Bilal YILDIZ, Işık YALÇIN, Nuran SALMAN, Ayper SOMER

Lökosit yüzey moleküllerinin infeksiyon belirteci olarak kullanımı

Amaç: Bu çalışma bakteriyel infeksiyonların tanısında 7 lökosit yüzey molekülünün (CD11 A,B,C, CD15, CD18, CD23, CD25 ve CD45) yerini araştırmayı amaçlamaktadır. Gereç ve Yöntem: Sepsis, bakteriyemi, pnömoni ve ampiyem tanılı 25 hasta ile kontrol grubu olarak 25 sağlıklı çocuk araştırıldı. Bütün çocuklar sepsis açısından tarandı. Lenfosit alt grupları, C-reaktif protein (CRP), prokalsitonin, lökosit sayısı ve eritrosit sedimantasyon hızı (ESH) standart biyokimyasal yöntemler ve flow sitometri ile tedavi öncesi ölçüldü. Tanısal amaçla duyarlılık ve özgüllük ölçümleri yapıldı. Bulgular: İnfeksiyonların tanısında, prokalsitonin en duyarlı ve özgül belirteç olarak belirlendi (sırasıyla % 91.7 ve 84.6). Bir infeksiyon belirteci olarak, 7 lökosit yüzey molekülü içinde, yalnızca CD45, kültürle kanıtlanmış infeksiyonlarda istatistiksel olarak en duyarlı ve özgül belirteç olarak saptandı. CD 45'in duyarlılığı % 100, özgüllüğü ise %53.8 idi. Hastalarda CD11 B, CD19, CD25 ve CD19 düzeyleri de kontrol grubuna göre istatistiksel olarak anlamlı derece yüksekti (p

Anahtar Kelimeler:

Antijenler, CD, Antijenler, yüzey, Bakteriyel enfeksiyonlar, Lökositler, Antijenler, CD11

Diagnostic value of leukocyte surface molecules for identification of bacterial infections

Objective: To evaluate the diagnostic value of seven leukocyte surface molecules (CD11 A,B,C, CD15, CD23, CD18, CD25 and CD45) for identification of bacterial infections in children. Material and Method: 25 children were evaluated for sepsis, bacteremia, pneumonia and pleural empyema. Also 25 healthy children were evaluated as control group. All were screened for sepsis. Leukocyte surface molecules, C-reactive protein, leukocyte count, ESR and procalcitonin levels were measured before therapy by standard biochemical methods and quantitative flow cytometric analysis. Sensitivity and specificity were calculated for diagnostic purposes. Results: Procalcitonin had the highest sensitivity and specificity (91.7% and 84.6% respectively) in the diagnosis of infections. In leukocyte surface molecules, CD45 levels were statistically significant as an infection marker only in culture proven infections. Sensitivity and specificity of CD45 level were 100 % and 53.8% respectively. Although CD11 A, B, CD19, and CD25 levels were also significantly higher than those of the control group (p<0.05), there was not any difference in culture proven infections. Conclusion: Procalcitonin was the best diagnostic marker in culture proven infections in this study. In addition, we have demonstrated that CD45 may be used as a sensitive diagnostic marker. But prospective studies should be performed in different categories of infections (viral, bacterial, and fungal) and in larger number of infants.

Keywords:

Antigens, CD, Antigens, Surface, Bacterial Infections, Leukocytes, Antigens, CD11,

