CRP、CD64、PCT对感染性和非感染性烧伤患者鉴别诊断的意义

目的探讨C反应蛋白(CRP)、中性粒细胞CD64、降钙素原(PCT)在感染性及非感染性烧伤患者中的诊断价值。方法选取2014年6月至2016年6月该院烧伤外科收治的160例烧伤患者,根据患者细菌感染情况分为感染组(n=110)及非感染组(n=50),感染组根据感染程度又分为脓毒症组(n=48)及局部感染组(n=62),感染组根据血培养结果将患者分为革兰阳性细菌感染组(n=52)及革兰阴性细菌感染组(n=58);另选取50例健康体检者作为健康对照组。采用流式细胞仪测定CD64,采用电化学发光法测定PCT,采用速率比浊法测定CRP。采用受试者工作特异曲线(ROC曲线)分析CRP、CD64、PCT在感染性烧伤患者中的应用价值。结果烧伤患者中脓毒症组、局部感染组及非感染组血清CRP水平差异均无统计学意义(P0.05);而脓毒症组、局部感染组血清CD64、PCT水平显著高于非感染组及健康对照组,差异有统计学意义(P0.05)。经ROC曲线分析可知,血清CRP、CD64、PCT在革兰阴性细菌感染组中的诊断灵敏度分别为55.2%、75.8%、71.8%,特异度分别为51.8%、50.2%、96.8%;血清CRP、CD64、PCT在革兰阳性菌感染组中的诊断灵敏度分别为36.3%、39.2%、40.8%,特异度分别为55.5%、55.6%、52.2%。结论血清CD64、PCT可作为感染性及非感染性烧伤患者的鉴别指标,其中PCT对于鉴别烧伤患者革兰阳性细菌与革兰阴性细菌感染具有较高的诊断价值,可为感染性烧伤患者诊断提供指导。

Significance of CRP,CD64 and PCT in differential diagnosis of infectious and noninfectious burn patients

Objective To investigate the diagnostic value of C‐reactive protein (CRP ) ,neutrophil CD64 ,and procalcitonin (PCT ) in patients with infectious and noninfectious burns .Methods Totally 160 cases of burn patients from June 2014 to June 2016 were collected ,and divided into infected group (n=110) and non‐infected group(n=50) ,while infection group were divided into degree of infection sepsis group (n=48) and local infection group (n=62) ,bacterial infection group according to blood culture results were divided into Gram‐positive bacteria infection group (n=52) and Gram‐negative bacteria infection group (n=58) .An‐other health examination person was selected as the healthy control group (n= 50) .CD64 was measured by flow cytometry ,and PCT was measured by electrochemical luminescence method ,and the rate of CRP was determined by the rate method .The applica‐tion value of CRP ,CD64 and PCT in the patients with infective burn were analyzed by receiver operating specific curve (ROC) .Re‐sults There was no significant difference in serum CRP between the sepsis group ,the local infection group and the non‐infection group (P>0 .05) ,the levels of serum CD64 and PCT in sepsis group and local infection group were significantly higher than those in non‐infection group and healthy control group(P<0 .05) .The ROC curve analysis showed that the diagnostic sensitivity of ser‐um CRP ,CD64 ,PCT in Gram‐negative bacterial infection group were 55 .2% ,75 .8% ,71 .8% ,the specificity was 51 .8% ,50 .2%and 96 .8% respectively .The diagnostic sensitivity of serum CRP ,CD64 and PCT were 36 .3% ,39 .2% and 40 .8% in Gram‐positive bacterial infection group ,the specificity was 55 .5% ,55 .6% ,52 .2% .Conclusion The serum CD64 and PCT can be used as an indi‐cator for the identification of infectious and non infective burn patients ,among them ,PCT has a high diagnostic value for the identi‐fication of Gram‐positive bacteria and gram‐negative bacterial infections in burn patients ,and can provide guidance for the diagnosis of infectious burn patients .