本文關(guān)鍵詞： 新生兒敗血癥 CD64 淋巴細(xì)胞亞群 流式細(xì)胞術(shù)　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析新生兒外周血中的CD64在機(jī)體感染時(shí)與各種淋巴細(xì)胞亞群之間的聯(lián)系,結(jié)合臨床資料對(duì)新生兒感染時(shí)的機(jī)體免疫情況進(jìn)行評(píng)價(jià),為新生兒感染疾病的早期診斷、治療、提高預(yù)后提供有力依據(jù)。方法選擇100例發(fā)生局部感染的新生兒作為局部感染組,50例健康新生兒作為對(duì)照組,100例發(fā)生敗血癥的新生兒作為敗血癥組,流式細(xì)胞分析技術(shù)檢測(cè)外周血CD3+T淋巴細(xì)胞亞群、CD4+T淋巴細(xì)胞亞群、CD8+T淋巴細(xì)胞亞群、B淋巴細(xì)胞亞群、NK淋巴細(xì)胞亞群、中性粒細(xì)胞CD64的頻率變化,并計(jì)算感染指數(shù);電阻抗法檢測(cè)白細(xì)胞計(jì)數(shù),散射比濁法檢測(cè)C反應(yīng)蛋白(CRP)、化學(xué)發(fā)光法檢測(cè)降鈣素原(PCT)、未成熟中性粒細(xì)胞與總中性粒細(xì)胞比值(人工涂片)。經(jīng)過(guò)治療后再次用流式細(xì)胞分析技術(shù)檢測(cè)外周血CD3+T淋巴細(xì)胞亞群、CD4+T淋巴細(xì)胞亞群、CD8+T淋巴細(xì)胞亞群、B淋巴細(xì)胞亞群、NK淋巴細(xì)胞亞群、中性粒細(xì)胞CD64的頻率變化。收集數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,所有數(shù)據(jù)均使用SPSS17.0統(tǒng)計(jì)軟件分析,用均數(shù)±標(biāo)準(zhǔn)差(X±S)表示,比較敗血癥患者治療前后的變化,選擇t檢驗(yàn),選擇Pearson進(jìn)行相關(guān)性分析,制作ROC曲線比較靈敏度、特異性,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果與正常對(duì)照組、局部感染組相比,敗血癥組中性粒細(xì)胞CD64顯著增高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);與正常對(duì)照組相比局部感染組的中性粒細(xì)胞CD64表達(dá)增高,差異具統(tǒng)計(jì)學(xué)意義(P0.05);和正常對(duì)照組、局部感染組相比,敗血癥組的CRP、PCT、I/T比值增高,差異具統(tǒng)計(jì)學(xué)意義(P0.05);而局部感染組與正常對(duì)照組無(wú)顯著差異(P0.05);比較三組之間WBC,結(jié)果顯示差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。繪制ROC(Receiver Operating Characteristic)曲線,中性粒細(xì)胞CD64靈敏度、特異度、陰性預(yù)測(cè)值、陽(yáng)性預(yù)測(cè)值明顯高于CRP、PCT、I/T比值。與正常對(duì)照組、局部感染組相比,敗血癥組患兒外周血CD3、CD4、NK細(xì)胞水平顯著降低,差異具統(tǒng)計(jì)學(xué)意義(P0.05);與正常對(duì)照組、局部感染組相比,敗血癥組CD8、增高,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),敗血癥組CD19增高,差異具統(tǒng)計(jì)學(xué)意義(P0.05)。使用Pearson相關(guān)分析法分析后發(fā)現(xiàn),CD3+、CD4+T淋巴細(xì)胞亞群、CD56+NK細(xì)胞表達(dá)越高CD64表達(dá)越低,反之則表達(dá)增高,CD19+B淋巴細(xì)胞表達(dá)越高CD64表達(dá)越高,反之則降低,CD64與CD8+T細(xì)胞亞群之間無(wú)關(guān)系。隨著治療的進(jìn)展,癥狀開始減輕,此時(shí)白血癥組CD64感染指數(shù)逐漸降低,治療前后有差異且差異具統(tǒng)計(jì)學(xué)意義(P0.05),CD3+CD4+T淋巴細(xì)胞亞群表達(dá)增高,治療前后差異具統(tǒng)計(jì)學(xué)意義(P0.05),而CD8+T淋巴細(xì)胞亞群在治療前后差異小,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論通過(guò)監(jiān)測(cè)各淋巴細(xì)胞亞群與新生兒感染在臨床進(jìn)展的相關(guān)性分析,提示新生兒發(fā)生免疫功能紊亂時(shí)與新生兒感染發(fā)生高度相關(guān)。對(duì)CD64與淋巴細(xì)胞亞群的檢測(cè)可以為新生兒感染初期診斷提供有力依據(jù)。
[Abstract]:Objective to analyze the relationship between CD64 in peripheral blood of neonates and various lymphocyte subsets during infection, and to evaluate the immune status of neonates with infection by clinical data. Methods 100 neonates with local infection were selected as the control group and 50 healthy neonates as the control group. The peripheral blood CD3 T lymphocyte subsets, CD4 T lymphocyte subsets and CD8 T lymphocyte subsets were detected by flow cytometry in 100 neonates with septicemia. B lymphocyte subsets NK lymphocyte subsets, neutrophils CD64 frequency change, and calculate the infection index; WBC count was detected by electrical impedance method, C-reactive protein (CRPN) was detected by turbidimetry, and procalcitonin (PCT) was detected by chemiluminescence. The ratio of immature neutrophils to total neutrophils (artificial smear) was used to detect the CD4 T lymphocyte subsets of peripheral blood CD3 T lymphocyte subsets by flow cytometry. The