白细胞VCS参数在血液细菌感染中的应用研究

目的 研究白细胞VCS参数在血液细菌感染中的临床应用.方法 采用Coulter LH 750血细胞分析仪检测120例血液细菌感染患者、69例非感染性发热患者、67名健康对照者的中性粒细胞和淋巴细胞的VCS参数,包括中性粒细胞平均体积(MNV)、中性粒细胞体积分布宽度(NDW)、中性粒细胞平均传导率(MNC)、中性粒细胞平均散射值(MNS);淋巴细胞平均体积(MLV)、淋巴细胞体积分布宽度(LDW)、淋巴细胞平均传导率(MLC)、淋巴细胞平均散射值(MLS).将血液细菌感染组根据白细胞总数分为WBC≤10×109/L组和＞10×109/L组;根据中性粒细胞比例分为≥85%组和＜85%组;根据细菌染色分为革兰阳性细菌感染组和革兰阴性细菌感染组.结果 血液细菌感染组的MNV、NDW、MNS、MLV、LDW、MLC、MLS分别为156 ±15、23.31±3.72、137±7、87±12、17.50±3.38、110±5、69±12;非感染性发热组分别为151±8、21.33 ±2.62、132±10、91±4、15.78±1.96、117±4、62±6;健康对照组分别为145±5、18.43±0.93、143±4、84±2、13.30 ±0.76、108±1、62±2;上述各指标在3组间差异均有统计学意义(F值分别为19.295、26.272、32.767、6.226、31.016、23.739、12.662,P＜0.05或＜0.01).WBC≤10×109/L组MNV和NDW分别为152±16、22.19±3.45,WBC＞10×109/L组分别为159±12、25.29±3.43,与健康对照组比较,3组间差异有统计学意义(F值分别为21.575、40.856,P＜0.01).中性粒细胞百分率≥85%组的MNV、NDW分别为159±12、24.88 ±3.74,中性粒细胞百分率＜85%组分别为151±16、21.68±2.29,与健康对照组比较,3组间差异有统计学意义(F值分别为23.76、43.22,P＜0.01).革兰阴性细菌感染组的MNV和NDW分别为157±15、24.25±3.39,革兰阳性细菌感染组分别为153 ±14、21.51±3.78,与健康对照组3组间比较,差异有统计学意义(F值分别为18.74、37.47,P＜0.01).在血液细菌感染诊断中,当NDW的临界值(cut-off值)取20.50时,敏感度为76.7%,特异度为98.3%.结论 VCS参数能反映血液细菌感染时白细胞的形态学变化,其中NDW参数能更加灵敏、特异地反映血液细菌感染.

The clinical application of leukocyte VCS parameters in the detection of blood bacterial infection

Objective To investigate the clinical application of VCS parameters of leukocyte in the detection of blood bacterial infection, Methods The subjects consisted of 120 patients with blood bacterial infection,69 non-infectious fever patients and 67 health controls.The VCS parameters of neutrophil and lymphocyte were examined with Coulter LH 750 hematology analyzer.The parameters examined including mean channel of neutrophil volume(MNV),neutrophil volume distribution width (NDW) ,mean channel of neutrophil conductivity (MNC),mean channel of neutrophil scatter (MNS),mean channel of lymphocyte volme(MLV),lymphocyte volume distfibufion width (LDW),mean channel of lymphocyte conductivity (MLC) and mean channel of lymphocyte scatter (MLS).Additionally,120 blood bacterial infection patients were grouped according to WBC count(WBC≤10×109/L group and WBC＞10×109/L group),neutrophii rate(≥85%group and＜85%group)and bacterial stain(Gram positive bacteria group and Gram negative bacteria group).VCS parameters among these groups were compared.Results The results of blood infection group were as follows:MNV 156±15,NDW 23.31±3.72,MNS 137±7,MLV 87±12,LDW 17.50±3.38.MLC 110±5 and MLS 69±12.The results of non-infectious fever group were as follows:MNV 151±8,NDW 21.33 ±2.62,MNS 132±10,MLV 91±4.LDW 15.78±1.96.MLC 117±4 and MLS 62±6.The results of control group were as follows:MNV145 ±5.NDW 18.43±0.93.MNS 143 ±4,MLV 84±2,LDW 13.30±0.76.MLC 108±1 and MLS 62±2.There were significant diffierences among these three groups (F value were 19.295,26.272,32.767,6.226,31.016,23.739 and 12.662 respectively,P＜0.05 or P＜0.01).In the infection group.the MNV and NDW were 152 ±16 and 22.19±3.45 respectively for WBC≤10×109/L group.159±12 and 25.29±3.43 respectively for WBC＞10×109/L group.They were both significantly different compared with control group (F valRe were 21.575 and 40.856 respectively,P＜0.01).Also in the infection group.the MNV and NDW were 159±12 and 24.88 ±3.74 respectively for neutrophil rate≥85%group.151±16 and 21.68±2.29 respectively for neutrophil rate＜85%group.They were both significantly different compared with control group(F value were 23.76 and 43.22 respectively,P＜0.01).The MNV and NDW were 157±15 and 24.25±3.39 respectively in those cases with gram-negative bacteremia,153±14 and 21.51±3.78 respectively in those cases with gram-positive bacteremia.They were both signifieanfly difierent compared with control group (F value were 18.74 and 37.47 respectively,P＜0.01).With a cut-off value of 20.50 for the NDW,a sensitivity of 76.7%and specificity of 98.3% were achieyed in diagnosing blood hacterial infection.Conclusion The VCS parameters can reflect the morphologic change of leukocyte in blood bacterial infection.Additionally.the NDW can detect blood bacterial infection more sensitively and specifically.