中性粒细胞群落参数在术后并发感染时的变化

Change of neutrophil VCS parameters in patients with postoperative infection

目的分析中性粒细胞群落参数(VCS参数)在机体应激状态时的变化,探讨其诊断应激状态并发细菌感染的可能。方法使用Coulter LH 750血液分析仪,检测41例经细菌培养确诊并发术后感染者和83例术后无感染症状者及212例正常对照者的外周血,记录白细胞计数(WBC)、中性粒细胞(NE)和中性粒细胞的各项VCS参数,并根据感染病原菌的革兰染色结果,将感染组分为革兰阴性菌感染组和革兰阳性菌感染组;然后再进行指标的组间比较分析。结果无感染症状组WBC为(15.40±2.40)×109/L,NE为(84.50±3.10)%,感染组WBC为(16.20±3.04)×109/L,NE为(85.60±3.40)%,两组差异无统计学意义;而中性粒细胞细胞平均体积(NEV)及其分布宽度(NVW)术后明显高于术前(P<0.01);NEV、NVW在ROC曲线中的线下面积为0.800和0.777,要大于其他指标,在取临界值≥152.15和≥22.55时,其敏感性和特异性分别为70.73%、79.52%和90.24%、51.81%;在革兰阴性菌、革兰阳性菌感染组间,NEV和NEC差异有统计学意义(P<0.05)。结论继发的细菌感染引起了应激状态下中性粒细胞VCS参数的显著性变化,NEV、NVW出现了显著性的增大,其对临床的诊治有一定帮助。

OBJECTIVE To analyze the change of neutrophil VCS parameters in stringent state, and investigate its potential in the the clinical application to diagnose postoperative infections. METHODS A total of 41 patients with postoperative infections, 83 postoperative patients with non-infectious symptom, and 212 normal healthy controls were included in the study. The 41 patients with infections were divided into gram-positive and gram-negative group according to bacterial stain. All peripheral Blood specimens were analyzed using Coulter LH 750. Neutrophil VCS data were collected, statistical analysis of the indexes between the two groups was performed. RESULTS WBC and NE% had no significant difference in postoperative patients with non-infectious symptom and the postoperative patients with infections （15.4±2.4 vs 16.2±3.04,t=--l. 589,P=0. 115：84.5±3.1 vs 85.6 ± 3.4, t= --1. 767,P=O. 080）. A significant increase in NEV and NVW were observed in patients with bacterial infection compared to patients with non-infectious symptom （P〈0. 001）. The area under curve（AUC） of NEV and NVW were 0. 800 and 0. 777, and exceeded other parameters. Using cut-off value of 2152.15 for NEV, the sensitivity and specificity for diagnosis of bacterial infections were 70.73 % and 79.52 % in postoperative patients; using cut-off value of ≥22.55 for NVW, the sensitivity and specificity were 90. 24% and 51.81%. Furthermore, NEV and NEC were significantly increased in gram-negative group as compared with gram-positive group （P〈0.05）. CONCLUSION The significant change in VCS parameter of neutrophil under stringent state is secondary to bacterial infections, and the significant increase in NEV and NVW will definitely benefit the clinical diagnosis and treatment.