Shao Jie, Huang Xin-wen, Sun Mei-yue, DU Li-zhong, Tang Yong-min, Le Yuan-luo
Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Zhonghua Er Ke Za Zhi. 2005 Jul;43(7):510-3.
Neonatal septicemia is a common and severe infection, which often results in death. Early diagnosis and treatment of neonatal septicemia may help decrease neonatal mortality. Recently, many studies sought to explore the possibility of early diagnosis of this disease. The high affinity Fcgamma-receptor I (CD(64)) was purposefully chosen as a potential marker for identifying neonatal septicemia. The present study was designed to evaluate neutrophil CD(64) level for early diagnosis of neonatal septicemia.
Eighty-nine suspected neonatal septicemia cases were recruited into the study. Five non-specific indices, i.e., C-reactive protein (CRP), micro-erythrocyte sedimentation rate (mESR), white blood cell count, platelet count and the ratio of immature neutrophil count to total neutrophil count were measured for each patient. The patients were divided into septicemia group (n = 39) and non-septisemic infection group (n = 50) according to the diagnostic criteria for neonatal septicemia. Nineteen hospitalized neonates with non-infectious diseases were enrolled as controls (n = 19). The levels of peripheral blood neutrophil CD(64) were measured by using flow cytometry. The positive rate, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CD(64) were calculated.
The levels of peripheral blood neutrophil CD(64) in septicemia patients were (75.6 +/- 8.9)%, which were significantly higher than those of non-septisemic infection group (29.1 +/- 6.2)% and control group (5.1 +/- 1.1)% (P < 0.05), respectively. There were no significant differences in the levels of CD(64) expression between the patients with Gram-negative (79.5 +/- 3.5)% and Gram- positive (76.4 +/- 5.0)% (P > 0.05) bacterial infection. The levels of CD(64) of the cases with septicemia significantly decreased at day 10 of treatment with antibiotics. The detection of CD(64) (cutoff value > 30%) for suspected septicemia showed high sensitivity (97.4%), specificity (84.0%), PPV (82.6%), and NPV (97.6%). The positive rate of CD(64) detection (62.9%) was much higher than that of the blood culture test (19.1%) and that of the five nonspecific indices (29.2%, P < 0.05, respectively).
The expression of CD(64) increased in neonatal septicemia cases. The measurement of cell surface expression of CD(64) on neutrophils may be helpful to early diagnosis, evaluation of severity of infection and observation of therapeutic effects for neonatal septicemia.
新生儿败血症是一种常见且严重的感染性疾病，常导致死亡。早期诊断和治疗新生儿败血症有助于降低新生儿死亡率。近年来，许多研究试图探索早期诊断该疾病的可能性。高亲和力Fcγ受体I（CD64）被特意选为识别新生儿败血症的潜在标志物。本研究旨在评估中性粒细胞CD64水平用于新生儿败血症的早期诊断。
89例疑似新生儿败血症病例纳入本研究。为每位患者检测5项非特异性指标，即C反应蛋白（CRP）、微量红细胞沉降率（mESR）、白细胞计数、血小板计数以及未成熟中性粒细胞计数与总中性粒细胞计数之比。根据新生儿败血症诊断标准将患者分为败血症组（n = 39）和非败血症感染组（n = 50）。选取19例住院的非感染性疾病新生儿作为对照组（n = 19）。采用流式细胞术检测外周血中性粒细胞CD64水平。计算CD64的阳性率、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
败血症患者外周血中性粒细胞CD64水平为（75.6 ± 8.9）%，显著高于非败血症感染组（29.1 ± 6.2）%和对照组（5.1 ± 1.1）%（P < 0.05）。革兰阴性菌（79.5 ± 3.5）%和革兰阳性菌（76.4 ± 5.0）%感染患者的CD64表达水平无显著差异（P > 0.05）。败血症病例在抗生素治疗第10天时CD64水平显著下降。对疑似败血症检测CD64（临界值> 30%）显示出高敏感性（97.4%）、特异性（84.0%）、PPV（82.6%）和NPV（97.6%）。CD64检测的阳性率（62.9%）远高于血培养检测阳性率（19.1%）和5项非特异性指标的阳性率（29.2%，P < 0.05）。
新生儿败血症病例中CD64表达增加。检测中性粒细胞表面CD64表达可能有助于新生儿败血症的早期诊断、评估感染严重程度及观察治疗效果。
