CD64与淋巴细胞亚群在新生儿感染中的作用研究

发布时间：2018-01-26 06:11

本文关键词： 新生儿败血症 CD64 淋巴细胞亚群流式细胞术　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析新生儿外周血中的CD64在机体感染时与各种淋巴细胞亚群之间的联系,结合临床资料对新生儿感染时的机体免疫情况进行评价,为新生儿感染疾病的早期诊断、治疗、提高预后提供有力依据。方法选择100例发生局部感染的新生儿作为局部感染组,50例健康新生儿作为对照组,100例发生败血症的新生儿作为败血症组,流式细胞分析技术检测外周血CD3+T淋巴细胞亚群、CD4+T淋巴细胞亚群、CD8+T淋巴细胞亚群、B淋巴细胞亚群、NK淋巴细胞亚群、中性粒细胞CD64的频率变化,并计算感染指数;电阻抗法检测白细胞计数,散射比浊法检测C反应蛋白(CRP)、化学发光法检测降钙素原(PCT)、未成熟中性粒细胞与总中性粒细胞比值(人工涂片)。经过治疗后再次用流式细胞分析技术检测外周血CD3+T淋巴细胞亚群、CD4+T淋巴细胞亚群、CD8+T淋巴细胞亚群、B淋巴细胞亚群、NK淋巴细胞亚群、中性粒细胞CD64的频率变化。收集数据进行统计学分析,所有数据均使用SPSS17.0统计软件分析,用均数±标准差(X±S)表示,比较败血症患者治疗前后的变化,选择t检验,选择Pearson进行相关性分析,制作ROC曲线比较灵敏度、特异性,以P0.05为差异有统计学意义。结果与正常对照组、局部感染组相比,败血症组中性粒细胞CD64显著增高,差异有统计学意义(P0.05);与正常对照组相比局部感染组的中性粒细胞CD64表达增高,差异具统计学意义(P0.05);和正常对照组、局部感染组相比,败血症组的CRP、PCT、I/T比值增高,差异具统计学意义(P0.05);而局部感染组与正常对照组无显著差异(P0.05);比较三组之间WBC,结果显示差异无统计学意义(P0.05)。绘制ROC(Receiver Operating Characteristic)曲线,中性粒细胞CD64灵敏度、特异度、阴性预测值、阳性预测值明显高于CRP、PCT、I/T比值。与正常对照组、局部感染组相比,败血症组患儿外周血CD3、CD4、NK细胞水平显著降低,差异具统计学意义(P0.05);与正常对照组、局部感染组相比,败血症组CD8、增高,差异无统计学意义(P0.05),败血症组CD19增高,差异具统计学意义(P0.05)。使用Pearson相关分析法分析后发现,CD3+、CD4+T淋巴细胞亚群、CD56+NK细胞表达越高CD64表达越低,反之则表达增高,CD19+B淋巴细胞表达越高CD64表达越高,反之则降低,CD64与CD8+T细胞亚群之间无关系。随着治疗的进展,症状开始减轻,此时白血症组CD64感染指数逐渐降低,治疗前后有差异且差异具统计学意义(P0.05),CD3+CD4+T淋巴细胞亚群表达增高,治疗前后差异具统计学意义(P0.05),而CD8+T淋巴细胞亚群在治疗前后差异小,无统计学意义(P0.05)。结论通过监测各淋巴细胞亚群与新生儿感染在临床进展的相关性分析,提示新生儿发生免疫功能紊乱时与新生儿感染发生高度相关。对CD64与淋巴细胞亚群的检测可以为新生儿感染初期诊断提供有力依据。
[Abstract]:Objective to analyze the relationship between CD64 in peripheral blood of neonates and various lymphocyte subsets during infection, and to evaluate the immune status of neonates with infection by clinical data. Methods 100 neonates with local infection were selected as the control group and 50 healthy neonates as the control group. The peripheral blood CD3 T lymphocyte subsets, CD4 T lymphocyte subsets and CD8 T lymphocyte subsets were detected by flow cytometry in 100 neonates with septicemia. B lymphocyte subsets NK lymphocyte subsets, neutrophils CD64 frequency change, and calculate the infection index; WBC count was detected by electrical impedance method, C-reactive protein (CRPN) was detected by turbidimetry, and procalcitonin (PCT) was detected by chemiluminescence. The ratio of immature neutrophils to total neutrophils (artificial smear) was used to detect the CD4 T lymphocyte subsets of peripheral blood CD3 T lymphocyte subsets by flow cytometry. The frequency of CD8 T lymphocyte subsets B lymphocyte subsets NK lymphocyte subsets and neutrophils CD64 were collected and analyzed statistically. All the data were analyzed by SPSS17.0 statistical software and expressed by mean 卤standard deviation X 卤S. The changes of septicemia patients before and after treatment were compared and t-test was selected. Choose Pearson for correlation analysis, make ROC curve to compare sensitivity, specificity, with P0.05 as the difference is statistically significant. Results compared with the normal control group, local infection group. The CD64 of neutrophils in septicemia group was significantly higher than that in control group (P 0.05). Compared with the control group, the expression of CD64 in neutrophils in the local infection group was higher than that in the control group, and the difference was statistically significant (P 0.05). Compared with the normal control group and the local infection group, the ratio of CRPnPCT / T in septicemia group was significantly higher than that in the control group (P 0.05). However, there was no significant difference between the local infection group and the normal control group (P 0.05). WBC was compared between the three groups. The results showed that the difference was not statistically significant (P 0.05). The curve of ROC(Receiver Operating character was drawn. The sensitivity, specificity, negative predictive value and positive predictive value of neutrophil CD64 were significantly higher than those of CRP- PCT / I / T ratio, compared with those of normal control group and local infection group. In the septicemia group, the level of CD3 + CD4 + NK cells in peripheral blood was significantly lower than that in the control group (P 0.05). Compared with normal control group and local infection group, CD8 in septicemia group was higher than that in local infection group, the difference was not statistically significant (P 0.05), and CD19 in septicemia group was higher than that in septicemia group. The difference was statistically significant (P 0.05). CD3 T lymphocyte subsets were found by Pearson correlation analysis. The higher the expression of CD56 NK cells, the lower the expression of CD64, the higher the expression of CD19B lymphocytes, the higher the expression of CD64, and the lower the expression of CD64. There was no relationship between CD64 and CD8 T cell subsets. With the progress of treatment, the symptoms began to decrease, and the CD64 infection index decreased gradually in the leukaemia group. The expression of CD3 CD4 T lymphocyte subsets was significantly increased before and after treatment, and the difference before and after treatment was statistically significant (P 0.05). However, there was no significant difference in CD8 T lymphocyte subsets before and after treatment (P 0.05). Conclusion the correlation between T lymphocyte subsets and neonatal infection in clinical progress was analyzed. It is suggested that the detection of CD64 and lymphocyte subsets may provide a powerful basis for the early diagnosis of neonatal infection.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.13

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