外周血CD64、CD11b/CD18指数对急性胰腺炎并感染的早期诊断价值

摘要

目的：探讨外周血CD64、CD11b/CD18指数及PCT水平对急性胰腺炎并细菌感染的早期诊断价值。方法选取急性胰腺炎患者158例，根据病情程度分为重症胰腺炎组（SAP组）60例，轻症胰腺炎组（MAP组）98例，并将是否合并细菌感染分为败血症组45例、局部感染组63例和单纯急性胰腺炎组60例；另选择健康体检者30例为对照组。应用流式细胞术检测CD64、CD11b/CD18指数，采用罗氏电化学发光法测定血清PCT水平，并比较各指标对急性胰腺炎合并感染的早期诊断的灵敏度、特异度和准确度，评价它们对该病的诊断价值。结果 SAP组CD64、CD11b/CD18指数及PCT均显著高于MAP组和对照组，差异均有统计学意义（P均<0.01）；败血症组CD64、CD11b/CD18指数及PCT表达水平显著高于局部感染组和单纯AP组（P均<0.01）。 Pearson相关分析显示外周血CD64指数与CD11/CD18及血清PCT水平成正相关（r=0.762，0.68；P<0.01）。以CD64指数>2.25，CD11b/CD18>33，PCT>1.85为阳性临界值标准时，其诊断细菌感染的敏感性分别为98%、94％和78%，特异性为95%、93%和76%。结论外周血CD64、CD11b/CD18指数升高对急性胰腺炎合并细菌感染具有早期诊断价值，其诊断效能优于PCT，并可作为病情评估和指导临床合理使用抗生素的生物学新指标。%Objective To evaluate the value of CD64 and CD11b/CD18 Index in the early diagnosis of acute pancreatitis with bacterial infection. Methods A total of 158 acute pancreatitis patients were divided into severe acute pancreatitis group (SAP ,60 cases) and mild pancreatitis group (MAP,98 cases) according to the degree of the disease,or divided into sepsis group (SEP,45 cases),local infection group(LOC,63 cases) and simple acute pancreatitis group(SIM,60 cases) according to whether were simulta-neously infected by bacteria;30 healthy individuals were served as normal control. Levels of CD64,CD11b/CD18 were detected by flow cytometry,and those of serum PCT were tested by Roche electrochemiluminescence immunoassay. The sensitivity,specificity and accuracy of each index for early diagnosis of acute pancreatitis with bacterial infection were evaluated and compared with each other. Results levels of CD64,CD11b/CD18 and PCT in SAP group were significantly higher than those in MAP group and control group (P<0.01);levels of CD64,CD11b/CD18 and PCT in sepsis group were significantly higher than those in local infection group and simple AP group(P<0.01). Pearson correlation analysis showed that the peripheral CD64,CD11/CD18 were positively correlat-ed with serum PCT levels (r=0.762,0.762;P<0.01). Taking CD64 index >2.25,the CD11b/CD18 index >33,PCT>1.85 as positive cutoff value,sensitivities of diagnosis of bacterial infection were 98%,94%and 78%,specificities of that were 95%,93%and 76%. Conclusion CD64 index,CD11b/CD18 index in peripheral blood were more efficient than PCT in early diagnosis of acute pan-creatitis with bacterial infection,and could be used as new candidate biomarkers to guide clinical rational use of antibiotics.