白细胞形态学和中性粒细胞碱性磷酸酶在手足口病合并感染患儿诊疗中的应用

目的探讨白细胞(WBC)形态学和中性粒细胞碱性磷酸酶(NAP)染色积分值在儿童手足口病(HFMD)合并感染诊疗中的应用价值。方法选取2017年1月至2017年10月于玉林市红十字会医院儿科门诊及住院的150例儿童作为研究对象,根据检查结果及病情分为正常对照组、单纯HFMD组及HFMD合并感染组,每组各50例。所有病例均采用一次性EDTA扩凝真空采血管,按常规静脉采血1～2 ml,同时做血涂片2张,1张用于瑞氏染色,另1张血片干燥后用10%甲醛固定30 s,按NAP试剂盒说明书进行染色,由细胞室工作人员在显微镜下鉴别WBC形态学变化并计数NAP阳性率和积分。结果正常对照组患儿NAP阳性率为(23.58±11.89)%,积分为(28.18±13.82);单纯HFMD组患儿NAP阳性率为(22.8±10.49)%,积分为(26.92±11.9);HFMD合并感染组患儿NAP阳性率为(77.96±8.99)%,积分为(332.7±58.42);HFMD合并感染抗感染治疗后组NAP阳性率为(22.38±10.54)%,积分为(27.74±12.16);HFMD合并感染组分别与正常对照组、单纯HFMD组、HFMD合并感染抗感染治疗后NAP阳性率比较,差异均有统计学意义(t=25.80、28.23、28.37,P均<0.001);HFMD合并感染组分别与正常对照组、单纯HFMD组、HFMD合并感染抗感染治疗后NAP积分比较,差异均有统计学意义(t=35.87、36.27、36.14,P均<0.001);其余各组NAP阳性率和积分两两比较,差异均无统计学意义(P均> 0.05)。正常对照组、单纯手足口病组、手足口病合并感染组患儿异型淋巴细胞、中毒颗粒、空泡变性细胞、杜勒小体比例差异均有统计学意义(H=81.9939、129.1737、117.5489、89.4793,P均<0.001);手足口病合并感染抗感染治疗前后患儿异常淋巴细胞、中毒颗粒、空泡变性细胞和杜勒小体比例差异有统计学意义(U=8.2967、8.6138、8.6318、5.4355,P均<0.001)。结论白细胞形态学检查和NAP阳性率及积分观察HFMD合并感染患儿疾病发生发展及对疾病诊断、预后监测均具有重要临床意义。

Application of white blood cell morphology combined with neutrophil alkaline phosphatase in the diagnosis and treatment of children with hand,foot and mouth disease complicated with infection

ObjectiveTo investigate the value of white blood cell (WBC) morphology and neutrophil alkaline phosphatase (NAP) staining score in the diagnosis and treatment of hand, foot and mouth disease (HFMD) complicated with infection. MethodsFrom January 2017 to October 2017, a total of 150 outpatient and hospitalized children in Hospital of Yulin Red Cross Society Guangxi were selected. According to the examination results and the disease condition, all patients were divided into three groups: normal control group, simple HFMD group and HFMD with infection group, 50 cases in each group. All cases were treated with disposable vacuum blood coagulation EDTA expansion, and blood samples were collected by routine venous blood collection of 1-2 ml, while two blood smears were carried out, one was for Rayleigh staining, the other was fixed with 10% formaldehyde for 30 seconds after drying, and stained according to the instructions of NAP kit. The morphological changes of WBC were identified under microscope and the positive rate and integral of alkaline phosphatase (ALP) in neutrophils were counted by cell room workers. ResultsThe positive rate of NAP in children of the control group was (23.58 ± 11.89)% and the score was (28.18 ± 13.82); the positive rate of NAP in children of simple HFMD group was (22.8 ± 10.49)% and the score was (26.92 ± 11.9); the positive rate of NAP in children of HFMD with infection group was (77.96 ± 8.99)% and the score was (332.7 ± 58.42); the positive rate of NAP in children of HFMD with infection for anti-infection treatment group was (22.38 ± 10.54)% and the score was (27.74 ± 12.16), respectively. The positive rate of NAP in HFMD with infection group was significantly higher than the other three groups, with significant differences (t = 25.80, 28.23, 28.37; all P < 0.001). The score of NAP in HFMD with infection group was significantly higher than the other three groups, with significant differences (t = 35.87, 36.27, 36.1374; all P < 0.001). There was no significant difference in positive rate and score of NAP between the other groups pairwise comparison (all P > 0. 05). The rates of abnormal lymphocytes, toxic particles, vacuolar degeneration and Duller bodies among normal control group, simple HFMD group and HFMD with infection group were significantly different (H = 81.9939, 129.1737, 117.5489, 89.4793; all P < 0.001). The rates of abnormal lymphocytes, toxic particles, vacuolar degeneration and Duller bodies in children of HFMD with infection group before and after anti-infection treatment were significantly different (U = 8.2967, 8.6138, 8.6318, 5.4355; all P < 0.001). ConclusionsWBC morphological examination, positive rate of neutrophil alkaline phosphoric acid staining and integral observation of the occurrence and development of HFMD children with infection were significantly important to disease diagnosis and prognosis monitoring.