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1.Urbach J, Slıapira I, Branski D, Berliner S. Acule phase response in the diagnosis of bacterial infections in children. Pediatr Infect Dis J 2004; 23: 159-60.
2.Carlet J. Bacterial sepsis and sepsis shock. Infect Dis Clin North Am 1999; 13: 483-94.
3.Stanley TV, Barret D, Salinnnd CE. Viral and bacterial infection in childhood. The value of CRP. NZ Med J 1991; 104: 138-9.
4.Jave DL, Wailes KB. Clinical applications of CRP in pediatrics .'Pediatr Infect Dis J 1997; 16: 735-46.
5.Povoa P, Almeida E, Mnreira P, et al. CRP as indicator of sepsis. Intensive Care Med 1998; 24: 1052-6.
6.Kono T, Otsuka M, Ito M, el al. Negative C-reactive protein in children with baclerial infectious. Pediatr Int. 1999; 41: 496-9.
7.Korppi M, Kruger L. CRP in viral and bacterial respiratory infection in children. Scand J Infect Dis 1992; 25: 207-13.
8.Toikka P, Irjala K, Juven T, et al. Serum procalsitonin, C-reactive protein and 1L-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J 2000; 19: 598-602.
9.Prat C, IJominguez J, Rodrigo C, et al. Procalcitonin, C-reactive protein and leukocyle count in children with lower respirator)' tract infection. Pediatr Infect Dis J 2003; 22: 963-8.
10.Hatherill M, Tibby S, Sykes K, et al. Diagnostic markers of infection: comprasion of procalcitonin with CRP and leucocyte count. Arch Dis Child 1999; 81: 417-21.
11.Korppi M. Non-specific host response markers in the differentiation between pneumococcal and viral pneumonia: what is the most accurate combination? Pediatr Int 2004; 46: 545-50.
12.Korppi M, Heiskanen-Kosma T, Leinonen M, Halonen P. Antigen and antibody assays in the etiological diagnosis of respi-ralory infections in children. Acta Paediatr 1993; 82: 137-4 i.
13.Dandona P, Nîx D, Wilson ME, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Endocrinol Metab 1994; 79: 1605-8.
14.Somech R, Zakuth V, Asia A, Spİrel Z. Procalcitonin corro-lates with CRP as an acute phase reactant in pediatric patients. Isr Med Assoc 2000; 2; 147-50.
15.Lorrot M, Moulin F, Costa J, Lebon P, Gendrel D. Procalcitonin in pediatric emergencies: comprasion with CRP, IL-6, in the differentiation between baclerial and viral infection. Presse Med 2000; 29: 128-34.
16.Moulin F, Raymond J, Lorrot M, et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 2001; 84: 332-6.
17.Van der Kaay DC, De Kleijn ED, De Rijke YB, Hop WC, De Groot R, Hazelzet JA. Procalcitonin as a prognostic marker iıı meningococcal disua.se. Intensive Care Med 2002; 28: 1606-12.
18.Nylen ES, Whang KT, Snider RH Jr, Steinwald PM, White JC, Becker KL. Mortality in increased by procalcitonin and decreased by an antiserum reactive to procalcitonin in experimental sepsis. Critical Care Medicine 1998; 26: 1001-6.
19.Pettit EJ, Hallett MB. Neutrophil activation and priming during engagement of CD11b/CD18 inlegrins. Biochem Soc Trans 1994; 22: 327.
20.Witthaut R, Farhood A, Smith CW, Jausclıke H. Complement and TNF-alpha contribute to Mac-1 up regulation and systemic neutrophil activation during endotoxemia in vivo. J Leukoc Biol 1994; 55: 105-11.
21.Weiricli E, Rabin RL, Maldonado Y, et al. Neutrophil Cdl lb expression as a diagnostic marker for early on set neonatal infection. J Pediatr 1998; 132: 445-51.
22.Kim SK, Keeney SE, Alpard SC, Schmalstieg FC. Comparison of L-selectin and CD1 lb on neutrophils of adults and neonates during the first month of life Pediatr Res 2003; 53: 132-6.
23.Yılmaz MT, Deniz G. Flow sitometri ve tıpta kullanımı. İÜ Deneysel Tıp Araştırma Enstitüsü Yayınları, 1999: 21-32.
24.Bruning T, Daiminger A, Enden; G. Diagnostic value of CD45RO expression on circulating T lymphocytes of fetuses and newborn infants with pre-, peri- or early post-natal infections. Clin Exp Immunol 1997; 107: 306-11.
25.Hodge S, Hodge G, Flower R, Han P. Surface activation markers of T lymphocytes: role in the detection of infection in neonates. Clin Exp Immunol 1998; 113: 33-8.
26.Pak CNG, Karen LI, Raymond PO, et al. Eok Neutrophil CD64 Expression: A sensitive diagnostic marker for late-onset nosocomial infection in very low birthweight infants. Ped Res 2002; 51:296-303.
27.Alexander DR. The CD45 tyrosine phosphatase: a positive and negative regulator of immune cell function. Semin Immunol 2000; 12: 349-59.
28.Raziuddin S, el-Awad ME, Mir NA. Bacterial meningitis: T ceil activation and imtnunoregulatory CD4+ T cell subset alteration. J Allergy Clin Immunol 1991; 87: 11 15-20.
29.Weinschenk NP, Farina A, Biancbi DW. Premature infants respond to eariy-onset and late-onset sepsis with leukoevte activation. J Pediatr 2000; 137: 345-50.
30.Hodge G, Hodge S, Han P, Haslam R. Multiple leucocyte activation markers to detect neonatal infection. Clin Exp Immunol 2004; 135: 125-9.