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[1]王虎,蔡苗苗,张姣姣,等.中性粒细胞CD64对脓毒症患者病情严重程度及预后的评估价值[J].医学研究与战创伤救治(原医学研究生学报),2023,25(1):43-49.[doi:10.3969/j.issn.1672-271X.2023.01.009]
　WANG Hu,CAI Miaomiao,ZHANG Jiaojiao,et al.The evaluation value of neutrophil CD64 on the severity and prognosis of patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2023,25(1):43-49.[doi:10.3969/j.issn.1672-271X.2023.01.009]
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中性粒细胞CD64对脓毒症患者病情严重程度及预后的评估价值()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第25卷
期数:
2023年1期
页码:
43-49
栏目:
临床研究
出版日期:
2023-05-10

文章信息/Info

Title:
The evaluation value of neutrophil CD64 on the severity and prognosis of patients with sepsis
作者:
王虎; 蔡苗苗; 张姣姣; 孙俊楠; 王海嵘
作者单位：200092上海，上海市胸科医院/上海交通大学医学院附属胸科医院急诊科（王虎）；200081上海，上海欧阳路街道卫生服务中心（蔡苗苗）；200000上海，上海交通大学医学院附属仁济医院南院急诊科（张姣姣）；200000上海，上海交通大学医学院（孙俊楠）；200092上海，上海交通大学医学院附属新华医院急诊科（王海嵘）
Author(s):
WANG Hu1; CAI Miaomiao2; ZHANG Jiaojiao3; SUN Junnan4; WANG Hairong5
(1.Department of Emergency Medicine,Shanghai Chest Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200092,China;2.Shanghai Ouyang Road Street Health Service Center,Shanghai 200081,China;3.Department of Emergency Medicine,South Hospit
关键词:
CD64; 脓毒症; 严重程度; 预后
Keywords:
CD64;  sepsis;  severity;  prognosis
分类号:
R459.7
DOI:
10.3969/j.issn.1672-271X.2023.01.009
文献标志码:
A
摘要:
目的探讨中性粒细胞CD64在脓毒症患者病情严重程度和预后评估中的价值。方法回顾性分析2018年6月-2021年6月上海交通大学医学院附属新华医院急诊医学科收治的190例成人脓毒症患者的临床资料，根据有无休克将患者分为脓毒症组129例和脓毒性休克组61例，根据28 d生存情况将其分为存活组148例和死亡组42例。收集患者入院24 h内的CD64、白细胞计数（WBC）、C-反应蛋白(CRP)、降钙素原（PCT）、（IL-6）等化验，计算入院24 h内APACHEⅡ、SOFA评分等指标，并进行统计分析。结果与脓毒症组相比，脓毒性休克组患者APACHEⅡ评分、SOFA评分、WBC、PCT、CRP、CD64、IL-6、IL-8及D二聚体水平明显升高，多因素logistic回归分析显示SOFA评分、APACHEⅡ评分、CD64及PCT是脓毒血症严重程度的独立影响因素，其预测脓毒症严重程度的曲线下面积（AUC）分别为0.819、0.799、0.795、0.778，CD64的AUC高于其他任一单个血标本检测项目，其灵敏度为75.7%，特异度为66.7%。与生存组相比，死亡组患者APACHEⅡ评分、SOFA评分、PCT、CD64、IL-6、IL-8及D二聚体水平均升高，CD4+T淋巴细胞及CD8+T淋巴细胞降低（P＜0.05）。CD64预测28 d死亡率的AUC为0.742，显著高于PCT（AUC=0.706）、IL-6（AUC=0.703）、IL-8（AUC=0.694）及D-二聚体（AUC=0.667），略低于SOFA评分（AUC=0.757）、APACHEⅡ评分（AUC=0.744），CD64预测脓毒症患者预后的最佳截断值为8.87，灵敏度为72.3%，特异度为65.8%。Kaplan-meier生存曲线结果提示CD64≥8.87组脓毒症患者28 d病死率显著高于CD64＜8.87组（P＜0.001）。结论CD64是评估脓毒症患者病情严重程度的有效指标，对于脓毒症患者住院28 d的病死率具有一定预测效能。
Abstract:
ObjectiveTo investigate the value of neutrophil CD64 in evaluating the severity and prognosis as a biomarker in sepsis patients.MethodsThe clinical data of 190 patients with sepsis admitted to the XinHua hsopital affiliated of ShangHai jiaotong university of medicine from Jun.2018 to Jun.2021 were retrospectively enrolled.Patients were divided into sepsis group(129 cases) and septic shock group(61 cases) according to whether ther were shock,and divided into the survival group(148 cases) and the death group(42 cases) accroding to the situation of survival in 28d.Neutrophil CD64,white blood cell, C-reactive protein ,procalcitonin and interleukin-6were collected within 24 hours after admission.Scores of APACHEⅡ and SOFA within 24h were calculated and statistically analyzed.ResultsCompared with the sepsis group, the levels of APACHE Ⅱ score, SOFA score, WBC, PCT, CRP, CD64, IL-6, IL-8 and D dimer in the septic shock group were significantly increased. Multivariate logistic regression analysis shows that SOFA score, APACHE Ⅱ score, CD64 and PCT are independent factors influencing the severity of sepsis. The area under curve (AUC) for predicting the severity of sepsis is 0.819, 0.799, 0.795, 0.778, respectively. The AUC of CD64 is higher than any other single blood sample detection item, with a sensitivity of 75.7% and a specificity of 66.7%. Compared with the survival group, the APACHEⅡ score, SOFA score, PCT, CD64, IL-6, IL-8 and D dimer levels of the death group increased, and the CD4+ T lymphocytes and CD8+ T lymphocytes decreased (P<0.05).CD64 predicts the 28-day mortality AUC is 0.742, which is significantly higher than PCT (AUC=0.706), IL-6 (AUC=0.703), IL-8 (AUC=0.694) and D-dimer (AUC=0.667), slightly Lower than the SOFA score (AUC=0.757) and APACHEⅡ score (AUC=0.744), the best cut-off value of CD64 for predicting the prognosis of sepsis patients is 8.87, the sensitivity is 72.3%, and the specificity is 65.8%. Kaplan-meier survival curve results suggest that the 28-day mortality rate of sepsis patients in the CD64≥8.87 group was significantly higher than that in the CD64<8.87 group (P＜0.001).ConclusionCD64 expression is valuable parameters for evaluate severity of sepsis and prognostic evaluation of sepsis patients.

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更新日期/Last Update: 2023-04-19