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目的探讨肝硬化合并自发性细菌性腹膜炎(SBP)患者腹水CD64及外周血mCD14的变化及其意义。方法选取肝硬化合并腹水患者87例,根据是否合并SBP将患者分为2组:合并SBP 44例为研究组,未合并SBP 43例为对照组,采用流式细胞术检测2组患者腹水中性粒细胞和淋巴细胞CD64平均荧光强度、CD64指数,外周血白细胞计数、mCD14阳性表达率、mCD14平均荧光强度和mCD14指数。研究组抗感染治疗1周后再按治疗有效与无效、生存与死亡分组评价腹水中性粒细胞和淋巴细胞CD64平均荧光强度、CD64指数,外周血mCD14平均荧光强度和mCD14指数。结果研究组腹水中性粒细胞CD64平均荧光强度、CD64指数和外周血白细胞计数明显高于对照组(P均<0.05),淋巴细胞CD64平均荧光强度、mCD14阳性表达率、mCD14平均荧光强度和mCD14指数均明显低于对照组(P均<0.05)。治疗有效组和生存组中性粒细胞CD64平均荧光强度和CD64指数均明显低于治疗无效组和死亡组(P均<0.05),淋巴细胞CD64平均荧光强度、mCD14平均荧光强度和mCD14指数均明显高于治疗无效组和死亡组(P均<0.05)。腹水CD64与外周血mCD14联合检测对治疗效果和预后判断的ROC曲线下面积、临界值、灵敏度和特异度均明显高于CD64、mCD14单项检测(P均<0.05)。结论肝硬化合并SBP患者腹水中性粒细胞CD64显著增高,腹水淋巴细胞CD64与外周血mCD14显著降低,腹水CD64与外周血mCD14联合检测预示肝硬化合并SBP治疗效果和预后的价值显著。
Objective To investigate the changes and clinical significance of ascites CD64 and peripheral blood mCD14 in cirrhotic patients with spontaneous bacterial peritonitis (SBP). Methods Eighty-seven patients with cirrhosis and ascites were divided into two groups according to whether SBP was combined or not: 44 patients with SBP combined with SBP and 43 patients without SBP as control group. Flow cytometry was used to detect the ascites in both groups The average fluorescence intensity of CD64 in granulocytes and lymphocytes, CD64 index, peripheral blood leukocyte count, mCD14 positive expression rate, mCD14 mean fluorescence intensity and mCD14 index. One week after anti-infective treatment in study group, the mean fluorescence intensity of CD64, CD64 index, average fluorescence intensity of mCD14 in peripheral blood and mCD14 index of ascites neutrophils and lymphocytes were evaluated by treatment-effective and ineffective, survival and death groups. Results The average fluorescence intensity, CD64 index and peripheral blood leukocyte count of ascitic neutrophils in study group were significantly higher than those in control group (all P <0.05). The average fluorescence intensity of CD64, the expression of mCD14, the average fluorescence intensity of mCD14 and the average fluorescence intensity of mCD14 Index were significantly lower than the control group (P all <0.05). The mean fluorescence intensity and CD64 index of neutrophil CD64 in the treatment-effect group and the survival group were significantly lower than those in the treatment-ineffective group and the death group (all P <0.05). The average fluorescence intensity of CD64, the average fluorescence intensity of mCD14 and the mCD14 index of lymphocytes were significantly higher Higher than the invalid treatment group and death group (all P <0.05). The area, the critical value, the sensitivity and the specificity of the combined detection of CD64 and peripheral blood mCD14 in the treatment and prognosis were significantly higher than those of CD64 and mCD14 (all P <0.05). Conclusions CD64 of ascitic neutrophils in cirrhotic patients with SBP is significantly increased, ascites lymphocytes CD64 and peripheral blood mCD14 significantly reduced, ascites CD64 and peripheral blood mCD14 combined predictive value of the treatment of liver cirrhosis with SBP and prognosis of significant value.