolute Neutrophil Count for Pyemia and Necrotizing Enterocolitis in Infants with Very Low Birth Weight

目的探讨CD_(64)指数联合中性粒细胞绝对值(ANC)对极低出生体质量儿(VLBW)脓毒血症及坏死性小肠结肠炎(NEC)的诊断价值。方法选取2016-09-01至2017-03-01于云南省第一人民医院新生儿重症监护病房住院的30例VLBW,检测其CD_(64)指数、ANC,进行Logistic回归分析并产生诊断脓毒血症的新变量(ps)和诊断NEC的新变量(p N),采用受试者工作特征(ROC)曲线分析CD_(64)指数、ANC以及ps、p N对脓毒血症和NEC的诊断价值。结果患儿CD_(64)指数为(1.57±0.92),ANC为(1.87±0.82)×10~9/L。CD_(64)指数诊断脓毒血症的ROC曲线下面积(AUC)为0.878[95%CI(0.707,0.968),P<0.001],灵敏度为87.5%,特异度为86.4%,正确率为86.7%,最佳临界值为2.00;ANC诊断脓毒血症的AUC为0.849[95%CI(0.672,0.953),P<0.001],灵敏度为75.0%,特异度为86.4%,正确率为83.3%,最佳临界值为1.17×109/L;ps诊断脓毒血症的AUC为0.943[95%CI(0.793,0.995),P<0.001],灵敏度为100.0%,特异度为86.4%,正确率为90.0%,最佳临界值为0.219 7。CD_(64)指数诊断NEC的AUC为0.968[95%CI(0.830,0.999),P<0.001],灵敏度为100.0%,特异度为80.0%,正确率为83.3%,最佳临界值为2.00;ANC诊断NEC的AUC为0.720[95%CI(0.527,0.868),P=0.045],灵敏度为40.0%,特异度为100.0%,正确率为93.3%,最佳临界值为0.95×109/L;p N诊断NEC的AUC为0.984[95%CI(0.856,0.999),P<0.001],灵敏度为100.0%,特异度为96.0%,正确率为96.7%,最佳临界值为0.240 1。ANC、p N诊断NEC的特异度均高于CD_(64)指数(P<0.05)。结论 CD_(64)指数联合ANC对脓毒血症的诊断具有较高的灵敏度及特异度,可作为诊断脓毒血症的重要指标;CD_(64)指数联合ANC诊断NEC的灵敏度较高,而特异度仅高于CD_(64)指数。

Objective To discuss the diagnostic value of CD64 index combined with absolute neutrophil count(ANC)for pyemia and necrotizing enterocolitis(NEC)in infants with very low birth weight(VLBW).Methods We enrolled 30 infants with VLBW who received treatment in the NICU of the First People's Hospital of Yunnan Province from September 1,2016 to March 1,2017 and measured their CD64 index and ANC.Logistic regression analysis was conducted to produce new variables for diagnosing pyemia(ps)and NEC(pN),respectively.ROC curve was used to analyze the diagnostic value of CD64 index,ANC and ps for pyemia,CD64 index,ANC and pN for NEC.Results The average level of CD64 index was(1.57±0.92),and that of ANC was(1.87±0.82)×109/L for the infants.ROC curve analysis of CD64 index,ANC and ps for the diagnosis of pyemia:the AUC of CD64 index was 0.878〔95%CI(0.707,0.968),P<0.001〕with a sensitivity of 87.5%,specificity of 86.4%and accuracy of 86.7%.When the critical value of CD64 index was 2.00,its corresponding Youden index reached the maximum.The AUC of ANC was 0.849〔95%CI(0.672,0.953),P<0.001〕with a sensitivity of 75.0%,specificity of 86.4%and accuracy of 83.3%.When the critical value of ANC was 1.17×109/L,its corresponding Youden index reached the maximum.The AUC of ps was 0.943〔95%CI(0.793,0.995),P<0.001〕with a sensitivity of 100.0%,specificity of 86.4%and accuracy of 90.0%.When the critical value of ps was 0.219 7,its Youden index reached the maximum.ROC curve analysis of CD64 index,ANC and pN for the diagnosis of NEC:the AUC of CD64 index was 0.968〔95%CI(0.830,0.999),P<0.001〕with a sensitivity of 100.0%,specificity of 80.0%and accuracy of 83.3%.When the critical value of CD64 index was 2.00,its corresponding Youden index reached the maximum.The AUC of ANC was 0.720〔95%CI(0.527,0.868),P=0.045〕with a sensitivity of 40.0%,specificity of 100.0%and accuracy of 93.3%.When the critical value of ANC was 0.95×109/L,its corresponding Youden index reached the maximum.The AUC of pN was 0.984〔95%CI(0.856,0.999),P<0.001〕with a sensitivity of 100.0%,specificity of 96.0%and accuracy of 96.7%.When the critical value of pN was 0.240 1,its corresponding Youden index reached the maximum.ANC and pN had higher specificity for NEC diagnosis than CD64 index(P<0.05).Conclusion CD64 index combined with ANC owns high sensitivity and specificity for the diagnosis of neonatal pyemia,which can be used as an important diagnostic index for neonatal pyemia.CD64 index combined with ANC owns high sensitivity for the diagnosis of NEC,but diagnostic specificity of CD64 index combined with ANC for NEC is higher than that of CD64 index alone.