中性粒细胞CD64指数和单核细胞HLA-DR在细菌与病毒性感染中的诊断价值

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摘要目的探讨中性粒细胞CD64指数（nCD64 index）和单核细胞人类白细胞抗原DR（mHLA-DR）在鉴别细菌与病毒性感染中的诊断价值。方法选取2019年1月—11月东莞康华医院（以下简称“我院”）诊治的74例发热患者，根据病因分为细菌感染组（40例）和病毒感染组（34例），同时选取我院同期体检的健康人群40名作为健康对照组。检测并比较各组CD64和HLA-DR水平，用受试者工作曲线（ROC）分析各指标在鉴别感染中的诊断价值。结果细菌感染组nCD64和nCD64 index显著高于健康对照组和病毒感染组，差异有统计学意义（P ＜ 0.05）；病毒感染组mHLA-DR和单核细胞HLA-DR阳性百分数[mHLA-DR+（%）]显著高于健康对照组和细菌感染组，差异有统计学意义（P ＜ 0.05）。nCD64、nCD64 index、mHLA-DR和mHLA-DR+（%）指标在鉴别感染的最佳截断值分别是30.8、0.53、325和93.9%，ROC曲线下面积分别是0.929、0.969、0.778和0.782。nCD64 index和mHLA-DR联合检测在鉴别感染曲线下面积为0.971，灵敏度（95.00%）和特异度（94.12%）均较高。结论流式细胞术联合检测nCD64 index和mHLA-DR可用于细菌与病毒性感染的鉴别诊断。

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	余建华1 张艳洪1 邹小凤1 朱文婷1 李鑫2 陈美琪3

关键词 ：中性粒细胞CD64, 人类白细胞抗原DR, 流式细胞术, 感染

Abstract：Objective To explore the diagnostic value of neutrophil CD64 index (nCD64 index) and monocyte human leukocyte antigen DR (mHLA-DR) in distinguishing bacterial and viral infections. Methods A total of 74 fever patients diagnosed and treated by Dongguan Kanghua Hospital (hereinafter referred to as “our hospital”) were selected from January to November 2019. According to the cause, they were divided into bacterial infection group (40 cases) and viral infection group (34 cases), while 40 healthy people who received physical examination in the hospital during the same period were served as healthy controls. The levels of CD64 and HLA-DR in each group were detected and compared, and receiver operating curve (ROC) was used to analyze the diagnostic value of each index in identifying infections. Results The nCD64 and nCD64 index of the bacterial infection group were significantly higher than those of the healthy control group and the virus infection group, and the differences were statistically significant (P < 0.05); the virus infection group was positive for mHLA-DR and the percentage of monocyte HLA-DR [mHLA-DR+(%)] were significantly higher than those of the healthy control group and the bacterial infection group, and the differences were statistically significant (P < 0.05). The best cut-off values of nCD64, nCD64 index, mHLA-DR and mHLA-DR+ (%) in identifying infections were 30.8, 0.53, 325 and 93.9%, respectively, while the area under the ROC were 0.929, 0.969, 0.778 and 0.782, respectively. The combined detection of nCD64 index and mHLA-DR had an area under the differential infection curve of 0.971, with high sensitivity (95.00%) and specificity (94.12%). Conclusion The combined detection of nCD64 index and mHLA-DR by flow cytometry can be used for the differential diagnosis of bacterial and viral infections.

Key words： Neutrophil CD64 Human leukocyte antigen DR Flow cytometry Infection

基金资助:广东省东莞市社会科技发展（一般）项目（20185 07150591256）。

作者简介: 余建华（1983.9-），男，硕士；研究方向：血液病诊断及流式细胞术临床应用。

引用本文:

余建华1 张艳洪1 邹小凤1 朱文婷1 李鑫2 陈美琪3. 中性粒细胞CD64指数和单核细胞HLA-DR在细菌与病毒性感染中的诊断价值[J]. 中国医药导报, 2021, 18(6): 34-37,53.
YU Jianhua1 ZHANG Yanhong1 ZOU Xiaofeng1 ZHU Wenting1 LI Xin2 CHEN Meiqi3. The diagnostic value of neutrophil CD64 and monocyte HLA-DR in bacterial and viral infections. 中国医药导报, 2021, 18(6): 34-37,53.

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