中性粒细胞膜碱性磷酸酶对革兰阴性菌和阳性菌血流感染的诊断价值  

Diagnostic value of alkaline phosphatase on the surface membrane of neutrophils in bloodstream infections of Gram-negative and Gram-positive bacteria

作　　者：赵雯[1] 汪海清[2] 王娜[1] 黄廷廷 胡明 王加平[1] ZHAO Wen;WANG Haiqing;WANG Na;HUANG Tingting;HU Ming;WANG Jiaping(Department of Clinical Laboratory,Donghai People′s Hospital,Donghai 223000,Jiangsu;Department of Clinical Laboratory,the First People′s Hospital of Lianyungang City,Lianyungang 222002,Jiangsu,China)

机构地区：[1]东海县人民医院检验科,江苏东海223000 [2]连云港市第一人民医院检验科,江苏连云港222002

出　　处：《临床检验杂志》2024年第11期877-880,共4页Chinese Journal of Clinical Laboratory Science

基　　金：连云港市社会发展项目重点研发计划资助(SF2350)。

摘　　要：目的探讨中性粒细胞膜碱性磷酸酶(alkaline phosphatase on the surface membrane of neutrophils,mNAP)对革兰阴性菌(GNB)和革兰阳性菌(GPB)血流感染(bloodstream infection,BSI)的临床诊断价值。方法收集2022年1月至2023年12月东海县人民医院诊断为BSI的患者418例作为研究对象,根据血培养阳性细菌革兰染色结果,进一步分为GNB感染患者329例和GPB感染患者89例。另选择同期住院的全身炎症反应综合征患者(SIRS)35例作为疾病对照组。收集3组患者的临床资料及常规实验室检查结果,并采集3组患者的静脉血标本,采用流式细胞仪检测各组mNAP的表达水平。采用ROC曲线评估mNAP对GNB和GPB发生BSI的鉴别诊断效能。结果GPB、GNB感染组和SIRS组mNAP的表达水平分别为9588(5677,11343)AB/C,16616(11853,22035)AB/C和5738(2613,9178)AB/C,3组间差异有统计学意义(H=43.95,P<0.0001);进一步行组间两两比较发现,GNB感染组显著高于GPB感染组(U=203.0,P<0.0001)和SIRS组(U=445.0,P<0.0001),且GPB感染组显著高于SIRS组(U=583.0,P<0.0001)。ROC曲线评估mNAP对GNB发生BSI的AUC ROC为0.91(95%CI:0.85~0.96),当cut-off值为10820 AB/C时,其敏感性为80.00%,特异性为88.57%;ROC曲线评估mNAP对GPB发生BSI的AUC ROC为0.69(95%CI:0.55~0.83),当cut-off值为10859 AB/C时,其敏感性为33.00%,特异性为88.13%。结论mNAP对GNB发生BSI的鉴别诊断效能明显高于GPB,或可成为区分GNB和GPB发生BSI的新型生物学标志物。Objective To explore the diagnostic value of alkaline phosphatase on the surface membrane of neutrophils(mNAP)in bloodstream infections(BSI)of Gram-negative bacteria(GNB)and Gram-positive bacteria(GPB).Methods A total of 418 patients diagnosed with BSI at Donghai People′s Hospital from January 2022 to December 2023 were enrolled in the study.Based on the results of Gram staining from positive blood cultures,the patients were divided into GNB bacteremia(n=329)and GPB bacteremia(n=89).Additionally,35 hospitalized patients with systemic inflammatory response syndrome(SIRS)during the same period were selected as the control group.Their clinical data,routine laboratory test results,blood cultures and venous blood samples were collected,and the expression levels of mNAP were detected by flow cytometry.The receiver operating characteristics(ROC)curve was used to evaluate the diagnostic performance of mNAP for BSI of GNB and GPB.Results The expression levels of mNAP in the GPB infection,GNB infection and SIRS groups were 9588(5677,11343)AB/C,16616(11853,22035)AB/C,and 5738(2613,9178)AB/C,respectively,and the difference among them was statistically significant(H=43.95,P<0.0001).Further pairwise comparisons showed that the expression levels of mNAP in the GNB infection group were significantly higher than those in the GPB infection group(U=203.0,P<0.0001)and the SIRS group(U=445.0,P<0.0001).Meanwhile,the expression levels of mNAP in the GPB infection group were significantly higher than that in the SIRS group(U=583.0,P<0.0001).The area under the ROC curve(AUC ROC)of mNAP for predicting the BSI of GNB was 0.91(95%CI:0.85-0.96).When the cut-off value was 10820 AB/C,its sensitivity and specificity were 80.00%and 88.57%,respectively.The AUC ROC of mNAP for predicting the BSI of GPB was 0.69(95%CI:0.55-0.83).When the cut-off value was 10859 AB/C,its sensitivity and specificity were 33.00%and 88.13%,respectively.Conclusion The diagnostic efficiency of mNAP for the BSI of GNB is significantly higher than that for the BSI of GPB

关 键 词：中性粒细胞膜碱性磷酸酶 血流感染 革兰阴性菌 革兰阳性菌 诊断 

分 类 号：R446[医药卫生—诊断学]