骨髓移植术后巨细胞病毒肺炎患者体内CD11b的表达及临床意义

摘要

目的 探讨骨髓移植术后巨细胞病毒(Human cytomegalovirus,CMV)肺炎患者体内中性粒细胞表面黏附分子CD11b的表达及诊断价值.方法 收集我院2000年11月至2016年10月收治的骨髓移植术后患者60例,依据CMV-pp65抗原检测结果分组,同时选择我院门诊体检健康者33例为对照组.采用流式细胞仪分别检测上述各组的CD11b表达情况,并计算CD11b在诊断骨髓移植术后CMV肺炎过程中的受试者工作曲线(ROC曲线).结果 本研究高活动性CMV感染组17例(28.33%),CMV活动性感染组29例(48.33%),阴性对照组(未感染CMV)14例(23.34%).高活动性CMV感染组CD11b表达率为39.11%±4.98%,与CMV活动性感染组、阴性对照组和健康对照组比较,差异均有统计学意义(P<0.05).CD11b在诊断骨髓移植术后高活动性CMV感染的最佳临界值表达率为43.47%,敏感度为100%,特异度为59.47%,ROC曲线下面积为0.631;CD11b诊断骨髓移植术后CMV肺炎活动性感染者的最佳临界值表达率为69.34%,敏感度为86.92%,特异度为98.81%,ROC曲线下面积为0.987.结论 骨髓移植术后CMV肺炎患者体内CD11b表达下调,可作为鉴别诊断骨髓移植术后CMV肺炎活动性感染的实验室依据.%Objective To investigate the expression and diagnostic value of neutrophil surface adhesion molecules CD11b in patients with cytomegalovirus (CMV) pneumonia after bone marrow transplantation.Methods Blood samples of 60 bone marrow transplantation patients in our hospital from November 2000 to October 2016 were collected and grouped according to the results of CMV-pp65 antigen detection.Meanwhile,33 healthy cases from the physical examination were taken as control group.Flow cytometry was used to detect the expression of CD11b,and the ROC curves of CD11b in all the subjects during CMV pneumonia after bone marrow transplantation were formulated.Results There were 17 cases (28.33%) in high-active CMV infection group,29 cases (48.33%) in CMV infection group and 14 cases (23.34%) in negative control group (non-infection of CMV).The expression ratio of CD11b in high-active CMV infection group was 39.11%±4.98%,which was lower than that of CMV infection group,negative control group and control group (P<0.05).The optimal cut-off value in high-active CMV infection group was 43.47%,the sensitivity was 100%,the specificity was 59.47%,and the area under the receiver-operating curve (ROC) was 0.631.The optimal cut-off value of CD11b in CMV infection group was 69.34%,the sensitivity was 86.92%,the specificity was 98.81%,and the area under of ROC of CD11b was 0.987.Conclusion The expression of CD11b in the patients with CMV pneumonia after bone marrow transplantation is down-regulated,which can be used as a laboratory basis for differential diagnosis of CMV pneumonia after bone marrow transplantation.