外周血CD64指数对呼吸机相关性肺炎的早期诊断价值
Significance of CD64 index for early diagnosis of ventilator associated pneumonia

魏卿,王昌明.外周血CD64指数对呼吸机相关性肺炎的早期诊断价值[J].内科急危重症杂志,2017,23(1):

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英文关键词:CD64 index Ventilator-associated pneumonia Diagnosis Clinical pulmonary infection score

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作者	单位	E-mail
魏卿	四川省彭州市人民医院	weiqing060608@163.com
王昌明	四川省彭州市人民医院

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中文摘要:

目的：探讨外周血CD64指数在呼吸机相关性肺炎(VAP)患者中的表达及早期诊断价值。方法：选取机械通气时间大于48 h的380例患者,根据是否发生VAP将其分为VAP组(78例)与非VAP组(302例)；健康对照组为50例体检者。采用流式细胞术检测CD64,同时检测C-反应蛋白(CRP)及白细胞计数(WBC),记录临床肺部感染评分(CPIS)情况。分别比较各组患者外周血CD64指数及CRP、WBC水平的差异以及CD64指数水平与CPIS评分的相关性,评价外周血CD64指数水平对VAP患者的早期诊断价值。结果：VAP组CD64指数水平显著升高,与非VAP组和健康对照组比较,差异具有统计学意义(P<0.05)；经过抗感染治疗后,VAP组患者外周血CD64指数、CRP、WBC水平及CPIS评分均较治疗前显著降低(P<0.05)；相关性分析显示,外周血CD64指数与CPIS评分呈正相关(r=0.78,P<0.01)。ROC曲线分析显示,以外周血CD64指数>5.83为早期诊断VAP界限时,诊断VAP的敏感性和特异性分别为84.2%和89.8%,ROC曲线下面积(AUC)为0.865(95%CI 0.786~0.903)。结论： CD64在VAP患者中高表达,其可作为早期诊断VAP的有效指标,动态观察其水平变化对于判断感染程度及治疗效果具有重要的临床应用价值。

英文摘要:

Objective: To investigate the expression levels and early diagnosis value of CD64 index of peripheral blood cells in patients with ventilator-associated pneumonia (VAP). Methods: 380 patients who undergone mechanical ventilation over 48 h were enrolled in the study. According to the occurrence of VAP, these patients were divided VAP group (78) and non-VAP group (302), 50 cases volunteers as healthy control group. CD64 was measured by flow cytometry, C-reactive protein (CRP) and white blood cell count (WBC) were detected, CPIS score were analyzed. The CD64 index, CRP and WBC levels in every group were compared, the correlation between CD64 index and CPIS score were analyzed, the early diagnosis value of CD64 index in VAP patients was assessed. Results: The CD64 index in VAP group was significantly increased, when compared with non-VAP group and the healthy control group, the difference was statistically significant (P<0.05); After anti-infection treatment, the CD64 index, CRP, WBC and CPIS score were significant lower than before treatment (P<0.05). The correlation analysis showed that the CD64 index in peripheral blood and CPIS scores were positively correlated (r=0.78,P<0.01). The ROC curve analysis showed that when CD64 index>5.83 considered as the boundary for diagnosis of VAP, the sensitivity and specificity of diagnosis were 84.2% and 89.8%, the area under the ROC curve (AUC) was 0.865 (95%CI 0.786~0.903). Conclusion: The expression of CD64 is higher in patients with VAP, which can be used as an effective indicator for early diagnosis of VAP. The dynamic monitoring of CD64 index may facilitate the evaluation of the extent of infection and treatment, which has an important clinical value.