外周血中性粒细胞CD64指数联合补体、CRP、白细胞计数及B细胞可提高系统性红斑狼疮患者细菌感染的诊断能力。
Peripheral neutrophil CD64 index combined with complement, CRP, WBC count and B cells improves the ability of diagnosing bacterial infection in SLE.
作者信息
Feng M, Zhang S L, Liang Z J, Wang Y L, Zhao X C, Gao C, Guo H, Luo J
机构信息
1 Shanxi Medical University, Taiyuan, Shanxi, China.
2 Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
出版信息
Lupus. 2019 Mar;28(3):304-316. doi: 10.1177/0961203319827646. Epub 2019 Feb 2.
OBJECTIVE
To investigate the diagnostic role of complement C3, complement C4, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), neutrophil CD64 (nCD64) index, lymphocyte subsets and their combination in differentiating bacterial infection from disease relapse in systemic lupus erythematosus (SLE).
METHODS
The above biomarkers in 36 hospitalized SLE patients with bacterial infection and 45 with lupus flare without infection were retrospectively studied. Bacterial infection was proven by positive cultures or typical clinical symptoms and signs combined with positive response to antibiotics. Lupus flare was defined as three points greater than their previous SLE disease activity index score. The diagnostic value for bacterial infection was evaluated by the areas under the receiver operating characteristic curves (AUC) and a novel bioscore system combining multiple biomarkers.
RESULTS
Increased CRP ( p = 0.049), WBC ( p = 0.028) and nCD64 index ( p = 0.034) were observed in the infected group and C3 ( p = 0.001), C4 ( p = 0.016) and B cells levels ( p = 0.010) were significantly reduced. The AUC for the above six biomarkers had no significant difference. Interestingly, the combination of nCD64 index, CRP, WBC, C3 and C4 improved significantly the diagnostic potential of SLE infection (AUC 0.783 (interquartile range 0.672, 0.871), p < 0.001; sensitivity 85.29% specificity 62.50%). In the bioscore system including the above six biomarkers, the bacterial infection rate in patients with bioscore ≤2, 3, 4, 5 and 6 were 0.00, 39.29, 59.10, 61.54 and 100.00%, respectively.
CONCLUSION
The combination of nCD64 index, C3, C4, CRP, WBC and B cells in a bioscore is useful to diagnose bacterial infection in SLE.
目的
探讨补体C3、补体C4、C反应蛋白（CRP）、降钙素原（PCT）、白细胞计数（WBC）、中性粒细胞CD64（nCD64）指数、淋巴细胞亚群及其组合在系统性红斑狼疮（SLE）患者细菌感染与疾病复发鉴别诊断中的作用。
方法
回顾性研究36例住院的SLE细菌感染患者及45例无感染的狼疮活动患者上述生物标志物情况。细菌感染通过培养阳性或典型临床症状体征及抗生素治疗有效证实。狼疮活动定义为较之前SLE疾病活动指数评分增加3分。采用受试者工作特征曲线（ROC）下面积及一种结合多种生物标志物的新型生物评分系统评估细菌感染的诊断价值。
结果
感染组患者CRP（p = 0.049）、WBC（p = 0.028）及nCD64指数（p = 0.034）升高，C3（p = 0.001）、C4（p = 0.016）及B细胞水平（p = 0.010）显著降低。上述6种生物标志物的ROC曲线下面积无显著差异。有趣的是，nCD64指数、CRP、WBC、C3及C4联合显著提高了SLE感染的诊断效能（AUC 0.783（四分位间距0.672，0.871），p < 0.001；敏感性85.29%，特异性62.50%）。在包含上述6种生物标志物的生物评分系统中，生物评分≤2、3、4、5及6的患者细菌感染率分别为0.00%、39.29%、59.10%、61.54%及100.00%。
结论
生物评分中nCD64指数、C3、C4、CRP、WBC及B细胞的联合有助于诊断SLE患者的细菌感染。
Zotero 插件