CD64和降钙素原检测在学龄前儿童感染性腹泻中的鉴别诊断价值
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摘要
目的探讨外周血中性粒细胞CD64和降钙素原(PCT)在学龄前儿童感染性腹泻中的鉴别诊断价值。方法收集152例腹泻患儿的临床资料,根据感染病原体类型,分为细菌性腹泻组(48例)、病毒性腹泻组(54例)及非感染性腹泻组(50例)。结果细菌性腹泻患儿CD64、PCT水平及阳性率明显高于病毒性腹泻组和非感染性腹泻组,差异有统计学意义(P<0.05),而病毒性腹泻组和非感染性腹泻组水平差异无统计学意义(P>0.05);细菌性腹泻患儿经有效治疗后CD64、PCT水平均显著下降,差异有统计学意义(P<0.05);CD64对细菌性腹泻诊断的敏感度、特异度、阳性预测值及阴性预测值与PCT比较差异均无统计学意义(P>0.05)。细菌性腹泻患儿的CD64表达与PCT水平之间呈正相关(r=0.827,P<0.05)。CD64联合PCT诊断细菌性腹泻的敏感度稍有降低,但是特异度却大大提高。结论联合检测CD64和PCT水平对学龄前儿童细菌性腹泻的早期诊断、疗效判断及预后评估具有一定的指导意义。
Objective To investigate the differential diagnostic value of peripheral blood neutrophil CD64 and procalcitonin(PCT) in preschool children with infectious diarrhea. Methods Clinical data of 152 children with diarrhea was collected and divided into bacterial diarrhea group(48 cases), viral diarrhea group(54 cases) and non-infectious diarrhea group(50 cases) according to the pathogen type. Results The levels of CD64 and PCT in children with bacterial diarrhea were significantly higher than those with viral diarrhea and non-infectious diarrhea, with the differences statistically significant(P<0.05), but the levels of viral diarrhea and non-infectious diarrhea were not statistically different(P>0.05); The effective treatment of children with bacterial diarrhea after CD64, PCT levels decreased significantly, with the differences statistically significant(P<0.05); the sensitivity, specificity, positive predictive value and negative predictive value of CD64 in the diagnosis of bacterial diarrhea were all higher than those in PCT, but the differences were not statistically significant(P>0.05). there was a positive correlation between CD64 expression and PCT levels in children with bacterial diarrhea before treatment(r=0.827, P<0.05). The sensitivity of CD64 combined with PCT in the diagnosis of bacterial diarrhea was slightly reduced, but the specificity was greatly improved. Conclusion The combined detection of CD64 and PCT levels has certain guiding significance in the early diagnosis, efficacy judgment and prognosis evaluation of preschool children with bacterial diarrhea.
Objective To investigate the differential diagnostic value of peripheral blood neutrophil CD64 and procalcitonin(PCT) in preschool children with infectious diarrhea. Methods Clinical data of 152 children with diarrhea was collected and divided into bacterial diarrhea group(48 cases), viral diarrhea group(54 cases) and non-infectious diarrhea group(50 cases) according to the pathogen type. Results The levels of CD64 and PCT in children with bacterial diarrhea were significantly higher than those with viral diarrhea and non-infectious diarrhea, with the differences statistically significant(P<0.05), but the levels of viral diarrhea and non-infectious diarrhea were not statistically different(P>0.05); The effective treatment of children with bacterial diarrhea after CD64, PCT levels decreased significantly, with the differences statistically significant(P<0.05); the sensitivity, specificity, positive predictive value and negative predictive value of CD64 in the diagnosis of bacterial diarrhea were all higher than those in PCT, but the differences were not statistically significant(P>0.05). there was a positive correlation between CD64 expression and PCT levels in children with bacterial diarrhea before treatment(r=0.827, P<0.05). The sensitivity of CD64 combined with PCT in the diagnosis of bacterial diarrhea was slightly reduced, but the specificity was greatly improved. Conclusion The combined detection of CD64 and PCT levels has certain guiding significance in the early diagnosis, efficacy judgment and prognosis evaluation of preschool children with bacterial diarrhea.
引文
[1] 程蓉, 吴成. CD64及C-反应蛋白在儿童感染性腹泻中的临床意义[J]. 安徽医学, 2014, 35(5): 613-615.
[2] 朱锐锋, 胡喜梅, 周水阳, 等. CD64结合其他炎性指标在细菌感染诊断中的意义[J]. 中国感染与化疗杂志, 2016, 16(6): 726-729.
[3] 郭向东, 阿曼古, 曹丽, 等. 降钙素原对细菌性痢疾患者病情评估的临床意义[J]. 新疆医学, 2015, 45(8): 1078-1081.
[4] 全国腹泻病防治学术研讨会组织委员会. 中国腹泻病诊断治疗方案[J]. 中国实用儿科杂志, 1998, 6(13): 381-384.
