中性粒细胞CD64指数、PCT及NLR在 感染性疾病诊断中的价值

目的探讨中性粒细胞CD64指数、降钙素原(PCT)和中性粒细胞与淋巴细胞比值(NLR)在感染性疾病诊断和鉴别诊断中的临床价值。方法选取确诊的感染性疾病患者127例和同期健康对照者54例为研究对象,感染性疾病患者按照血培养和微生物检测结果分为病毒感染组(51例)和细菌感染组(76例)。分别检测每一位受试对象的外周血中性粒细胞CD64指数、PCT水平和NLR,应用受试者工作特征曲线(ROC)研究这3项指标在感染性疾病诊断和鉴别中的临床价值。结果感染性疾病患者中性粒细胞CD64指数、PCT水平和NLR明显高于健康对照组(P0.01)。细菌感染组患者中性粒细胞CD64指数、PCT水平和NLR明显高于病毒感染组(P0.01)。ROC曲线显示:当用于诊断感染性疾病时,中性粒细胞CD64指数、PCT和NLR的AUC值分别为0.799、0.655、0.622,灵敏度分别为75.4%、63.5%、60.3%,特异度分别为79.6%、67.4%、60.0%,3项指标联合检测的AUC值为0.812;当用于鉴别诊断细菌感染和病毒感染时,中性粒细胞CD64指数、PCT和NLR的AUC值分别为0.931、0.728、0.551,灵敏度分别为89.1%、70.3%、60.9%,特异度分别为80.0%、64.6%、57.2%,3项指标联合检测的AUC值为0.935。结论在感染性疾病的诊断和鉴别感染类型中,中性粒细胞CD64指数明显优于PCT和NLR。3项指标联合检测优于任何一个单项指标的检测效果。

The clinical values of neutrophil CD64 index, PCT and NLR for diagnosis of infectious diseases

Abstract: Objective To explore the clinical values of neutrophil CD64 index, procalcitonin (PCT) and neutrophils-lymphocytes ratio (NLR) for the diagnosis and differential diagnosis of infectious diseases. Methods 127 patients diagnosed as microbial infection and 54 healthy individuals were enrolled. The patients were divided into bacterial infection group (76 cases) and viral infection group (51 cases) based on blood culturing. The levels of peripheral blood CD64 index, PCT and NLR of each subject were determined. ROC curves were plotted to analyze the clinical values of the 3 indicators. Results The levels of CD64 index, PCT and NLR of the patients were significantly higher than those of the healthy subjects (P<0.01). The levels of CD64 index, PCT and NLR in the bacterial infection group were significantly higher than those in the viral infection group (P<0.01). ROC curves showed that for diagnosis of infections, the AUCs of CD64, NLR and PCT were 0.799, 0.655 and 0.622 respectively, with the sensitivities being 75.4%, 63.5% and 60.3% respectively and the specificities being 79.6%, 67.4% and 60.0% respectively; the AUC of combined detection of the 3 indicators was 0.812. While for differential diagnosis between bacterial infection and viral infection, the AUCs of CD64, NLR and PCT were 0.931, 0.728 and 0.551 respectively, with the sensitivities being 89.1%, 70.3% and 60.9% respectively and the specificities being 80.0%, 64.6% and 57.2% respectively; the AUC of combined detection of the 3 indicators was 0.935. Conclusion In the diagnosis of infections and differential diagnosis between bacterial infection and viral infection, the value of neutrophil CD64 index is better than that of PCT or NLR. The combined detection of the 3 indicators is superior to individual detection of any single indicator.