本文選題：感染性腹瀉 + 中性粒細胞CD64�。� 參考：《安徽醫(yī)科大學》2014年碩士論文

【摘要】：目的 腹瀉病是兒童最常見的疾病之一，發(fā)病率僅次于呼吸道感染。目前臨床診斷兒童感染性腹瀉主要依據患兒的臨床表現(xiàn)及病原學檢測，然而兒童感染性腹瀉早期臨床特征不典型，病原學檢測陽性率不高且滯后，不利于早期診斷。本研究通過檢測腹瀉患兒外周血中中性粒細胞CD64指數和CRP水平，探討CD64用于早期診斷兒童感染性腹瀉的臨床意義和在評價抗感染療效中的應用價值。 方法 收集我院收治的100例急性腹瀉患兒的外周血標本及大便標本，其中細菌性腹瀉組（40例）、病毒性腹瀉組（40例）及非感染性腹瀉組（20例）；依據患兒臨床癥狀及體征將40例細菌性腹瀉患兒分為輕度細菌性腹瀉組（27例）和重度細菌性腹瀉組（13例）。所有患兒在接受治療前采集靜脈血，利用流式細胞術檢測患兒外周血中中性粒細胞表面CD64指數；使用免疫比濁法檢測患兒外周血中C反應蛋白的水平。細菌性腹瀉組患兒進行規(guī)范治療，臨床癥狀消失、復查大便常規(guī)正常及大便培養(yǎng)轉陰后，再次抽取靜脈血，利用上述方法再次檢測中性粒細胞CD64指數和CRP水平。三組患兒治療前外周血中性粒細胞CD64指數及CRP水平之間的比較采用單因素方差分析，組間兩兩比較采用SNK-q檢驗；細菌性腹瀉患兒治療前后均數的比較采用配對t檢驗；兩獨立樣本均數的比較采用t檢驗；計數資料的比較采用卡方檢驗；中性粒細胞CD64指數和CRP的相關性分析采用Pearson相關分析。 結果 1、治療前細菌性腹瀉組患兒外周血中中性粒細胞CD64指數和CRP水平顯著高于病毒性腹瀉組及非感染性腹瀉組，差異有統(tǒng)計學意義(P＜0．01)。 2、重度細菌性腹瀉組患兒外周血中中性粒細胞CD64指數明顯高于輕度細菌性腹瀉組，差異有統(tǒng)計學意義(P＜0．05)。 3、細菌性腹瀉患兒經過規(guī)范的治療后，外周血中中性粒細胞CD64指數及CRP水平和治療前相比明顯下降，，差異有統(tǒng)計學意義(P＜0．01)。 4、中性粒細胞CD64指數診斷兒童細菌性腹瀉的敏感性和特異性分別為89.0%和88.3%，陽性預測值和陰性預測值分別為83.7%（36/43）和92.9%（53/57）；CRP診斷細菌性腹瀉的敏感性和特異性分別為70.0%和76.7%，陽性預測值和陰性預測值分別為66.6%（28/42）和79.3%（46/58）。 5、相關性分析結果顯示治療前外周血中中性粒細胞CD64指數與CRP水平呈正相關(r=0．784，P＜0．01)。 結論 細菌性腹瀉患兒的外周血中性粒細胞CD64指數及CRP水平明顯升高，且病情程度越重，CD64升高的水平也越明顯；隨著感染的控制，中性粒細胞表面CD64指數也趨于正常。因此，檢測外周血中性粒細胞CD64指數對兒童細菌性腹瀉的早期診斷、判斷病情嚴重程度及觀察療效具有重要的臨床意義。
[Abstract]:Objective diarrhea is one of the most common diseases in children, and the incidence is second only to respiratory tract infection. At present, the clinical diagnosis of infective diarrhea in children is mainly based on the clinical manifestations and etiological detection. However, the early clinical characteristics of infective diarrhea in children are not typical, the positive rate of etiology detection is not high and lag, which is not conducive to early diagnosis. In this study, the levels of CD64 index and CRP in peripheral blood neutrophils were measured in children with diarrhea. To explore the clinical significance of CD64 in the early diagnosis of infective diarrhea in children and the value of CD64 in evaluating the efficacy of anti-infective diarrhea. Methods the peripheral blood and stool samples of 100 children with acute diarrhea were collected. According to clinical symptoms and signs, 40 patients with bacterial diarrhea were divided into mild bacterial diarrhea group (n = 27) and severe bacterial diarrhea group (n = 13). Venous blood was collected before treatment and CD64 index of neutrophils in peripheral blood was detected by flow cytometry and C-reactive protein level in peripheral blood was detected by immunoturbidimetry. In the group of bacterial diarrhea, the clinical symptoms disappeared, the routine stool was normal and stool culture turned negative, the venous blood was drawn again, and the CD64 index and CRP level of neutrophils were detected again by the above method. The levels of CD64 and CRP in peripheral blood of the three groups were compared by single factor ANOVA, SNK-q test and paired t test before and after treatment for children with bacterial diarrhea. T test was used to compare the mean of two independent samples, chi-square test was used to compare counting data. The correlation between neutrophil CD64 index and CRP was analyzed by Pearson correlation analysis. Results 1 the levels of CD64 index and CRP in peripheral blood of children with bacterial diarrhea before treatment were significantly higher than those in viral diarrhea group and non-infectious diarrhea group. The CD64 index of peripheral blood neutrophils in severe bacterial diarrhea group was significantly higher than that in mild bacterial diarrhea group (P < 0.05). The levels of CD64 index and CRP in peripheral blood neutrophils were significantly lower than those before treatment. The sensitivity and specificity of CD64 index of neutrophils in the diagnosis of bacterial diarrhea in children were 89.0% and 88.3%, respectively. The positive predictive value and negative predictive value were 83.7% and 36.43%, respectively. The sensitivity and specificity of CD64 index of neutrophils in the diagnosis of bacterial diarrhea were 92.9% and 92.9% / 57% respectively. The positive predictive value and negative predictive value were 66.6% and 79.3%, respectively. The correlation analysis showed that the CD64 index of peripheral blood neutrophils was positively correlated with CRP level before treatment (P < 0.01.Conclusion in children with bacterial diarrhea, the CD64 index of peripheral blood neutrophils is positively correlated with CRP level (P < 0.01). The levels of CD64 index and CRP in peripheral blood neutrophils were significantly increased. With the control of infection, the CD64 index of neutrophil surface tended to be normal. Therefore, the detection of peripheral blood neutrophil CD64 index is of great clinical significance in the early diagnosis of bacterial diarrhea in children, in judging the severity of the disease and in observing the curative effect.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R725.7

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