外周血中性粒细胞CD64指数对呼吸机相关性肺炎的早期诊断价值  

Significance of neutrophil CD64 index in peripheral blood for early diagnosis of ventilator associated pneumonia

作　　者：魏卿[1] 王昌明[1] 

机构地区：[1]四川省彭州市人民医院,彭州611930

出　　处：《内科急危重症杂志》2017年第1期26-28,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的:观察外周血中性粒细胞CD64指数在呼吸机相关性肺炎(VAP)患者中的表达及探讨早期诊断价值。方法:选择380例行机械通气时间>48 h的患者,根据是否发生VAP将其分为VAP组78例与非VAP组302例;选择同期50例体检者为健康对照组。采用流式细胞术检测外周血中性粒细胞CD64指数,记录临床肺部感染评分(CPIS)情况。分别比较3组患者外周血中性粒细胞CD64指数及C-反应蛋白(CRP)、白细胞计数(WBC)水平的差异以及分析中性粒细胞CD64指数水平与CPIS评分的相关性。结果:与非VAP组和健康对照组比较,VAP组中性粒细胞CD64指数水平显著升高(P<0.05);抗感染治疗3 d、7 d后,VAP组患者外周血中性粒细胞CD64指数、CRP、WBC水平及CPIS评分均较治疗前显著降低(P<0.05);相关性分析显示,外周血中性粒细胞CD64指数与CPIS评分呈正相关(r=0.78,P<0.01)。ROC曲线分析显示,以外周血中性粒细胞CD64指数>5.83为界限时,诊断VAP的敏感性和特异性分别为84.2%和89.8%,ROC曲线下面积(AUC)为0.865(95%CI 0.786~0.903)。结论:VAP患者外周血中性粒细胞CD64指数呈高表达,其可作为早期诊断VAP的有效指标,动态观察其水平变化对于判断感染程度及治疗效果具有一定的临床意义。Objective： To investigate the expression levels and early diagnostic value of neutrophil CD64 index in peripheral blood of patients with ventilator-associated pneumonia（ VAP）. Methods： 380 patients who underwent mechanical ventilation over 48 h were enrolled in the study. According to the occurrence of VAP,these patients were divided into VAP group（ n = 78） and non-VAP group（ n = 302）,and 50 volunteers served as healthy control group. Neutrophil CD64 index in peripheral blood was measured by flow cytometry,C reactive protein（ CRP） and white blood cell count（ WBC） were detected,and CPIS score was analyzed. The neutrophil CD64 index,CRP and WBC were compared among groups,and the correlation between neutrophil CD64 index and CPIS score was analyzed. Results： The neutrophil CD64 index in VAP group was significantly increased as compared with non-VAP group and the healthy control group（ P〈0.05）. After anti-infection treatment for 3 days and 7 days,the neutrophil CD64 index,CRP,WBC and CPIS score were significantly lower than those before treatment（ P〈0. 05）. The correlation analysis showed that the neutrophil CD64 index in peripheral blood and CPIS scores were positively correlated（ r = 0.78,P〈0.01）. The ROC curve analysis revealed that neutrophil CD64 index 5.83 was considered as the boundary for diagnosis of VAP with the sensitivity and specificity of diagnosis being 84.2% and 89.8% respectively,and the area under the ROC curve（ AUC） was 0.865（ 95%CI 0.786-0.903）. Conclusion： The expression of neutrophil CD64 is higher in patients with VAP,which can be used as an effective indicator for early diagnosis of VAP. The dynamic monitoring of neutrophil CD64 index may facilitate the evaluation of the extent of infection and treatment,which has an important clinical significance.

关 键 词：CD64指数 呼吸机相关性肺炎 诊断 临床肺部感染评分 

分 类 号：R563.1[医药卫生—呼吸系统]