frequency of CD8 T lymphocyte subsets B lymphocyte subsets NK lymphocyte subsets and neutrophils CD64 were collected and analyzed statistically. All the data were analyzed by SPSS17.0 statistical software and expressed by mean 鹵standard deviation X 鹵S. The changes of septicemia patients before and after treatment were compared and t-test was selected. Choose Pearson for correlation analysis, make ROC curve to compare sensitivity, specificity, with P0.05 as the difference is statistically significant. Results compared with the normal control group, local infection group. The CD64 of neutrophils in septicemia group was significantly higher than that in control group (P 0.05). Compared with the control group, the expression of CD64 in neutrophils in the local infection group was higher than that in the control group, and the difference was statistically significant (P 0.05). Compared with the normal control group and the local infection group, the ratio of CRPnPCT / T in septicemia group was significantly higher than that in the control group (P 0.05). However, there was no significant difference between the local infection group and the normal control group (P 0.05). WBC was compared between the three groups. The results showed that the difference was not statistically significant (P 0.05). The curve of ROC(Receiver Operating character was drawn. The sensitivity, specificity, negative predictive value and positive predictive value of neutrophil CD64 were significantly higher than those of CRP- PCT / I / T ratio, compared with those of normal control group and local infection group. In the septicemia group, the level of CD3 + CD4 + NK cells in peripheral blood was significantly lower than that in the control group (P 0.05). Compared with normal control group and local infection group, CD8 in septicemia group was higher than that in local infection group, the difference was not statistically significant (P 0.05), and CD19 in septicemia group was higher than that in septicemia group. The difference was statistically significant (P 0.05). CD3 T lymphocyte subsets were found by Pearson correlation analysis. The higher the expression of CD56 NK cells, the lower the expression of CD64, the higher the expression of CD19B lymphocytes, the higher the expression of CD64, and the lower the expression of CD64. There was no relationship between CD64 and CD8 T cell subsets. With the progress of treatment, the symptoms began to decrease, and the CD64 infection index decreased gradually in the leukaemia group. The expression of CD3 CD4 T lymphocyte subsets was significantly increased before and after treatment, and the difference before and after treatment was statistically significant (P 0.05). However, there was no significant difference in CD8 T lymphocyte subsets before and after treatment (P 0.05). Conclusion the correlation between T lymphocyte subsets and neonatal infection in clinical progress was analyzed. It is suggested that the detection of CD64 and lymphocyte subsets may provide a powerful basis for the early diagnosis of neonatal infection.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R722.13

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