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目的探讨外周血中性粒细胞CD64表达在新生儿败血症早期诊断中的价值。方法89例疑似败血症患儿,通过临床表现、血培养及5项非特异性指标:白细胞、血小板、血浆C反应蛋白、微量血沉和未成熟中性粒细胞与中性粒细胞总数比值,分为败血症组39例和非败血症感染组50例。另设对照组19例。采用流式细胞仪检测外周血中性粒细胞CD64表达。结果败血症组患儿外周血中性粒细胞CD64表达率为(75.6±8.9)%,显著高于非败血症感染组(29.1±6.2)%和对照组(5.1±1.1)%(P均<0.05),非败血症感染组与对照组比较差异也有统计学意义(P<0.05);革兰阴性菌败血症患儿CD64表达率(79.5±3.5)%高于革兰阳性菌败血症(76.4±4.6)%,但二者差异无统计学意义(P>0.05);败血症组经抗感染治疗后CD64表达水平下降。中性粒细胞CD64对新生儿败血症诊断的敏感性97.4%,特异性84.0%,阳性预测值82.6%,阴性预测值分别为97.6%。CD64检测阳性率62.9%(56/89)高于血培养19.1%(17/89)和5项非特异性指标29.2%(26/89)(P均<0.05)。结论外周血中性粒细胞CD64测定可作为新生儿败血症早期诊断的指标,并可以判断疗效。
Objective To investigate the value of peripheral blood neutrophil CD64 expression in the early diagnosis of neonatal sepsis. Methods Eighty-nine children with suspected septicemia were divided into sepsis through clinical manifestations, blood culture and five nonspecific indexes of white blood cells, platelets, plasma C-reactive protein, micro-erythrocyte sedimentation rate and the ratio of immature neutrophils to total neutrophils Group 39 cases and non-sepsis infection group 50 cases. Another control group of 19 cases. Flow cytometry was used to detect CD64 expression in peripheral blood neutrophils. Results The positive rate of CD64 in neutrophils was (75.6 ± 8.9)% in sepsis group, significantly higher than that in non-sepsis group (29.1 ± 6.2%) and control group (5.1 ± 1.1)% (all P <0.05) (79.5 ± 3.5)% of children with Gram-negative septicemia were significantly higher than those of Gram-positive sepsis (76.4 ± 4.6)%, while those with non-sepsis infection were also significantly different from those of the control group (P0.05) However, there was no significant difference between the two groups (P> 0.05). The expression of CD64 in sepsis group decreased after anti-infective treatment. The sensitivity of neutrophil CD64 to neonatal sepsis diagnosis was 97.4%, specificity 84.0%, positive predictive value 82.6% and negative predictive value 97.6% respectively. The positive rate of CD64 was 62.9% (56/89) higher than that of 19.1% (17/89) of blood culture and 29.2% (26/89) of 5 non-specific indicators (all P <0.05). Conclusion Peripheral blood neutrophil CD64 assay can be used as an indicator of early diagnosis of neonatal sepsis and can determine the efficacy.