[5] 张勇刚. 中性粒细胞CD64和C-反应蛋白检测在儿童感染性腹泻诊断中的意义[J]. 中国妇幼保健, 2016, 31(8): 1664-1666.
[6] 何念海, 赵文利. 中国儿童感染性腹泻诊治进展[J]. 实用儿科临床杂志, 2010, 25(22): 1694-1696.
[7] 史晋叔, 涂怀军, 李剑. 中性粒细胞CD64鉴别细菌感染的研究进展[J]. 广东医学, 2016, 37(2): 303-304.
[8] 张可琚, 陈鸣. 中性粒细胞CD64在感染性疾病诊治中的应用[J]. 中华检验医学杂志, 2016, 39(5): 340-343.
[9] 林阳, 万岁桂. 中性粒细胞表面CD64在细菌感染诊断与鉴别诊断中的应用价值[J]. 标记免疫分析与临床, 2014, 21(2): 111-114.
[10] 瞿晓华, 张莉. C-反应蛋白、降钙素原和CD64在儿科临床中的应用[J]. 医学综述, 2015, 21(11): 1954-1956.
[11] 王磊, 潘家华, 陈信, 等. 降钙素原在儿科感染性疾病中的临床价值[J]. 中华全科医学, 2013, 11(7): 1106-1114.
[12] 李智文. 早期CD64和降钙素原检测在小儿腹泻鉴别诊断中的价值探讨[J]. 黑龙江医学, 2017, 41(4): 352-353.
[13] 廖长风, 陈懿建. CD64和降钙素原在小儿细菌性腹泻早期诊断中的价值探讨[J]. 国际检验医学杂志, 2015, 36(23): 3413-3415.
[14] 奎莉越, 聂文莎, 袁廷运, 等. 降钙素原在监测儿童急性腹泻中的临床研究[J]. 云南医药, 2015, 36(2): 139-141.
[15] Yang AP, Liu J, Yue LH, et al. Neutrophil CD64 combined with PCT, CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis[J]. Clin Chem Lab Med, 2016, 54(2): 345-351.
[2] 朱锐锋, 胡喜梅, 周水阳, 等. CD64结合其他炎性指标在细菌感染诊断中的意义[J]. 中国感染与化疗杂志, 2016, 16(6): 726-729.
[3] 郭向东, 阿曼古, 曹丽, 等. 降钙素原对细菌性痢疾患者病情评估的临床意义[J]. 新疆医学, 2015, 45(8): 1078-1081.
[4] 全国腹泻病防治学术研讨会组织委员会. 中国腹泻病诊断治疗方案[J]. 中国实用儿科杂志, 1998, 6(13): 381-384.
[5] 张勇刚. 中性粒细胞CD64和C-反应蛋白检测在儿童感染性腹泻诊断中的意义[J]. 中国妇幼保健, 2016, 31(8): 1664-1666.
[6] 何念海, 赵文利. 中国儿童感染性腹泻诊治进展[J]. 实用儿科临床杂志, 2010, 25(22): 1694-1696.
[7] 史晋叔, 涂怀军, 李剑. 中性粒细胞CD64鉴别细菌感染的研究进展[J]. 广东医学, 2016, 37(2): 303-304.
[8] 张可琚, 陈鸣. 中性粒细胞CD64在感染性疾病诊治中的应用[J]. 中华检验医学杂志, 2016, 39(5): 340-343.
[9] 林阳, 万岁桂. 中性粒细胞表面CD64在细菌感染诊断与鉴别诊断中的应用价值[J]. 标记免疫分析与临床, 2014, 21(2): 111-114.
[10] 瞿晓华, 张莉. C-反应蛋白、降钙素原和CD64在儿科临床中的应用[J]. 医学综述, 2015, 21(11): 1954-1956.
[11] 王磊, 潘家华, 陈信, 等. 降钙素原在儿科感染性疾病中的临床价值[J]. 中华全科医学, 2013, 11(7): 1106-1114.
[12] 李智文. 早期CD64和降钙素原检测在小儿腹泻鉴别诊断中的价值探讨[J]. 黑龙江医学, 2017, 41(4): 352-353.
[13] 廖长风, 陈懿建. CD64和降钙素原在小儿细菌性腹泻早期诊断中的价值探讨[J]. 国际检验医学杂志, 2015, 36(23): 3413-3415.
[14] 奎莉越, 聂文莎, 袁廷运, 等. 降钙素原在监测儿童急性腹泻中的临床研究[J]. 云南医药, 2015, 36(2): 139-141.
[15] Yang AP, Liu J, Yue LH, et al. Neutrophil CD64 combined with PCT, CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis[J]. Clin Chem Lab Med, 2016, 54(2): 345-351.