中性粒细胞CD64在儿童社区获得性肺炎诊断中的价值

Value of neutrophil CD64 in the diagnosis of community acquired pneumonia in children

摘要:

目的：探讨外周血中性粒细胞CD64的表达在儿童社区获得性肺炎（CAP）诊断中的价值。方法：依据病原体不同将98例社区获得性肺炎患儿分为细菌感染组（48例）、病毒感染组（29例）以及支原体感染组（21例）；另设健康对照组（20例）。细菌感染组依据患儿的入院情况分为轻症感染组（36例）和重症感染组（12例）。采用流式细胞术检测外周血中性粒细胞CD64的表达，同时免疫比浊法检测外周血C反应蛋白（CRP）的水平。结果：治疗前细菌感染组CD64指数和CRP水平显著高于其他3组，差异有统计学意义（P<0.05）。重症组CD64指数和CRP水平较轻症组显著增高，差异有统计学意义（P<0.05）。细菌感染组经过有效的抗菌治疗后，CD64表达水平下降，和治疗前相比差异有统计学意义（P<0.05）。相关分析结果显示CD64指数与CRP呈正相关（r=0.545，P＜0.01）。 ROC曲线分析结果显示CD64、CRP最佳临界值分别为2.8和8 mg/L，CD64指数的特异性（90%）远高于CRP（74%）。结论：外周血中性粒细胞CD64测定有助于肺部细菌感染的早期诊断，并可以判断病情的严重程度及疗效。

Abstract:

OBJECTIVE: To study the clinical value of the expression of neutrophil surface CD64 in the diagnosis of community acquired pneumonia in children. METHODS: Ninety-eight children with community acquired pneumonia were recruited into the study and were classified into three groups according to pathogene: bacterial pneumonia (n=48), viral pneumonia (n=29) and Mycoplasmal pneumonia (n=21). Twenty healthy children were enrolled as controls. The bacterial infection group was subdivided into mild infection (n=36) and severe infection groups (n=12). The levels of peripheral blood neutrophil CD64 were measured using flow cytometry. Dynamic changes of C-reactive protein were also detected for each patient. RESULTS: The CD64 index and CRP levels in the bacterial pneumonia group were significantly higher than in the other three groups (P<0.05). The CD64 index in the severe bacterial infection group was significantly higher than in the mild group (P<0.05). After antibiotic treatment, expression of CD64 in the severe bacterial infection group decreased significantly (P<0.05). The CD64 index was positively correlated with CRP value (r=0.545, P<0.01). ROC curve analysis showed that the threshold of CD64 and CRP was 2.8 and 8 mg/L respectively. Specificity of CD64 index (90%) was much higher than CRP (74%). CONCLUSIONS: The determination of peripheral blood neutrophil CD64 contributes to the early diagnosis of pulmonary bacterial infection and the evaluation of anti-infection effect.