| 黄穹琼.中性粒细胞 CD64指数、中性粒细胞与淋巴细胞比值、白介素 -6对呼吸机相关性肺炎的早期诊断价值[J].安徽医药,2022,26(3):480-484. |
| 中性粒细胞 CD64指数、中性粒细胞与淋巴细胞比值、白介素 -6对呼吸机相关性肺炎的早期诊断价值 |
| Early diagnostic value of the neutrophil CD64 index, neutrophil to lymphocyte ratio and interleukin-6 in ventilator-associated pneumonia |
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| DOI：10.3969/j.issn.1009-6469.2022.03.013 |
| 中文关键词: 肺炎，呼吸机相关性 中性粒细胞 CD64指数 中性粒细胞与淋巴细胞比值 白介素 -6 诊断价值 |
| 英文关键词: Pneumonia, ventilator-associated CD64 index of neutrophils Ratio of neutrophils to lymphocytes Interleukin-6 Diagnostic value |
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| 中文摘要: |
| 目的观察中性粒细胞 CD64指数、中性粒细胞与淋巴细胞比值( NLR)、白介素 -6(IL-6)在呼吸机相关性肺炎( VAP)病人外周血中的水平及探讨三者诊断 VAP的价值。方法前瞻性选取 2014年 5月至 2019年 4月哈尔滨医科大学附属第一医院收治的行机械通气重症监护室病人 149例，依据 7d内是否发生 VAP分为非 VAP组 87例和 VAP组 62例，并以同期该院健康体检者 70例为对照组。收集分析各组基本资料；利用流式细胞术测定外周血中性粒细胞 CD64指数；测定各组外周血 NLR水平；以酶联免疫吸附测定(ELISA)检验各组血清 IL-6水平； Pearson相关性分析探索 VAP病人外周血 CD64指数、 NLR及 IL-6与临床肺部感染评分( CPIS)的关系； logistic回归分析 VAP发生的影响因素；以受试者工作特征( ROC)曲线评价外周血 CD64指数、 NLR、IL-6、CPIS对 VAP的诊断价值。结果 VAP组病人白细胞计数( 10.15±3.22)×109/L、体温( 38.36±0.30)℃、CD64指数(6.75±1.92)、 NLR(9.67±2.58)及 IL-6(30.53±5.42)ng/L水平均明显高于对照组及非 VAP组(均 P<0.05)，且 VAP组 CPIS(7.76± 1.56)评分明显高于非 VAP组( P<0.05)； VAP病人外周血 CD64指数、 NLR、IL-6与 CPIS均呈正相关( r=0.487、0.567、0.559，均 P< 0.05)； CPIS、CD64指数、 NLR、IL-6均是影响 VAP发生的独立危险因素(均 P<0.05)；外周血 CD64指数、 NLR、IL-6、CPIS诊断 VAP的曲线下面积(AUC)分别为 0.853、0.882、0.818、0.752，此时对应灵敏度分别为 71.0%、79.0%、75.8%、67.7%，特异度分别为87.4%、83.9%、83.9%、67.8%；外周血 CD64指数、 NLR、IL-6联合检测 VAP的 AUC为 0.936，此时对应灵敏度、特异度分别为90.3%、87.9%，其灵敏度、诊断价值高于 CD64指数、 NLR、IL-6、CPIS。结论外周血 CD64指数、 NLR、IL-6在 VAP病人呈高水平，具有一定诊断价值，三者联合可更好地诊断 VAP。 |
| 英文摘要: |
| Objective To observe the levels of neutrophil CD64 index, neutrophil to lymphocyte ratio (NLR) and interleukin-6 (IL6) levels in the peripheral blood of patients with ventilator-associated pneumonia (VAP), and to explore their values in diagnosing VAP. Methods A total of 149 patients in the intensive care unit (ICU) with mechanical ventilation who were admitted to the First AffiliatedHospital of Harbin Medical University from May 2014 to April 2019 were prospectively selected. According to whether VAP occurred within 7 days, they were divided into a non-VAP group (87 cases) and a VAP group (62 cases), and 70 healthy people during the sameperiod were used as the control group. The basic data of each group were collected and analyzed; the neutrophil CD64 index in peripheral blood was determined by flow cytometry; the NLR level in peripheral blood of each group was measured; the serum IL-6 level of each group was detected by enzyme-linked immunosorbent assay (ELISA); Pearson correlation analysis was used to explore the relationships between peripheral blood CD64 index, NLR and IL-6 and clinical pulmonary infection score (CPIS) in patients with VAP; logisticregression analysis was used to analyze the influencing factors of VAP occurrence; the diagnostic value of peripheral blood CD64 index,NLR, IL-6 and CPIS for VAP was evaluated by receiver operating characteristic (ROC) curve.Results In the VAP group, white blood cell count (10.15±3.22)×109/L, body temperature (38.36±0.30)°C, CD64 index (6.75±1.92), NLR (9.67±2.58) and IL-6 (30.53±5.42) ng/ L level were significantly higher than those in the control group and non-VAP group (P < 0.05), and the CPIS (7.76±1.56) score in the VAP group was significantly higher than that in the non-VAP group (P < 0.05); Peripheral blood CD64 index, NLR, IL-6 and CPIS of VAP patients were all positively correlated (r = 0.487, 0.567, 0.559, P < 0.05); CPIS, CD64 index, NLR and IL-6 were all independent risk factors for VAP (P < 0.05); the area under curve (AUC) of peripheral blood CD64 index, NLR, IL-6 and CPIS for the diagnosis ofVAP were 0.853, 0.882, 0.818 and 0.752, the corresponding sensitivities were 71.0%, 79.0%, 75.8% and 67.7%, and the specificitieswere 87.4%, 83.9%, 83.9% and 67.8%, respectively; the AUC of the combination of CD64 index, NLR, IL-6 in peripheral blood for diagnosing VAP was 0.936, and the corresponding sensitivity and specificity were 90.3% and 87.9%, respectively, and its sensitivity anddiagnostic value were higher than CD64 index, NLR, IL-6 and CPIS.Conclusion The peripheral blood CD64 index, NLR and IL-6 are high in VAP patients and have certain diagnostic value, which suggests that the combination of the three can better diagnose VAP. |
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