中性粒细胞VCS参数在全身炎症反应综合征患者中的变化及意义

Changes of neutrophil VCS parameters in the patients with systemic inflammatory response syndrome

目的:探讨全身炎症反应综合征(SIRS)患者中性粒细胞VCS参数的变化及意义。方法:利用Beck-man-CoulterGen.S自动血细胞分析仪的体积、高频传导、激光散射(VCS)技术,测定45例健康体检者(对照组)和121例重症监护病房(ICU)的患者(非SIRS组47例、非感染性SIRS组34例、感染性SIRS组40例)的白细胞总数(WBC)、中性粒细胞百分数(NE%)和NE的体积(NE-V)、浆核比(NE-C)、胞浆颗粒特性(NE-S)及它们各自的平均分布宽度(SD),并用ROC曲线评价各参数监测ICU的患者SIRS病情的敏感性和特异性。结果:ICU的患者WBC、NE%、NE-V、NEV-SD、NEC-SD、NES-SD明显高于对照组,而NE-C、NE-S明显下降(P<0.01);SIRS组第2、4、6天的WBC与NE%和第4、6天的NEV-SD及第6天的NE-V均高于非SIRS组相应的时间点,而NE-S明显降低(P<0.01或P<0.05);SIRS组的患者在进入ICU的第2天与第4、6天NE-V、NES-SD差异有统计学意义;非感染性SIRS组的NEV-SD、NEC-SD、NES-SD、NE-S和感染性SIRS组除NE-C外的NE-VCS参数与非SIRS组均差异有统计学意义(P<0.01或P<0.05),且以感染性SIRS组的WBC、NE-V、NE-S、NEV-SD、NEC-SD的变化最显著;评价患者非SIRS与SIRS的病情,NE-VCS参数的ROC曲线下面积明显高于WBC和NE%。结论:中性粒细胞VCS参数在ICU的患者不同病情中可发生明显的变化,其变化随着病情的加重而更加显著;NE-VCS参数对评价SIRS病情的敏感性和特异性优于WBC和NE%。

Objective：To explore the changes and the clinical significance of the neutrophil VCS parameters in the patients with systemic inflammatory response syndrome （SIRS）. Method：45 normal persons （control group） and 121 patients hospitalized in Intensive Care Unit（ICU）were selected in this study. According to the clinical manifestation, all patients were divided into non-SIRS group （n= 47）, nonsepsis SIRS group （n= 34） and sepsis infection SIRS group （n=40）. Data included total WBC counts（WBC）, percentage of neutrophil（NE%）, and the VCS parameters of neutrophil（NE-VCS）, were measured by the Automatic Blood Cell analyzer（Beckman Coulter Gen. S）. The VCS technology of analyzer could obtain directly data including not only the mean channels of cell volume（NE-V）, conductivity（NE-C）, and light scatter（NE-S） but also the SD of each parameter（NEV-SD, NEC-SD, NES-SD）. The sensitivity and specificity of WBC, NE%, and the VCS parameters of neutrophil, which were used to predict the state of SIRS, were analyzed at designated cutoff points. Result： The levels of WBC, NE%, NE-V, NEV-SD and NES-SD in the patients showed higher obviously than those in the controls, but the levels of NEC and NE-S showed lower obviously （P〈0. 01）. The WBC and NE% on day 2, 4 or 6, NEV-SD on day 4 or 6, NE-V on day 6 in SIRS group were higher obviously than those values on corresponding time in non SIRS group （P〈0.01 or P〈0.05）. The NE-S on day 2, 4 or 6 decreased significantly in SIRS patients（P〈0.01 or P〈 0.05）. And there were many differences between NE-V, NES-SD on day 4 or 6 and the values on day 2 in SIRS group. The NEV-SD, NEC-SD, NES-SD and NE-S in nonsepsis SIRS group were different from those in non- SIRS group （P〈0.01 or P〈0.05）. Also WBC, NE%, NE-V, NE-S, NEV-SD, NES-SD and NEC-SD in sepsis infection SIRS group were different from those in non-SIRS group （P〈0.01 or P〈0.05）. The changes of WBC. NE-V.NE-S.NEV SD and NEC-SD in sepsis infection SIRS group were more obvious than those in other groups. To evaluate the state of SIRS or non-SIRS, the areas under ROC Curve of the neutrophil VCS parameters were higher obviously than that of WBC or NE%. Conclusion： The variety of the neutrophils VCS parameters showed obviously in ICU patients with different disease states. The more serious illness was, the more obvious the changes of the neutrophils VCS parameters were. The sensitivity and specificity of the neutrophil VCS parameters were higher than that of WBC or NE% in predicting the state of SIRS.