| Purpose : To investigate the clinical value of Neutrophil CD64 index in the early diagnosis of etiology and the severe degree in pediatric community-acquired pneumonia,at the same time,to compare with the clinical commonly used inflammation index,numeration of leukocyte,Neutrophil percentage,C-reactive protein,calcitonin,Erythrocyte sedimentation and d-dimer.Method:A total of 108 hospitalized children with CAP diagnosed were selected in the department of pediatrics,affiliated hospital of Qingdao university during November 2018 to July 2019,aged from 1 to 13 years old.According to the clinical data standard and the empirical etiology judgment,the patients were divided into 3 groups,including 57 cases in the bacterial group,with an average age of 4.21±2.52 years.The average age of 31 patients in the virus group was 4.13±2.03 years.There were 20 cases in mycoplasma pneumoniae group with an average age of 4.85±2.46 years.The combination of the viral group and mycoplasma pneumoniae was called the non-bacterial CAP group.According to clinical symptoms,signs,laboratory tests and imaging tests,all the children were diagnosed in accordance with the diagnostic criteria of the 2013 revised "guidelines for the management of children's community-acquired pneumonia".Blood samples were collected within 24 hours after admission,and the mean fluorescence intensity of peripheral blood Neutrophils and lymphocytes CD64 was detected by flow cytometry.CD64 index = mean fluorescence intensity of granulocyte CD64 / mean fluorescence intensity of lymphocyte CD64.The levels of WBC,Neu%,ESR,d-dimer,CRP and PCT were also measured in the meantime.Statistical software SPSS 24.0 was used for statistical analysis and processing of the data obtained from the test.single factor analysis of variance,paired-t test,chi-square test,Pearson correlation analysis and ROC were used for statistical methods.p<0.05 was considered as significant difference.Result:1.CD64 index,WBC,Neu%,PCT,CRP and ESR in the bacterial group were significantly higher than those in the virus group and the mycoplasma pneumoniae group(p < 0.05).CD64 index,WBC,d-dimer,CRP,and PCT also increased in the mycoplasma pneumoniae group,which was higher than the virus group(p < 0.05).d-dimer in the bacterial group was significantly higher than that in the virus group(p<0.05),and was not significantly different from that in the mycoplasma pneumoniae group(p > 0.05).Neu% and ESR had no significant difference in mycoplasma pneumoniae group and virus group(p > 0.05).2.According to ROC curve.The areas under the curves of CD64 index,WBC,ESR,CRP and PCT were 0.982,0.832,0.767,0.866 and 0.944,respectively.The optimal cut-off value of CD64 index was 2.14 with 94.7% sensitivity,92.2% specificity and93.5% accuracy.The optimal cut-off value of WBC was 9.49×109/L,with a sensitivity of 80.7%,specificity of 74.5% and accuracy of 77.8%.The optimal cut-off value of ESR was 16.60mm/h,with a sensitivity of 75.4%,specificity of 68.6% and accuracy of 73.1%.The optimal cut-off value of CRP was 6.51 mg/L,with a sensitivity of 86.0%,specificity of 72.5% and accuracy of 79.6%.The optimal truncation value of PCT was 0.55ng/m L,with a sensitivity of 93.0%,specificity of84.3% and accuracy of 88.9%.3.The sensitivity,specificity and accuracy of WBC+ESR combined detection were80.7%,78.4% and 79.6%.The sensitivity,specificity and accuracy of CRP+PCT combined detection were 96.5%,80.4% and 88.9%.CD64 index +CRP combined detection showed 98.2% sensitivity,92.2% specificity and 95.4% accuracy.CD64 index +PCT combined detection showed 96.5% sensitivity,100% specificity and98.1% accuracy.CD64 index +CRP+PCT combined detection showed 96.5%sensitivity,100% specificity and 98.1% accuracy.4.According to Pearson's test,the correlation coefficients of CD64 index,WBC,ESR,CRP and PCT in the bacterial group were 0.370,0.393,0.573 and 0.508,respectively(p < 0.05).There was no significant correlation between CD64 index and WBC,ESR,CRP and PCT in the virus group(p > 0.05).The correlation coefficient between CD64 index and ESR in the mycoplasma pneumoniae group was 0.569(p < 0.05),showing a positive correlation.The correlation analysis between CD64 index and WBC,CRP and PCT showed no significant correlation(p > 0.05).5.CD64 index,WBC,Neu%,ESR,d-dimer,CRP and PCT were significantly higher in the severe group than in the mild group(p < 0.05).Conclusion:1.CD64 index has good inspiration,specificity and accuracy in determining bacterial pathogens in children CAP,which is better than WBC,ESR,D-dimer and CRP.It is similar to PCT,suggesting that CD64 index is a good diagnostic indicator of bacterial children CAP2.The necessary combined detection of inflammatory markers can improve the diagnosis of CAP bacterial pathogens in children.Combined detection of PCT+CD64index is more valuable. |
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