中性粒细胞CD64指数对播散性非结核分枝杆菌感染诊断价值的评估

Diagnostic value of neutrophil CD64 index in disseminated nontuberculous mycobacteria infection

目的探讨中性粒细胞CD64指数(nCD64)在播散性非结核分枝杆菌(NTM)感染中的诊断价值。方法纳入2020年1月至2021年6月复旦大学附属华山医院NTM感染患者36例,根据患者病史资料和出院诊断分为播散性感染患者和局灶性感染患者,收集并分析治疗开始前nCD64在局灶性感染和播散性感染中的表达情况。统计学分析采用曼-惠特尼U检验,采用受试者操作特征曲线(ROC曲线)分析nCD64对播散性NTM感染的诊断价值。结果36例NTM感染患者中,局灶性感染18例(1例患者为骨髓增生异常综合征,因其白细胞计数少,检测结果有偏差,故后续分析中剔除),播散性感染18例。局灶性感染患者的nCD64为0.72(0.50,1.55),播散性感染患者为13.63(6.77,32.31),差异有统计学意义(U=15.50,P<0.001)。以局灶性感染为对照,播散性NTM感染的ROC曲线下面积为0.9493,以nCD64为3.06作为诊断临界值,播散性NTM感染的灵敏度为88.89%,特异度为100.00%。结论在未有效治疗的NTM感染中,以nCD64为3.06作为诊断临界值,其灵敏度和特异度均较高,具有辅助诊断播散性NTM感染的作用。

Objective To investigate the diagnostic value of neutrophil CD64 index(nCD64)in disseminated nontuberculous mycobacteria(NTM)infection.Methods Thirty-six patients with NTM infection from January 2020 to June 2021 in Huashan Hospital,Fudan University were included.Patients were classified into groups of disseminated infection and focal infection according to their medical history and discharge diagnosis.The expressions of nCD64 in patients with focal infection and disseminated infection before treatment were collected and analyzed.Statistical analysis was performed using the Mann-Whitney U test,and the diagnostic value of nCD64 for disseminated NTM infection was analyzed using the receiver operator characteristic curve(ROC curve).Results Among the 36 patients with NTM infection,18 cases were focal infection(due to the low white blood cell count of the patient with myelodysplastic syndrome,the detection results were biased,which were excluded from the subsequent analysis)and 18 cases were disseminated infection.The expression of nCD64 in focal infection was 0.72(0.50,1.55),and that in disseminated infection was 13.63(6.77,32.31).The difference was statistically significant(U=15.50,P<0.001).Using focal infection as a control,the area under the ROC curve for the operational characteristics of the subjects was 0.9493 for disseminated NTM infection.The diagnostic cut-off value of nCD64 was 3.06,with the sensitivity and specificity of the disseminated NTM infection were 88.89%and 100.00%,respectively.Conclusions In patients with NTM infection before effective treatment,the diagnostic cut-off value of nCD64 of 3.06 has high sensitivity and specificity,which is useful for the aided diagnosis of disseminated NTM infection.