血浆CD64 和可溶性髓系细胞触发受体-1在肺炎患儿中的诊断价值

Diagnostic values of plasma CD64 and sTREM-1 for pediatric pneumonia

摘要:

目的探讨血浆CD64、可溶性髓系细胞触发受体-1 （sTREM-1）在肺炎患儿中的诊断价值。方法选取2014年8月至2015年10月住院治疗的肺炎患儿60例，根据临床表现、病原体培养和X线片结果，分为细菌性肺炎组 （n=25）、病毒性肺炎组 （n=17）和支原体肺炎组 （n=18）；另选取同期健康体检儿童30例作为健康对照组。采用酶联免疫吸附试验法 （ELISIA）检测各组儿童血浆CD64和sTREM-1浓度；采用受试者工作特征曲线 （ROC）分析血浆CD64、sTREM-1表达水平对肺炎的诊断价值。结果CD64、sTREM-1在细菌性肺炎患儿中的表达水平均高于病毒性肺炎组、支原体肺炎组和健康对照组 （P<0.05）。CD64、sTREM-1单独以及两种指标联合诊断细菌性肺炎的ROC曲线下面积分别为0.878、0.805、0.956。CD64在临界值为641pg/mL时，其对细菌性肺炎诊断的敏感度为81.30%，特异度为92.32%；sTREM-1在临界值为1479pg/mL时，其对细菌性肺炎诊断的敏感度为78.65%，特异度为84.67%；两项指标联合诊断细菌性肺炎的敏感度为93.15%，特异度为91.54%。结论血浆CD64、sTREM-1可作为儿童细菌性肺炎的诊断指标，二者联合诊断细菌性肺炎的效果更佳。

Abstract:

Objective To determine the diagnostic values of plasma CD64 and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in children with pneumonia. Methods Sixty children with pneumonia between August 2014 and October 2015 were classified into bacterial pneumonia group (25 cases), viral pneumonia group (17 cases), and Mycoplasma pneumonia group (18 cases) according to their clinical manifestations, pathogen cultures, and X-ray findings. Another 30 healthy children who underwent physical examination during the same period were selected as the control group. The concentrations of CD64 and sTREM-1 in blood samples were determined using ELISA. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic sensitivity and specificity of plasma CD64 and/or sTREM-1 for bacterial pneumonia. Results The expression of CD64 and sTREM-1 in the bacterial pneumonia group was significantly higher than that in the viral pneumonia, Mycoplasma pneumonia, and control groups (P<0.05). The areas under the ROC curves of CD64, sTREM-1, and a combination of the two markers for diagnosing bacterial pneumonia were 0.878, 0.805, and 0.956, respectively. The sensitivity and specificity of CD64 for diagnosing bacterial pneumonia were 81.30% and 92.32%, respectively, when the cut-off value was 641 pg/mL. The sensitivity and specificity of sTREM-1 for diagnosing bacterial pneumonia were 78.65% and 84.67%, respectively, when the cut-off value was 1 479 pg/mL. The sensitivity and specificity of a combination of the two markers for diagnosing bacterial pneumonia were 93.15% and 91.54%, respectively. Conclusions Plasma CD64 and sTREM-1 can be used as markers for diagnosing pediatric bacterial pneumonia, and a combination of the two markers results in better diagnosis.