摘要目的:探讨外周血中性粒细胞CD64、单核细胞人类白细胞抗原DR基因(mHLA-DR)等指标在输尿管软镜钬激光碎石术(RIRS)后全身炎性反应综合征(SIRS)早期监测中的诊断价值。方法:选取金华市人民医院2015年1月至2019年6月407例RIRS患者，依据临床SIRS诊断标准分为非SIRS组374例和SIRS组33例，分别检测患者术前、术后2 h、6 h、1 d、3 d、6 d外周血中性粒细胞CD64、mHLA-DR、降钙素原(PCT)和C反应蛋白(CRP)，应用流式细胞仪检测CD64和mHLA-DR，采用干式免疫荧光分析法检测PCT和CRP。不同时间点的4种检测指标采用重复测量设计资料的方差分析。结果:SIRS组与非SIRS组间的外周血中性粒细胞CD64 ( F＝1 072.000， P<0.01)、mHLA-DR( F＝338.120， P<0.01)和PCT差异有统计学意义( F＝155.000， P<0.01)，各时间点差异有统计学意义( P<0.01)。术后2、6 h的CD64、mHLA-DR和PCT的受试者工作特征(ROC)曲线下面积最大，均大于0.900( P<0.05)。 结论:CD64、mHLA-DR、PCT可有效预测RIRS后SIRS的发生和发展。

abstractsObjective:To evaluate the diagnostic value of CD64, human leukocyte antigen-DR (HLA-DR), C reactive protein (CRP) and procalcitonin (PCT) in peripheral blood neutrophil of patients in the early monitoring of systemic inflammatory response syndrome (SIRS) after retrograde intrarenal surgery (RIRS) with holmium laser lithotripsy.Methods:According to the diagnostic criteria of clinical SIRS, the 407 patients with RIRS between January 2015 and June 2019 were divided into two groups: non-SIRS group and SIRS group. Neutrophils CD64, monocyte HLA-DR (mHLA-DR), PCT and CRP of peripheral blood were detected at before operation, after operation 2 h, 6 h, 1 d, 3 d and 6 d respectively. CD64 and mHLA-DR were detected by flow cytometry, PCT and CRP were detected by dry immunofluorescence. SPSS 20.0 software analysis was applied.Results:There were significant differences in CD64, mHLA-DR and PCT between SIRS group and non SIRS group ( F=1 072.000, 338.120, 155.000, P< 0.01), and between time points ( P< 0.01). The area under ROC curve of CD64, mHLA-DR and PCT was the largest at 2 h and 6 h after operation, which were greater than 0.900 ( P<0.05). Conclusion:CD64, mHLA-DR, PCT can effectively predict the occurrence and development of SIRS after RIRS.