腹水 CD64及外周血 mCD14检测在肝硬化合并自发性细菌性腹膜炎中的价值研究

摘要

ObjectiveIt is to investigate the change and significance of ascites CD 64 and peripheral mCD14for hepatocir-rhosis patients with spontaneous bacterial peritonitis (SBP).Methods 87 hepatocirrhosis patients with ascites were selected and divided into two groups according to whether combined SBP, 44 cases combined SBP in research group, and 43 cases none SBP in control group.Flow cytometry was used to detect the average fluorescent intensity and index of CD 64 in ascites neutro-phils and lymphocytes, and the peripheral blood white blood cell count , mCD14 positive expression rate, mCD14 average fluo-rescence intensity and mCD14 index of the two groups.The fluorescent intensity and index of CD64 in ascites neutrophils and lymphoctesand the peripheral blood mCD14 in research group were compared according to effective and invalid, survival and death respectively.Results The neutrophils CD64 average fluorescence intensity and CD64 index of and peripheral blood leu-kocyte count of the research group were significantly higher than those of the control group (all P<0.05), the lymphocyte CD64 average fluorescence intensity, mCD14 positive expression rate, monocytes mCD14 average fluorescence intensity and mCD14 index were significantly lower than those of the control group (all P<0.05).The neutrophils CD64 average fluores-cence intensity and CD64 index of effective treatment/survival group were significantly lower than those of ineffective /death group(all P<0.05), and lymphocyte CD64 average fluorescence intensity, monocytes mCD14 average fluorescence intensity and mCD14 index were significantly higher than those of ineffective /death group ( all P<0.05 ) .The area under the ROC curve ( AUC) , the critical value, sensitivity and speciality rate of ascites CD64 and peripheral blood mCD14 combined detec-tion for therapeutic effect and prognosis prediction were significantly higher than those of CD64 or mCD14 single detection ( all P<0.05) .Conclusion Ascites neutrophils CD64 level is significantly higher, ascites lymphocytes CD64 and peripheral blood mononuclear cells mCD14 levels is decreased significantly, the combined detection of ascites CD64 and peripheral blood mCD14 has significant value in the predicts therapeutic effect and prognosis for hepatocirrhosis with SBP.%目的：探讨肝硬化合并自发性细菌性腹膜炎（ SBP）患者腹水CD64及外周血mCD14的变化及其意义。方法选取肝硬化合并腹水患者87例，根据是否合并SBP将患者分为2组：合并SBP 44例为研究组，未合并SBP 43例为对照组，采用流式细胞术检测2组患者腹水中性粒细胞和淋巴细胞CD64平均荧光强度、CD64指数，外周血白细胞计数、mCD14阳性表达率、mCD14平均荧光强度和mCD14指数。研究组抗感染治疗1周后再按治疗有效与无效、生存与死亡分组评价腹水中性粒细胞和淋巴细胞CD64平均荧光强度、CD64指数，外周血mCD14平均荧光强度和mCD14指数。结果研究组腹水中性粒细胞CD64平均荧光强度、CD64指数和外周血白细胞计数明显高于对照组（P均＜0．05），淋巴细胞CD64平均荧光强度、mCD14阳性表达率、mCD14平均荧光强度和mCD14指数均明显低于对照组（ P均＜0．05）。治疗有效组和生存组中性粒细胞CD64平均荧光强度和CD64指数均明显低于治疗无效组和死亡组（P均＜0．05），淋巴细胞CD64平均荧光强度、mCD14平均荧光强度和mCD14指数均明显高于治疗无效组和死亡组（P均＜0．05）。腹水CD64与外周血mCD14联合检测对治疗效果和预后判断的ROC曲线下面积、临界值、灵敏度和特异度均明显高于CD64、mCD14单项检测（P均＜0．05）。结论肝硬化合并SBP患者腹水中性粒细胞CD64显著增高，腹水淋巴细胞CD64与外周血mCD14显著降低，腹水CD64与外周血mCD14联合检测预示肝硬化合并SBP治疗效果和预后的价值显著。