Choo Young Kwang, Cho Hyun-Seok, Seo In Bum, Lee Hyeon-Soo
Department of Pediatrics, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea.
Korean J Pediatr. 2012 Jan;55(1):11-7. doi: 10.3345/kjp.2012.55.1.11. Epub 2012 Jan 31.
Early identification of neonatal sepsis is a global issue because of limitations in diagnostic procedures. The objective of this study was to compare the diagnostic accuracy of neutrophil CD64 and C-reactive protein (CRP) as a single test for the early detection of neonatal sepsis.
A prospective study enrolled newborns with documented sepsis (n=11), clinical sepsis (n=12) and control newborns (n=14). CRP, neutrophil CD64, complete blood counts and blood culture were taken at the time of the suspected sepsis for the documented or clinical group and at the time of venipuncture for laboratory tests in control newborns. Neutrophil CD64 was analyzed by flow cytometry.
CD64 was significantly elevated in the groups with documented or clinical sepsis, whereas CRP was not significantly increased compared with controls. For documented sepsis, CD64 and CRP had a sensitivity of 91% and 9%, a specificity of 83% and 83%, a positive predictive value of 83% and 33% and a negative predictive value of 91% and 50%, respectively, with a cutoff value of 3.0 mg/dL for CD64 and 1.0 mg/dL for CRP. The area under the receiver-operating characteristic curves for CD64 index and CRP were 0.955 and 0.527 (P<0.01), respectively.
These preliminary data show that diagnostic accuracy of CD64 is superior to CRP when measured at the time of suspected sepsis, which implies that CD64 is a more reliable marker for the early identification of neonatal sepsis as a single determination compared with CRP.
由于诊断方法存在局限性，新生儿败血症的早期识别是一个全球性问题。本研究的目的是比较中性粒细胞CD64和C反应蛋白（CRP）作为早期检测新生儿败血症单一检测方法的诊断准确性。
一项前瞻性研究纳入了确诊败血症的新生儿（n = 11）、临床败血症的新生儿（n = 12）和对照新生儿（n = 14）。对于确诊或临床组，在怀疑败血症时采集CRP、中性粒细胞CD64、全血细胞计数和血培养；对于对照新生儿，在静脉穿刺进行实验室检测时采集。通过流式细胞术分析中性粒细胞CD64。
确诊或临床败血症组中CD64显著升高，而与对照组相比，CRP没有显著增加。对于确诊败血症，CD64和CRP的敏感性分别为91%和9%，特异性分别为83%和83%，阳性预测值分别为83%和33%，阴性预测值分别为91%和50%，CD64的临界值为3.0mg/dL，CRP的临界值为1.0mg/dL。CD64指数和CRP的受试者工作特征曲线下面积分别为0.955和0.527（P<0.01）。
这些初步数据表明，在怀疑败血症时测量，CD64的诊断准确性优于CRP，这意味着与CRP相比，CD64作为单一测定指标是早期识别新生儿败血症更可靠的标志物。
