白细胞VCS参数参考区间的建立及其在菌血症和白血病中的应用

目的建立健康人群白细胞体积、浆核比例、胞浆颗粒变化的参考区间并探讨其在菌血症和白血病中的应用。方法选取健康体检人群290名,其中男137名,女153名,统计并建立白细胞VCS参数的参考范围。另取经骨髓穿刺符合血液病诊断标准的白血病患者260例,其中男147例,女113例;排除血液疾病的血培养阳性患者42例,其中男23例,女19例。通过受试者工作特征(ROC)曲线分析挑选出用于筛查菌血症和白血病敏感度和特异度都较高的VCS参数及其相应的cutoff值。结果通过数据分析得到VCS参数的参考区间;淋巴细胞平均传导率(MLC)可以较好地区分正常人群与菌血症及白血病人群;中性粒细胞平均传导率(MNC)可以较好地区分菌血症与白血病;淋巴细胞体积平均分布宽度(MLV-SD)可以较好地鉴别髓系与淋系白血病;单核细胞平均传导率分布宽度(MMC-SD)可以较好地鉴别急性骨髓系白血病(AML)和慢性粒细胞白血病(CML);淋巴细胞平均体积(MLV)可以较好地鉴别急性淋巴细胞白血病(ALL)和慢性淋巴细胞白血病(CLL)。结论健康人群白细胞VCS参数参考范围的确立可能会给临床判断是否有细菌感染,白血病等提供更早更及时的参考指标。VCS参数不仅能较好地反映外周血幼稚细胞的形态学变化,有效筛选菌血症和白血病,也是一种快速、经济的临床筛选指标。

Establishment of reference intervals of the white blood cell VCS parameters and their application in sepsis and leukemia

Objective To establish the reference intervals of the white blood cell volume, nucleus-cytoplasm ratio and the granules of plasma in healthy subjects, and to evaluate the clinical application in screening sepsis and leukemia. Methods Peripheral blood samples from 290 healthy subjects （including 137 males and 153 females） , 42 infective patients （ including 23 males and 19 females） with positive blood culture （ excluding any hematological disease） and 260 patients （including 147 males and 113 females） with various leukemia were collected. Then, the reference intervals of the white blood cell VCS parameters were established and analyzed statistically. The cut-off values with high sensitivity and specificity were chosen by receiver operating characteristic （ROC） curves in screening sepsis and leukemia. Results The reference intervals of VCS parameters were obtained by the data analysis. Mean channel of lymphocyte conductivity （MLC） was a useful indicator in discriminating the healthy subjects and patients with sepsis and leukemia. The parameters of mean channel of neutrophil conductivity （MNC） could be used as indicators in distinguishing sepsis from leukemia. Myeloid leukemia and lymphocytic leukemia could be discriminated by mean channel of lymphocyte volume distribution width （MLV-SD）. Mean channel of nononuclear cell conductivity distribution width （MMC-SD） was a good indicator in distinguishing acute myelogenous leukemia （AML） from chronic myelogenous leukemia （CML）. mean channel of lymphocyte volume （MLV） was useful in discriminating acute lymphoblastic leukemia （ALL） and chronic lymphoblastic leukemia （CLL）. Conclusions The establishment of reference intervals of the white blood cell VCS parameters makes it possible to deciding earlier whether there is an infection with bacteria and leukemia. VCS parameters not only reflect morphological changes of immature cells in peripheral blood samples when it comes to sepsis or leukemia, but also is used to screen leukemia quickly, economically and effectively.