中性粒细胞VCS参数在诊断血液细菌感染中的应用

The application of neutrophil VCS parameters in the diagnosis of blood bacterial infection

目的 分析中性粒细胞VCS参数对诊断血液细菌感染的应用价值.方法 使用贝克曼-库尔特五分群（类）血细胞分析仪（LH750）检测102例血液细菌感染患者、58例非细菌感染白细胞增高患者和62名健康体检者的中性粒细胞VCS参数,并与传统的WBC计数、WBC分类、细胞形态学等感染指标进行比较分析.结果 血液细菌感染组的MNV、NDW、MNS分别为155±14, 24.05±3.84,136±7,非细菌感染WBC增高组的MNV、NDW、MNS分别为151±9,21.23±3.02,141±6,健康对照组的MNV、NDW、MNS分别为144±11,18.76±1.64,144±3.三组相比差异有统计学意义（F值分别为19.574,27.421,28.475,P〈0.05或〈0.01）. WBC≤10×109/L组MNV、NDW、MNS分别为151±12、22.72±2.54、138±5,WBC〉10×109/L组分别为158±16、25.62±3.17、136±6,与健康对照组比较,3组间差异有统计学意义,（F值分别为20.864、41.014、18.873. P〈0.05或〈0.01）.中性粒细胞百分率≥85%组的MNV、NDW、MNS为159±13、25.76±4.02、134±5,中性粒细胞百分率〈85%组分别为150±15、22.13±2.32、138±4,与健康对照组比差异有统计学意义（F值分别为24.05、45.34、19.145,P〈0.05或〈0.01）.血液细菌感染组的MNV在临界值（cut-off值）为150时,敏感度为71%（72/102）,特异度为92%（57/62）,NDW在cut-off值为23时,敏感度为74%（75/102）,特异度为98%（61/62）.MNV与NDW的敏感度、特异度均较好,敏感度高于传统的WBC计数（WBC cut-off值〉10×109/L 时,敏感度为57%）、NE（NE的cut-off值≥0.85时,敏感度为53%）等感染指标.结论 中性粒细胞的MNV、NDW参数诊断细菌感染比传统的WBC总数、NE值、形态学分析更加特异而灵敏,而且客观、快速经济.

Objective To investigate the clinical value of VCS parameters of neutrophil in the detection of blood bacterial infection. Methods The subjects consisted of 102 patients with positive blood cultures for bacteria, 58 non - infection subjects with high white blood cell count, and 62 healthy subjectS. The VCS parameters of neutrophil were examineed with Coulter LH 750 hematology analyzer. Mean channel of neutrophil volume （MNV）,neutrophil volume distribution width（NDW）, mean channel of neutrophil scatter（MNS） were retrospeetively analyzed and compared with total WBC, percentage of neutrophils, neutrophil left shift. 102 blood bacterial infection patients were grouped according to WBC count（WBC≤ 10 × 10^9/L and WBC 〉 10 × 10^9/L）, neutrophil rate（ 〉 85% group and 〈 85% group）. Result The results of blood infection group were as follows ： M.NW 155 ± 14,NDW 24.05 ± 3.84,MNS 136 ± 7. The results of non - infection subjects with high white blood cell count were as follows MNV 151 ± 9,NDW 21.23 ± 3.02,MNS 141 ± 6. The results of healthy subjects were as follows MNV 144 ± 11, NDW 18.76 ± 1.64, MNS 144 ± 3. There were significant differences among these three groups（ F value were 19.574,27.421, 28. 475, P 〈0.05 or P〈 0.01）. In the infection group, the MNV, NDW and MNS nf WBC≤ 10 × 10^9/L group were 151 ± 12, 22.72 ± 2.54,13± 5 respectively, the MNV, NDW and MNS of WBC 〉 10 × 10^9/L group were 158 ± 16,25.62 ± 3.17,136 ± 6 respectively. There were significant differences compared with control group（ F value were 20. 864,41.014,18.873. P 〈 0.05 or P 〈 0.01 ）. Also In the iriectiton group, the MNV, NDW and MNS of NE 〉 85 % group were 159 ± 13, 25.76 ± 4.02,134 ± 5 respectively, the MNW, NDW and MNS of NE 〈 85 % group were 150 ± 15.22,22.13 ± 2.32,138 ± 4 respectively. There were both significant differences compared with control grout,（ F value were 24.05,45.34,19.145, P 〈 0.05 or P 〈 0.01 ）. With a cut - off of 150 for the MNV, a specificity, of 92% and a sensitvity of 71% were achieved. With a cut - off of 23 for the NDW, a specificity of 98 % and a sensitivity of 74 % were achieved. The sensitivity of the MNV and NDW was better than total white blood cell count （ with a cut off 〉 10× 10^9/L,the sensitivity, was 57%）. Percentage of neutrophils （with a cut off≥ 85 %, the sensitivity was 53% ）. Conclusions The MNV and NDW of neutrophil can reflect the morphologic chang of neutrenhil sensitively and specifieialy in blood bacterial infection. As quantitative objective and more sensitive parameters, MNB and NDW may have a potcntial role for predicting the acute blood bacterial infection.