2021 年第 10 期 第 16 卷

中性粒细胞白细胞分化抗原64指数联合可溶性髓样细胞触发受体1对肺结核合并肺部细菌感染患者的诊断价值

Diagnostic value of cluster of differentiation 64 index combined with soluble triggering receptor expressed on myeloid cell 1 in patients with pulmonary tuberculosis complicated with pulmonary bacterial infection

作者：陈红梅余艳艳方喆袁甜蒋源

英文作者：Chen Hongmei Yu Yanyan Fang Zhe Yuan Tian Jiang Yuan

单位：湖南省胸科医院湖南省结核病防治所院内一科，长沙410006

英文单位：The First Department of Internal Medicine Hunan Chest Hospital Hunan Institute for Tuberculosis Control Changsha 410006 China

关键词：肺结核合并肺部细菌感染；中性粒细胞白细胞分化抗原64指数；可溶性髓样细胞触发受体1；诊断价值

英文关键词：Pulmonarytuberculosiscomplicatedwithpulmonarybacterialinfection;Clusterofdifferentiation64index;Solubletriggeringreceptorexpressedonmyeloidcell1;Diagnosticvalue

• 摘要：

• 目的  探讨中性粒细胞白细胞分化抗原64（CD64）指数联合可溶性髓样细胞触发受体1（sTREM-1）对肺结核合并肺部细菌感染患者的诊断价值。方法选择2017年2月至2020年7月在湖南省胸科医院接受治疗的131例肺结核住院患者进行研究。收集患者人口学及临床资料，并检测CD64指数、sTREM-1，根据影像学及临床诊断结果 将患者分为单纯肺结核组（72例）与肺结核合并细菌感染组（59例），比较2组患者CD64指数及sTREM-1水平，并以受试者工作特征（ROC）曲线分析各指标单独检测与联合检测对肺结核合并肺部细菌感染的诊断价值。结果 2组患者性别、年龄、体重指数等人口学资料及咳嗽、咳痰、发热等临床特征比较差异均无统计学意义（均P>0.05）。肺结核合并细菌感染组患者CD64指数及sTREM-1水平均明显高于单纯肺结核组［（5.4±1.6）比（3.9±1.3）、（18±3）μg/L比（15±3）μg/L］，差异均有统计学意义（t=-5.855、-5.088，均P<0.001）。ROC曲线分析结果 显示，CD64指数、sTREM-1对肺结核合并肺部细菌感染患者诊断的截断值分别为4.103、15.69 μg/L；曲线下面积（AUC）分别为0.767、0.754。CD64指数和sTREM-1联合诊断肺结核合并肺部细菌感染的AUC为0.873，其诊断效能高于两指标单独检测（Z=4.102，P=0.007；Z=4.655，P=0.002）。结论 肺结核合并肺部细菌感染患者CD64指数、sTREM-1水平均明显高于单纯肺结核，二者均可作为肺结核合并肺部细菌感染的诊断指标且联合检测可有效提高诊断效能。

• Objective To investigate the diagnostic value of cluster of differentiation 64(CD64) index combined with soluble triggering receptor expressed on myeloid cell 1(sTREM-1) in patients with pulmonary tuberculosis complicated with pulmonary bacterial infection. Methods From February 2017 to July 2020, 131 inpatients with pulmonary tuberculosis in Hunan Chest Hospital were selected. The demographic and clinical data of patients were collected, and the CD64 index and sTREM-1 were detected. According to the imaging and clinical diagnosis results, patients were divided into simple pulmonary tuberculosis group(72 cases) and pulmonary tuberculosis complicated with bacterial infection group(59 cases). The CD64 index and sTREM-1 level of the two groups were compared. The receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of individual detection and combined detection of each index for pulmonary tuberculosis complicated with pulmonary bacterial infection. Results There were no significant differences in demographic data such as gender, age, body mass index, and clinical characteristics such as cough, sputum and fever between the two groups(all P>0.05). The CD64 index and sTREM-1 level of patients in the pulmonary tuberculosis complicated with bacterial infection group were significantly higher than those in the simple pulmonary tuberculosis group［（5.4±1.6） vs （3.9±1.3）, （18±3）μg/L vs （15±3）μg/L］(both P<0.05). ROC curve analysis showed that the cut-off values of CD64 index and sTREM-1 for diagnosis of pulmonary tuberculosis patients with pulmonary bacterial infection were 4.103 and 15.69 μg/L, respectively; the area under the curve (AUC) were 0.767 and 0.754, respectively. The AUC of CD64 index combined with sTREM-1 in the diagnosis of pulmonary tuberculosis complicated with pulmonary bacterial infection was 0.873, and its diagnostic efficiency was higher than the two indicators alone(Z=4.102, P=0.007; Z=4.655, P=0.002). Conclusions  The CD64 index and sTREM-1 level of patients with pulmonary tuberculosis complicated with pulmonary bacterial infection are significantly higher than those of simple pulmonary tuberculosis. Both can be used as diagnostic indicators for pulmonary tuberculosis complicated with pulmonary bacterial infection, and the combined detection can effectively improve the diagnostic efficiency.