Yang Ai-Ping, Liu Jun, Yue Lei-He, Wang Hong-Qi, Yang Wen-Juan, Yang Guo-Hui
Clin Chem Lab Med. 2016 Feb;54(2):345-51. doi: 10.1515/cclm-2015-0277.
The aim of this study was to determine whether neutrophil CD64 (nCD64) combined with procalcitonin (PCT), C-reactive protein (CRP) and white blood cell count (WBC) can increase the sensitivity and accuracy of neonatal sepsis diagnosis.
The serum levels of nCD64, CRP, PCT and WBC were detected in 60 patients with neonatal sepsis and 60 patients with non-sepsis. Sensitivity, specificity, positive and negative predictive values, receiver operating characteristic (ROC) area under the curve (AUC), and logistic regression analysis were performed to evaluate the diagnostic value of these markers on neonatal sepsis.
Serum levels of nCD64, PCT, CRP and WBC were higher in the sepsis group than non-sepsis group (p<0.001). The sensitivities of nCD64, PCT, CRP and WBC at the recommended cut-off level for all infants were 79.5%, 68.2%, 38.6% and 52.3%, respectively. The best combination was nCD64 and PCT, which obtained sensitivity of 90.9%, largest AUC of 0.922, and a negative predictive value of 89.2%. However by using an optimal cut-off value, the sensitivities of all four biomarkers for the diagnosis of neonatal sepsis were increased to 95.5%. Except for WBC, the birth weight and gestational age had no effects on the diagnostic value of these serum biomarkers.
nCD64 and PCT are better diagnostic biomarkers for early diagnosis of neonatal sepsis as compared to CRP. With the help of optimal cut-off value based on ROC curve and logistic regression analysis, the combination of these biomarkers could improve the sensitivity for the diagnosis of suspected late-onset neonatal sepsis based on common serum biomarkers.
本研究旨在确定中性粒细胞CD64（nCD64）联合降钙素原（PCT）、C反应蛋白（CRP）和白细胞计数（WBC）是否能提高新生儿败血症诊断的敏感性和准确性。
检测60例新生儿败血症患者和60例非败血症患者的血清nCD64、CRP、PCT和WBC水平。进行敏感性、特异性、阳性和阴性预测值、受试者操作特征（ROC）曲线下面积（AUC）以及逻辑回归分析，以评估这些标志物对新生儿败血症的诊断价值。
败血症组血清nCD64、PCT、CRP和WBC水平高于非败血症组（p<0.001）。所有婴儿在推荐临界值水平时，nCD64、PCT、CRP和WBC的敏感性分别为79.5%、68.2%、38.6%和52.3%。最佳组合是nCD64和PCT，其敏感性为90.9%，最大AUC为0.922，阴性预测值为89.2%。然而，通过使用最佳临界值，所有四种生物标志物对新生儿败血症诊断的敏感性提高到了95.5%。除WBC外，出生体重和胎龄对这些血清生物标志物的诊断价值没有影响。
与CRP相比，nCD64和PCT是早期诊断新生儿败血症更好的诊断生物标志物。借助基于ROC曲线和逻辑回归分析的最佳临界值，这些生物标志物的组合可以提高基于常见血清生物标志物对疑似晚发性新生儿败血症诊断的敏感性。
