改良中性粒细胞CD64指数鉴别诊断感染的临床应用效能  

Diagnostic efficacy of different neutrophils CD64 index in differential diagnosis of infection

作　　者：高雪丹 蔡宜含 冯伟华[1] 李壹[1] 罗俐梅[1] 王兰兰[1] 蔡蓓[1] GAO Xuedan;CAI Yihan;FENG Weihua;LI Yi;LUO Limei;WANG Lanlan;CAI Bei(Department of Laboratory Medicine,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院实验医学科,成都610041

出　　处：《实用医学杂志》2021年第11期1418-1422,1427,共6页The Journal of Practical Medicine

基　　金：国家自然基金项目(编号:81702002)。

摘　　要：目的探讨改良中性粒细胞CD64(nCD64)指数与传统nCD64指数鉴别诊断感染的临床应用效能差异。方法纳入自身免疫性疾病(AID)患者32例、血液肿瘤患者32例、急诊发热患者59例及健康体检者41例。所有患者中确诊感染者76例,非感染者47例。采用流式细胞术检测外周血淋巴细胞、单核细胞和中性粒细胞的CD64荧光强度,计算改良nCD64指数和传统nCD64指数并比较两种指数对感染的鉴别诊断效能。结果感染患者的改良nCD64指数和传统nCD64指数均显著高于非感染患者及健康体检者(均P<0.05);两种指数鉴别感染的AUC分别为0.782和0.770(均P<0.05),最佳临界值分别为1.00和4.74。传统指数仅在AID中具有较好的诊断效能(AUC=0.887,P<0.05),改良指数在三类患者中均有较好的诊断效能(AUC均>0.75,P<0.05)。结论两种nCD64指数对感染的鉴别诊断均有一定的临床价值,且二者在自身免疫性疾病中诊断价值最高,改良nCD64指数较传统nCD64指数在急诊发热患者和血液肿瘤中有更高的诊断效能。Objective To explore the difference of clinical significance of modified neutrophil CD64(nCD64)index and traditional nCD64 index in diagnosing infection.Methods We include 32 patients with auto⁃immune diseases(AID),32 patients with hematologic tumors,59 patients in the emergency department and 41 healthy cases.Among which 76 were diagnosed with infection and 47 were non⁃infected.Fluorescence intensity of CD64 on the peripheral blood lymphocytes,monocytes and neutrophils was detected by flow cytometry.The modi⁃fied nCD64 index and the traditional nCD64 index were calculated and were used to make a ROC analysis.Results The modified nCD64 index and the traditional nCD64 index in infected patients were significantly higher than those in non⁃infected patients and healthy control(all P<0.05).The AUCs of modified nCD64 indexes and traditional nCD64 index were 0.782 and 0.770,respectively(all P<0.05),and their optimal cut⁃off values were 1.00 and 4.74,respectively.The traditional nCD64 index only had good diagnostic efficacy in AID patients(AUC=0.887,P<0.05).The modified index had preferable diagnostic efficacy in all three diseases(all AUCs>0.75,P<0.05).Conclusion Both modified nCD64 index and the traditional nCD64 index have potential diagnostic efficacy in the differential diagnosis of infection,and their diagnostic values are best in AID.The modified nCD64 index is more valuable in auxiliary diagnosing infection in patients with fever symptom from emergency department or patients with hematological malignancies than the traditional nCD64 index.

关 键 词：感染 中性粒细胞CD64指数 自身免疫性疾病 血液肿瘤 

分 类 号：R446.6[医药卫生—诊断学]