中性粒细胞CD64指数联合降钙素原和超敏C反应蛋白对新生儿宫内细菌感染的诊断价值

Diagnostic value of neutrophil CD64 index combined with procalcitonin and hypersensitive C-reactive protein in neonatal intrauterine bacterial infection

目的探讨中性粒细胞CD64指数联合降钙素原(PCT)、超敏C反应蛋白(hs-CRP)对新生儿宫内细菌感染的诊断价值。方法选取2017年8月至2018年8月海口市妇幼保健院新生儿科收治的有宫内细菌感染高危因素的新生儿共138例作为研究对象,根据感染结局分为感染组(28例)和非感染组(110例),采用流式细胞术检测中性粒细胞CD64指数,采用免疫荧光快速定量检测血清PCT和hs-CRP水平;观察两组患者中性粒细胞CD64指数、PCT、hs-CRP表达,并采用受试者工作特征曲线(ROC曲线)分析联合检测对新生儿宫内细菌感染的诊断价值。结果感染组患儿中性粒细胞CD64指数[(0.89±0.25)%]、PCT[(2.24±0.53)ng/ml]和hs-CRP水平[(21.25±2.37)mg/L]均显著高于非感染组新生儿[CD64指数:(0.26±0.08)%、PCT:(0.42±0.09)ng/ml、hs-CRP:(6.37±1.33)mg/L],差异均有统计学意义(t=22.475、P<0.001,t=34.459、P<0.001,t=44.171、P<0.001);ROC曲线分析显示,CD64指数+PCT+hs-CRP联合检测曲线下面积为0.897,敏感性为85.71%、特异性为92.73%、准确度为91.30%,高于两指标联合检测及单独指标检测;且3指标联合检测误诊率(7.27%)和漏诊率(14.29%)也较低。结论中性粒细胞CD64指数和PCT可作为新生儿宫内细菌感染早期诊断检测指标,而CD64指数、PCT和hs-CRP三者联合检测可显著提高诊断的敏感性、特异性和准确度。

Objective To investigate the diagnostic value of neutrophil CD64 index combined with procalcitonin(PCT)and hypersensitive C-reactive protein(hs-CRP)in neonatal intrauterine bacterial infection.Methods Total of 138 neonates with high risk factors of intrauterine bacterial infection in Department of Neonatology,Haikou Maternal and Child Health Hospital from August 2017 to August 2018 were selected,according to the infection outcomes,138 neonates were divided into infection group(28 cases)and non-infection group(110 case),CD64 index of neutrophils was measured by flow cytometry,the levels of serum PCT and hs-CRP were detected by immunofluorescence assay.CD64 index,expressions of PCT and hs-CRP in neutrophils of the two groups were observed,respectively;the diagnostic value of combined detection for neonatal intrauterine bacterial infection was also analyzed by receiver operating characteristic curve(ROC curve).Results CD64 index[(0.89±0.25)%],PCT[(2.24±0.53)ng/ml]and hs-CRP[(21.25±2.37)mg/L]of neutrophils in the infection group were significantly higher than those in the non-infection group[CD64:(0.26±0.08)%,PCT:(0.42±0.09)ng/ml,hs-CRP:(6.37±1.33)mg/L],with significant differences(t=22.475,P<0.001;t=34.459,P<0.001;t=44.171,P<0.001).ROC curve analysis showed that the area under CD64 index+PCT+hs-CRP combined detection curve was 0.897,with the sensitivity for 85.71%,specificity for 92.73%,accuracy for 91.30%,which were higher than that of the two indicators combined detection and single indicator detection,and the misdiagnosis rate of the three indicators combined detection was 7.27%and the missed diagnosis rate was 14.29%.Conclusions Neutrophil CD64 index and PCT could be taken as early diagnostic indexes for neonatal intrauterine bacterial infection,the combined detection of CD64 index,PCT,and hs-CRP could significantly improve the sensitivity,specificity and accuracy of diagnosis.