CAJ | 학술논문

目的：探讨流式细胞术检测外周血中性粒细胞膜碱性磷酸酶（ mNAP）表达在血流感染诊断中的应用价值。方法选择2013年6月至2014年10月在连云港市第一人民医院住院病例中疑似血流感染而行血培养检查的患者298例，以同期医院体检中心80名健康体检者作为对照组。通过病原微生物学证实血流感染的诊断，应用流式细胞术检测mNAP，电化学发光法检测血清降钙素原（PCT），散射免疫比浊法检测血清 C反应蛋白（CRP）。采用受试者工作特征（ROC）曲线评价mNAP、PCT、CRP诊断血流感染的价值。结果298例患者中，根据病原微生物学证实血流感染109例，其中革兰阳性菌感染43例，革兰阴性菌感染66例。血流感染患者组CRP、PCT、mNAP中位数分别为138.71 mg／L、7.04 ng／mL、13929 AB／c，显著高于健康对照组的1.50 mg／L、0.12 ng／mL、1831 AB／c（U＝5.00、48.50和65.01，P＜0.01）。革兰阳性菌感染患者的mNAP为9598（6064～11643） AB／c，低于革兰阴性菌感染患者16512（11654～22001） AB／c，差异有统计学意义（ U＝250．00，P＜0.01）。 ROC曲线分析结果表明，mNAP、PCT 及CRP 诊断血流感染的曲线下面积（AUC）分别为0.987、0.962和0.901，最佳切点分别为4578AB／c、0.90 ng／mL 和13.50 mg／L，敏感性分别为95.8％、93.0％和90.3％，特异性分别为97.8％、95.6％和85.5％。结论在mNAP、PCT、CRP三个指标中，mNAP诊断血流感染的效能最高，可作为血流感染诊断的生物标志物。
목적：탐토류식세포술검측외주혈중성립세포막감성린산매（ mNAP）표체재혈류감염진단중적응용개치。방법선택2013년6월지2014년10월재련운항시제일인민의원주원병례중의사혈류감염이행혈배양검사적환자298례，이동기의원체검중심80명건강체검자작위대조조。통과병원미생물학증실혈류감염적진단，응용류식세포술검측mNAP，전화학발광법검측혈청강개소원（PCT），산사면역비탁법검측혈청 C반응단백（CRP）。채용수시자공작특정（ROC）곡선평개mNAP、PCT、CRP진단혈류감염적개치。결과298례환자중，근거병원미생물학증실혈류감염109례，기중혁란양성균감염43례，혁란음성균감염66례。혈류감염환자조CRP、PCT、mNAP중위수분별위138.71 mg／L、7.04 ng／mL、13929 AB／c，현저고우건강대조조적1.50 mg／L、0.12 ng／mL、1831 AB／c（U＝5.00、48.50화65.01，P＜0.01）。혁란양성균감염환자적mNAP위9598（6064～11643） AB／c，저우혁란음성균감염환자16512（11654～22001） AB／c，차이유통계학의의（ U＝250．00，P＜0.01）。 ROC곡선분석결과표명，mNAP、PCT 급CRP 진단혈류감염적곡선하면적（AUC）분별위0.987、0.962화0.901，최가절점분별위4578AB／c、0.90 ng／mL 화13.50 mg／L，민감성분별위95.8％、93.0％화90.3％，특이성분별위97.8％、95.6％화85.5％。결론재mNAP、PCT、CRP삼개지표중，mNAP진단혈류감염적효능최고，가작위혈류감염진단적생물표지물。
Objective To evaluate the detection of membrane neutrophilic alkaline phosphatase ( mNAP) by flow cytometry in diagnosis of bloodstream infection .Methods A total of 298 patients with suspected bloodstream infections admitted in the First People ’ s Hospital of Lianyungang during June 2013 and October 2014 were enrolled;80 healthy subjects in physical examination center were also enrolled as the control group.Bloodstream infection was diagnosed by blood culture and mNAP was detected by flow cytometry.Serum levels of procalcitonin (PCT) and C-reactive protein (CRP) were detected by electro-chemiluminescence (ECL) and immune scatter turbidimetry , respectively.The value of mNAP, PCT and CRP in diagnosing bloodstream infection was determined by receiver operating characteristic ( ROC) curve. Results Among 298 patients, 109 were confirmed with bloodstream infections , including 43 patients with Gram-positive bacterial infections and 66 with Gram-negative bacterial infections .The median levels of CRP , PCT and mNAP in bloodstream infection group were 138.71 mg/L, 7.04 ng/mL and 13 929 AB/c, which were significantly higher than those in healthy control group (1.50 mg/L, 0.12 ng/mL, 1 831 AB/c;U=5.00, 48.50 and 65.01, P<0.01).The expression of mNAP in Gram-positive bacterial infection group was 9 598 ( 6 064-11 643 ) AB/c, which was significantly lower than that in Gram-negative bacterial infection group [16 512 (11 654-22 001) AB/c] (U=250.00, P<0.01).ROC curve analysis showed that, the areas under the curve (AUCs) of mNAP, PCT and CRP in diagnosing bloodstream infection were 0.987, 0.962 and 0.901.When 4 578AB/c, 0.90 ng/mL and 13.50mg/L were taken as optimal cut-off values, the sensitivities of mNAP, PCT and CRP in diagnosis of bloodstream infection were 95.8%, 93.0%and 90.3%; the specificities were 97.8%, 95.6% and 85.5%, respectively.Conclusion Among mNAP, PCT and CRP, mNAP is of the highest value in diagnosing bloodstream infection , and may be used as a biomarker for clinical diagnosis of bloodstream infection .