CAJ | 학술논문

目的：探讨炎性指标中性粒细胞表面CD64、单核细胞 HLA‐DR、降钙素原（PCT ）检测在细菌感染性疾病诊断中的价值。方法选取2013年10月至2014年3月福建省立医院临床初步诊断为感染性疾病的住院患者90例，按出院时回顾性分析，将患者分为细菌感染组、非细菌感染组（包括真菌或支原体感染）；另选取同期健康体检者30例作为对照组。比较各组之间CD64、HLA‐DR、PCT、C反应蛋白（CRP）、中性粒细胞碱性磷酸酶（NAP）积分、白细胞计数（WBC）的检测结果。结果细菌感染组CD64、PCT、CRP明显高于非细菌感染组与对照组，差异有统计学意义（P＜0．01），NAP、WBC明显高于对照组，差异有统计学意义（P＜0．01），HLA‐DR明显低于非细菌感染组与对照组，差异有统计学意义（P＜0．01）；非细菌感染组CD64、CRP、NAP积分（P＜0．01）与WBC计数（P＜0．05）明显高于对照组，而PCT及单核细胞HLA‐DR与对照组相比较，差异无统计学意义（P＞0．05）。细菌感染组各炎性指标相关性分析表明：CD64与HLA‐DR呈负相关（r＝－0．36，P＜0．01）；PCT与CRP呈正相关（r＝0．43， P＜0．01）；HLA‐DR除与CD64呈负相关外，还与CRP、WBC呈负相关（P＜0．01）。按PCT水平对感染程度分级，结果显示PCT各水平组的HLA‐DR水平均明显低于对照组（P＜0．05，P＜0．01），并呈现明显递减趋势；除0．05～0．5 ng／mL组外，其他PCT水平组的CD64水平均明显高于对照组（P＜0．05，P＜0．01），并呈现明显的递增趋势。结论 PCT、CD64、HLA‐DR是较好的细菌感染指标，3者联合检测对细菌感染的诊断、评估与监测有着重要的意义。
목적：탐토염성지표중성립세포표면CD64、단핵세포 HLA‐DR、강개소원（PCT ）검측재세균감염성질병진단중적개치。방법선취2013년10월지2014년3월복건성립의원림상초보진단위감염성질병적주원환자90례，안출원시회고성분석，장환자분위세균감염조、비세균감염조（포괄진균혹지원체감염）；령선취동기건강체검자30례작위대조조。비교각조지간CD64、HLA‐DR、PCT、C반응단백（CRP）、중성립세포감성린산매（NAP）적분、백세포계수（WBC）적검측결과。결과세균감염조CD64、PCT、CRP명현고우비세균감염조여대조조，차이유통계학의의（P＜0．01），NAP、WBC명현고우대조조，차이유통계학의의（P＜0．01），HLA‐DR명현저우비세균감염조여대조조，차이유통계학의의（P＜0．01）；비세균감염조CD64、CRP、NAP적분（P＜0．01）여WBC계수（P＜0．05）명현고우대조조，이PCT급단핵세포HLA‐DR여대조조상비교，차이무통계학의의（P＞0．05）。세균감염조각염성지표상관성분석표명：CD64여HLA‐DR정부상관（r＝－0．36，P＜0．01）；PCT여CRP정정상관（r＝0．43， P＜0．01）；HLA‐DR제여CD64정부상관외，환여CRP、WBC정부상관（P＜0．01）。안PCT수평대감염정도분급，결과현시PCT각수평조적HLA‐DR수평균명현저우대조조（P＜0．05，P＜0．01），병정현명현체감추세；제0．05～0．5 ng／mL조외，기타PCT수평조적CD64수평균명현고우대조조（P＜0．05，P＜0．01），병정현명현적체증추세。결론 PCT、CD64、HLA‐DR시교호적세균감염지표，3자연합검측대세균감염적진단、평고여감측유착중요적의의。
Objective To explore the value of inflammatory indexes of neutrophil surface CD64 ,monocyte HLA‐DR and procalcitonin(PCT) in the diagnosis of bacterial infectious diseases .Methods 90 inpatients with pri‐marily diagnosed infectious diseases in the Fujian Provincial Hospital from October 2013 to March 2014 were ran‐domly selected and detected CD64 ,HLA‐DR ,PCT ,CRP ,NAP integral and WBC count .According to the retrospec‐tive analysis at hospital discharge ,the patients were divided into the bacterial infection group and non‐bacterial infec‐tion (including fungal or mycoplasma infection) group;at the same period 30 individuals of healthy physical examina‐tion were selected as the control group .The detection results of inflammatory indexes were analyzed an compared a‐mong various groups .Results The CD64 ,PCT and CRP levels in the bacterial infection group were significantly higher than those in the non‐bacterial infection group and the control group with statistical differences(P<0 .01) ,the NAP integral and WBC counts were significantly higher than those in the control group with statistical differences (P<0 .01) ,the HLA‐DR expression was significantly lower than that in the control group and the non‐bacterial in‐fection group with statistical difference(P<0 .01);the CD64 and CRP levels ,NAP integral and WBC counts in the non‐bacterial infection group were significantly higher than those in the control group(P< 0 .01 ,P< 0 .05) ,while PCT and the monocyte HLA‐DR had no statistical differences between the non‐bacterial infection group and the con‐trol group(P>0 .05) .The correlation analysis indicated that CD64 was negatively correlated with HLA‐DR (r=-0 .36 ,P<0 .01);PCT and CRP was positively correlated (r=0 .43 ,P<0 .01) ,HLA‐DR also was negatively corre‐lated with CRP and WBC(P<0 .01) .The infection degree was graded according to the PCT level ,the results showed that the HLA‐DR level in various PCT levels groups was significantly lower than that in the control group(P<0 .05 , P<0 .01) ,moreover which showing the decline trend;except for the 0 .05-0 .5 ng/mL group ,the CD64 level in the other PCT levels groups was significantly higher than that in the control group(P<0 .05 ,P<0 .01) ,moreover which showing the ascending trend .Conclusion PCT ,neutrophil CD64 and monocyte HLA‐DR are better indicators of bac‐terial infection and their combined detection has an important significance for the diagnosis ,evaluation and monitoring of bacterial infection .