目的:研究外周血中性粒细胞CD64指数(nCD64IND)、单核细胞CD14指数(mCD14IND)和白细胞介素6(IL-6)水平在成人肺部感染中的诊断价值。方法:选择2020年12月至2021年2月在福建医科大学附属漳州市医院呼吸科住院的成人肺部感染患者63例作为研究组,47例健康成人作为对照组;应用流式细胞术测定外周血中nCD64IND、mCD14IND和IL-6水平;用Pearson法分析三者与肺部感染常用指标CRP、PCT的相关性;通过绘制ROC曲线评估三者对肺部感染诊断的敏感度和特异度。结果:成人肺部感染患者外周血nCD64IND、mCD14IND和IL-6水平明显高于健康对照组(均P<0.05);相关性分析显示,患者外周血nCD64IND、IL-6水平与CRP呈正相关,mCD14IND与CRP呈负相关,三者与PCT相关性均不显著;ROC曲线分析显示,nCD64IND、mCD14IND、IL-6水平在肺部感染诊断中的敏感度分别是81 %、58.7 %、84.1 %,特异度分别是89.4 %、78.7 %、89.4 %。结论:外周血nCD64IND、mCD14IND和IL-6水平测定对肺部感染具有一定诊断价值。
Objective: To investigate the diagnostic value of peripheral blood neutrophil CD64 index (nCD64IND), monocyte CD14 index (mCD14IND) and interleukin 6 (IL-6) levels in adult pulmonary infection. Methods: A total of 63 adult patients with pulmonary infection hospitalized from December 2020 to February 2021 were selected as the study group and 47 healthy adults as the control group. The levels of nCD64IND, mCD14IND and IL-6 in peripheral blood were determined by flow cytometry. Pearson's method was used to analyze the correlation between the three indices and the common indicators of pulmonary infection, such as CRP and PCT. The ROC curve was drawn to evaluate the sensitivity and specificity of the three indices in the diagnosis of pulmonary infection. Results: The levels of nCD64IND, mCD14IND and IL-6 in peripheral blood of adult patients with pulmonary infection were significantly higher than those of healthy control group (all P<0.05). Correlation analysis showed that the levels of nCD64IND and IL-6 in peripheral blood of patients were positively correlated with CRP, mCD14IND was negatively correlated with CRP, and the three indices were not significantly correlated with PCT. ROC curve analysis showed that the sensitivity of nCD64IND, mCD14IND and IL-6 levels in the diagnosis of lung infection was 81 %, 58.7 % and 84.1 %, respectively, and the specificity was 89.4 %, 78.7 % and 89.4 %, respectively. Conclusion: The determination of nCD64IND, mCD14IND and IL-6 in peripheral blood has certain diagnostic value for pulmonary infection.
[1] 杨旭燕,林进,厉有名. 系统性红斑狼疮患者外周血中性粒细胞CD64的表达[J].中华内科杂志,2003,42(12): 854-856.
[2] 秦婷婷,赵建美. 中性粒细胞CD64在肺部感染诊断中的研究进展[J].交通医学,2020,34(3): 258-261,267.
[3] 卢仁辉,陈婉婷,孙晓丽,等. 肺部感染急性加重期慢性阻塞性肺疾病患者血清C-反应蛋白和降钙素原及CD64感染指数变化研究[J].中华医院感染学杂志,2017,27(7): 1514-1517.
[4] 宋中海. 血清降钙素原联合T淋巴细胞亚群及中性粒细胞CD64检测对脓毒症患者病情程度与预后评估价值的临床研究[D].石家庄:河北医科大学,2017.
[5] Yo CH, Hsieh PS, Lee SH, et al. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: a systematic review and meta-analysis[J].Ann Emerg Med,2012,60(5): 591-600.
[6] 齐曼,夏成青,李文雄,等. 外周血单核细胞膜CD14表达预测脓毒症患者预后的研究[J].中华临床医师杂志(电子版),2012,6(8): 1993-1997.
[7] 马劲夫,张纪元,周银苹,等. 脓毒症患者CD14+CD16+单核细胞的作用探讨[J].中国急救复苏与灾害医学杂志,2013(8): 717-720.
[8] 王雅宁,崔立业,陶越安. IL-6、PCT、CRP对老年肺部感染患者预后评价的价值及最佳截断值分析[J].解放军医药杂志,2020,32(8): 53-56,69.
[9] 张立营,陈朴,唐灵通,等. 降钙素原、白细胞介素-6和CD64指数在小儿肺部细菌性感染诊断中的价值[J].实用医院临床杂志,2016,13(4):177-179.