Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
Neonatology. 2011;99(2):118-24. doi: 10.1159/000311289. Epub 2010 Aug 24.
Newborn infants with intra-abdominal inflammation/sepsis often present with nonspecific signs in the early stages of the disease, but can rapidly develop life-threatening complications. A reliable 'early' biomarker would be invaluable.
To evaluate the effectiveness of neutrophil CD64 as an 'early' biomarker of intra-abdominal inflammation/sepsis.
Blood was collected from newborns with suspected intra-abdominal pathology for neutrophil CD64 and C-reactive protein (CRP) determination at the onset of clinical presentation and 24 h later. They were classified into three groups: intra-abdominal inflammation/sepsis (group 1), extra-abdominal sepsis (group 2) and nonsepsis (group 3). Between-group comparisons were made by Kruskal-Wallis and χ(2) tests. Receiver-operating characteristic curves and diagnostic utilities for single and combination of tests were determined.
310 infants were recruited (102, 34 and 174 in groups 1, 2 and 3, respectively). CD64 (conventional cutoff = 6,010 antibody-PE molecules bound/cell) had substantially better sensitivity (0.81 vs. 0.56) and negative predictive value (0.90 vs. 0.79) for diagnosing intra-abdominal sepsis than CRP, at presentation. Pairing CD64 with routine abdominal radiograph (AXR) substantially increased the sensitivity and negative predictive value for group 1 to 0.99 and 0.99, respectively. By adjusting the CD64 cutoff to 12,500 units, a substantial improvement in specificity could be achieved (0.62 to 0.80) without significantly compromising sensitivity (0.99 to 0.97).
CD64 is a sensitive and 'early' biomarker for diagnosing intra-abdominal inflammation/sepsis. Intra-abdominal catastrophes, including necrotizing enterocolitis, intestinal necrosis, perforation and peritonitis can confidently be excluded using CD64 and AXR early in the course of the disease.
患有腹内炎症/败血症的新生儿在疾病早期常出现非特异性体征，但可迅速发展为危及生命的并发症。一个可靠的“早期”生物标志物将是非常宝贵的。
评估中性粒细胞 CD64 作为腹内炎症/败血症的“早期”生物标志物的有效性。
对疑似腹内病理的新生儿在出现临床症状时和 24 小时后采集血液，用于中性粒细胞 CD64 和 C 反应蛋白（CRP）测定。他们被分为三组：腹内炎症/败血症（组 1）、腹外败血症（组 2）和非败血症（组 3）。采用 Kruskal-Wallis 和 χ(2)检验进行组间比较。确定单个和联合检测的受试者工作特征曲线和诊断效用。
共纳入 310 例婴儿（组 1、2 和 3 分别为 102、34 和 174 例）。CD64（常规截定点=6010 个抗体-PE 分子结合/细胞）在诊断腹内败血症方面的敏感性（0.81 比 0.56）和阴性预测值（0.90 比 0.79）均显著优于 CRP，在就诊时。将 CD64 与常规腹部 X 线摄影（AXR）相结合，可将组 1 的敏感性和阴性预测值分别提高至 0.99 和 0.99。通过将 CD64 截定点调整为 12500 个单位，可以在不显著降低敏感性（0.99 至 0.97）的情况下，显著提高特异性（0.62 至 0.80）。
CD64 是诊断腹内炎症/败血症的敏感和“早期”生物标志物。使用 CD64 和 AXR 可以在疾病早期排除包括坏死性小肠结肠炎、肠坏死、穿孔和腹膜炎在内的腹内灾难。
