中性粒细胞CD64在早期诊断儿童感染性腹泻中的价值

发布时间：2018-06-09 23:47

本文选题：感染性腹泻 + 中性粒细胞CD64　；参考：《安徽医科大学》2014年硕士论文

【摘要】：目的腹泻病是儿童最常见的疾病之一，发病率仅次于呼吸道感染。目前临床诊断儿童感染性腹泻主要依据患儿的临床表现及病原学检测，然而儿童感染性腹泻早期临床特征不典型，病原学检测阳性率不高且滞后，不利于早期诊断。本研究通过检测腹泻患儿外周血中中性粒细胞CD64指数和CRP水平，探讨CD64用于早期诊断儿童感染性腹泻的临床意义和在评价抗感染疗效中的应用价值。方法收集我院收治的100例急性腹泻患儿的外周血标本及大便标本，其中细菌性腹泻组（40例）、病毒性腹泻组（40例）及非感染性腹泻组（20例）；依据患儿临床症状及体征将40例细菌性腹泻患儿分为轻度细菌性腹泻组（27例）和重度细菌性腹泻组（13例）。所有患儿在接受治疗前采集静脉血，利用流式细胞术检测患儿外周血中中性粒细胞表面CD64指数；使用免疫比浊法检测患儿外周血中C反应蛋白的水平。细菌性腹泻组患儿进行规范治疗，临床症状消失、复查大便常规正常及大便培养转阴后，再次抽取静脉血，利用上述方法再次检测中性粒细胞CD64指数和CRP水平。三组患儿治疗前外周血中性粒细胞CD64指数及CRP水平之间的比较采用单因素方差分析，组间两两比较采用SNK-q检验；细菌性腹泻患儿治疗前后均数的比较采用配对t检验；两独立样本均数的比较采用t检验；计数资料的比较采用卡方检验；中性粒细胞CD64指数和CRP的相关性分析采用Pearson相关分析。结果 1、治疗前细菌性腹泻组患儿外周血中中性粒细胞CD64指数和CRP水平显著高于病毒性腹泻组及非感染性腹泻组，差异有统计学意义(P＜0．01)。 2、重度细菌性腹泻组患儿外周血中中性粒细胞CD64指数明显高于轻度细菌性腹泻组，差异有统计学意义(P＜0．05)。 3、细菌性腹泻患儿经过规范的治疗后，外周血中中性粒细胞CD64指数及CRP水平和治疗前相比明显下降，，差异有统计学意义(P＜0．01)。 4、中性粒细胞CD64指数诊断儿童细菌性腹泻的敏感性和特异性分别为89.0%和88.3%，阳性预测值和阴性预测值分别为83.7%（36/43）和92.9%（53/57）；CRP诊断细菌性腹泻的敏感性和特异性分别为70.0%和76.7%，阳性预测值和阴性预测值分别为66.6%（28/42）和79.3%（46/58）。 5、相关性分析结果显示治疗前外周血中中性粒细胞CD64指数与CRP水平呈正相关(r=0．784，P＜0．01)。结论细菌性腹泻患儿的外周血中性粒细胞CD64指数及CRP水平明显升高，且病情程度越重，CD64升高的水平也越明显；随着感染的控制，中性粒细胞表面CD64指数也趋于正常。因此，检测外周血中性粒细胞CD64指数对儿童细菌性腹泻的早期诊断、判断病情严重程度及观察疗效具有重要的临床意义。
[Abstract]:Objective diarrhea is one of the most common diseases in children, and the incidence is second only to respiratory tract infection. At present, the clinical diagnosis of infective diarrhea in children is mainly based on the clinical manifestations and etiological detection. However, the early clinical characteristics of infective diarrhea in children are not typical, the positive rate of etiology detection is not high and lag, which is not conducive to early diagnosis. In this study, the levels of CD64 index and CRP in peripheral blood neutrophils were measured in children with diarrhea. To explore the clinical significance of CD64 in the early diagnosis of infective diarrhea in children and the value of CD64 in evaluating the efficacy of anti-infective diarrhea. Methods the peripheral blood and stool samples of 100 children with acute diarrhea were collected. According to clinical symptoms and signs, 40 patients with bacterial diarrhea were divided into mild bacterial diarrhea group (n = 27) and severe bacterial diarrhea group (n = 13). Venous blood was collected before treatment and CD64 index of neutrophils in peripheral blood was detected by flow cytometry and C-reactive protein level in peripheral blood was detected by immunoturbidimetry. In the group of bacterial diarrhea, the clinical symptoms disappeared, the routine stool was normal and stool culture turned negative, the venous blood was drawn again, and the CD64 index and CRP level of neutrophils were detected again by the above method. The levels of CD64 and CRP in peripheral blood of the three groups were compared by single factor ANOVA, SNK-q test and paired t test before and after treatment for children with bacterial diarrhea. T test was used to compare the mean of two independent samples, chi-square test was used to compare counting data. The correlation between neutrophil CD64 index and CRP was analyzed by Pearson correlation analysis. Results 1 the levels of CD64 index and CRP in peripheral blood of children with bacterial diarrhea before treatment were significantly higher than those in viral diarrhea group and non-infectious diarrhea group. The CD64 index of peripheral blood neutrophils in severe bacterial diarrhea group was significantly higher than that in mild bacterial diarrhea group (P < 0.05). The levels of CD64 index and CRP in peripheral blood neutrophils were significantly lower than those before treatment. The sensitivity and specificity of CD64 index of neutrophils in the diagnosis of bacterial diarrhea in children were 89.0% and 88.3%, respectively. The positive predictive value and negative predictive value were 83.7% and 36.43%, respectively. The sensitivity and specificity of CD64 index of neutrophils in the diagnosis of bacterial diarrhea were 92.9% and 92.9% / 57% respectively. The positive predictive value and negative predictive value were 66.6% and 79.3%, respectively. The correlation analysis showed that the CD64 index of peripheral blood neutrophils was positively correlated with CRP level before treatment (P < 0.01.Conclusion in children with bacterial diarrhea, the CD64 index of peripheral blood neutrophils is positively correlated with CRP level (P < 0.01). The levels of CD64 index and CRP in peripheral blood neutrophils were significantly increased. With the control of infection, the CD64 index of neutrophil surface tended to be normal. Therefore, the detection of peripheral blood neutrophil CD64 index is of great clinical significance in the early diagnosis of bacterial diarrhea in children, in judging the severity of the disease and in observing the curative effect.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.7

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