外周血中性粒细胞CD64表达在儿童社区获得性肺炎早期病原学鉴别诊断中的应用价值

目的 评价外周血中性粒细胞CD64表达在儿童社区获得性肺炎早期病原学鉴别诊断中的应用价值.方法 选取2014年6月至2015年6月就诊我院儿科的99例患儿,依据感染的病原体不同分为3组,细菌性肺炎组(41例)、非细菌性肺炎组(38例)及正常对照组(20例);非细菌性肺炎组又分为病毒性肺炎组(22例)和肺炎支原体肺炎组(16例).采用流式细胞术检测外周血中性粒细胞CD64的平均荧光强度(median fluorescence intensity,MFI),同时检测外周血C-反应蛋白(C-reactive protein,CRP)、WBC计数及中性粒细胞比例的水平.结果 细菌性肺炎组患儿中性粒细胞CD64表达水平、CRP值及WBC计数均较非细菌性肺炎组及正常对照组高,差异均有统计学意义(P均＜0.01);以ROC曲线确定CD64的最佳截断值为6 519 MFI,其诊断细菌性肺炎的敏感性及特异性分别为87.8％、89.7％;细菌性肺炎组CD64表达水平较病毒性肺炎组、肺炎支原体肺炎组及正常对照组明显增高,差异均有统计学意义(P均＜0.01).结论 儿童社区获得性肺炎细菌感染患儿,外周血中性粒细胞表面标志物CD64表达水平显著升高,可以作为小儿细菌性肺炎的早期诊断依据,用于指导临床是否使用抗生素的依据.

The value of peripheral blood neutrophil CD64 expression in early differential diagnosis of etiology in children with community-acquired pneumonia

Objective To evaluate the apphcation value of peripheral blood neutrophil CD64 expression in early differential diagnosis of etiology in children with community-acquired pneumonia.Methods From June 2014 to June 2015 in our hospital,total of 99 cases of different pathogen infection were divided into three groups,bacterial pneumonia group (n =41),non-bacterial pneumonia group(n =38),healthy children group (n =20);and the non-bacterial pneumonia group was divided into two subgroups,viral pneumonia group (n =22) and mycoplasma pneumoniae pneumonia group(n =16).Flow cytometry was used to test the median fluorescence intensity (MFI) of peripheral blood neutrophil CD64.The levels of peripheral blood CRP,WBC and neutrophil percentage were detected.Results The levels of CD64 expression,CRP and WBC in bacterial pneumonia group were statistically higher than those of non-bacterial pneumonia group and healthy children group respectively (both P ＜ 0.01).The optimal cutoff value of CD64 was 6 519 MFI when using ROC curve,and the sensitivity and specificity of the diagnosis of bacterial pneumonia were 87.8％ and 89.7％ respectively.The levels of CD64 expression in bacterial pneumonia group were significantly higher than those in viral pneumonia group,mycoplasma pneumoniae pneumonia group and healthy children group (all P ＜ 0.01).Conclusion The expression of peripheral blood neutrophil CD64 increases in children with community-acquired pneumonia of bacteria infection.It can be used to guide early diagnosis of children with bacterial pneumonia and the using of antibiotics.