【摘要】 目的 探讨血小板活化指标CD40L、CD62P和CD63对川崎病（KD）与脓毒症的早期鉴别价值。方法 纳入2021年2月至2022年1月安徽省儿童医院收治的65例KD[完全性KD(cKD)55例，不完全性KD(iKD)10例]和46例脓毒症患儿，另选取同期至安徽省儿童医院体检的健康儿童30名作为健康对照组。采用流式细胞术检测KD、脓毒症患儿和健康对照组儿童CD40L、CD62P和CD63阳性表达率，并进行比较。绘制受试者操作特征（ROC）曲线评价CD40L、CD62P、CD63鉴别KD与脓毒症的效能。结果 KD、脓毒症患儿与健康对照组儿童CD40L、CD62P、CD63阳性表达率差异均有统计学意义（P均<0.01）,KD患儿最高，健康对照组儿童最低；治疗前、治疗后iKD患儿CD40L、CD62P、CD63阳性表达率均高于cKD患儿（P <0.01）；治疗后cKD、iKD患儿CD40L、CD62P、CD63阳性表达率均较治疗前降低（P均<0.01）;CD40L、CD62P、CD63联合诊断KD的ROC曲线下面积为0.918(95%CI:0.867～0.969,P <0.01)，敏感度和特异度分别为80.0%、93.5%。结论 KD和脓毒症患儿均存在血小板活化，KD患儿血小板活化程度高于脓毒症患儿，iKD患儿血小板活化程度较cKD患儿高；CD40L、CD62P、CD63联合检测对早期鉴别KD和脓毒症有较高的临床应用价值。更多还原

【Abstract】 Objective To investigate the early differential diagnostic value of platelet activation indicators CD40L, CD62P and CD63 expression levels combined test for Kawasaki disease(KD) and sepsis. Methods A total of 65 patients with KD and 46patients with sepsis in Anhui Children’s Hospital from February 2021 to January 2022 were enrolled. The other 30 healthy children were selected as the group of control at the same time. The expression rates of CD40L, CD62P and CD63 in the group of KD,sepsis and control were detected by flow cytometry. The expression rates of CD40L, CD62P and CD63 in platelets of each group were compared. Receiver operating characteristic(ROC) curve was used to analyze the differential diagnostic value of CD40L,CD62P and CD63 expression levels for early identification of KD and sepsis. Results The positive expression rates of CD40L,CD62P and CD63 in the group of KD, sepsis and control were statistically significant(P<0.01), with the highest in the group of KD and the lowest in the group of control. The positive expression rates of CD40L, CD62P and CD63 in the group of iKD were higher than those in the group of cKD before and after treatment(P <0.01). The positive expression rates of CD40L, CD62P and CD63 in the group of cKD and the group of iKD after treatment were lower than those before treatment(P<0.01). The area under ROC curve(AUC) of CD40L, CD62P combined with CD63 for the diagnosis of KD was 0.918(95%CI: 0.867-0.969, P<0.01), the sensitivity was 80.0%, and the specificity was 93.5%. Conclusions Platelet activation was found in both KD and sepsis patients.The platelet activation of KD was higher than sepsis, and the platelet activation of iKD was higher than cKD. Combined detection of CD40L, CD62P and CD63 have early differential diagnostic value for KD and sepsis.更多还原