中性粒细胞粘附分子CD_(11b)表达对新生儿败血症早期诊断价值的研究  

Expression of neutrophil adhesion molecule CD_ (11b)as an early diagnostic marker for neonatal sepsis

作　　者：崔英波[1] 杜立中[2] 陈意振[1] 郁玉波[1] 王凤敏[1] 毛倩倩[1] 

机构地区：[1]浙江省宁波市妇女儿童医院重症监护病房,315012 [2]浙江大学医学院附属儿童医院新生儿科

出　　处：《中华儿科杂志》2003年第5期348-351,共4页Chinese Journal of Pediatrics

摘　　要：目的　观察新生儿败血症中性粒细胞粘附分子CD11b表达的规律 ,并评价其在新生儿败血症早期诊断中的价值。方法　将 5 1例临床疑似败血症的新生儿根据其临床表现及WBC、PLT、血浆CRP和未成熟中性粒细胞数与中性粒细胞总数比值 (I/T)四项指标 ,分为败血症和可疑败血症两组。采用全血流式细胞术检测患儿和 15例正常对照组新生儿中性粒细胞CD11b的平均荧光强度 (MFI)。结果　败血症组 2 3例 ,可疑败血症组 2 8例。两组中性粒细胞CD11b分别为 (32 0± 189)、(4 5 6± 2 13)MFI,均显著低于正常对照组的 (10 90± 338)MFI(t分别为 - 9 0 1、- 7 5 6 ,P均 <0 0 0 1) ,败血症组又低于可疑败血症组 ,差异有显著性 (t=- 2 39,P <0 0 5 )。高CRP组患儿CD11b为 (2 11± 16 4 )MFI,低于低CRP组的 (5 0 5± 2 6 5 )MFI,差异有显著性 (t=2 6 4 ,P <0 0 5 )。中性粒细胞CD11b≤ 6 0 0MFI对疑似败血症新生儿诊断的敏感性、特异性、阳性和阴性预测值分别为 86 3%、10 0 %、10 0 %、6 8 2 % ,CD11b检测阳性率为 86 3% ,高于血培养的阳性率 (17 6 % ) ,差异有显著性 (χ2 m=31 2 ,P <0 0 5 )。结论　新生儿败血症中性粒细胞粘附分子CD11b表达下调 ,其下调与感染严重程度有一定关系。中性粒细胞CD11b的动态检测对早期?Objective Neonatal sepsis is a common disease and the sepsis-related mortality rate is still high. Until now, there has no ideal diagnostic marker to early identify neonatal sepsis. Expression of neutrophil adhesion molecule CD 11b was showed as the earlier reaction to the infection/inflammation, and may be applied as an early diagnostic marker for sepsis. This study was to investigate this antigen for early diagnosis of neonatal sepsis related to bacterial infection. Methods According to clinical symptoms, signs and four indices (WBC, PLT, plasma CRP and ratio of I/T), fifty-one neonates with established or suspected sepsis were allocated retrospectively into two groups of sepsis [n=23, gestational age of (38.3±2.4)weeks, postnatal age of (12.7±8.8)days, body weight: (3.1±0.8) kg]and suspected sepsis[n=28, gestational age of (38.8±1.6)weeks, postnatal age of(11.7±7.3)days, body weight:(3.3±0.6)kg]. Fifteen healthy neonates were served as controls[gestational age:(38.5±1.4)weeks, postnatal age:(8.2±5.5)days, body weight:(3.3±0.3)kg]. CD 11b was quantified with the whole blood flow cytometry and direct immunofluorescence technique. Results The expressions of neutrophil CD 11b in neonates with sepsis and suspected sepsis were (320±189)MFI and (456±213)MFI, respectively, which was lower than that of controls [(1 090±338)MFI, t=-9.01 and -7.56, respectively; P<0.001]. The expression of CD 11b was lower in neonates with sepsis than that with suspected sepsis(t= -2.39,P<0.05). The expression of CD 11b in neonates with CRP≥30 mg/L was(211±164)MFI, which was lower than those with CRP<30 mg/L[(505±265)MFI, t=2.64, P<0.05]. The detection of CD 11b (≤600 MFI) for suspected sepsis showed a sensitivity of 86.3%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 68.2%. The positive rate of CD 11b detection was 86.3%, which was higher than the blood culture test (17.6% , χ 2 m=31.2,P<0.05). Conclusion The expression of CD 11b in neon

关 键 词：中性粒细胞粘附分子 CD11B 新生儿败血症 早期诊断 流式细胞术 感染 炎症反应 

分 类 号：R722.1[医药卫生—儿科]