流感疑似病例血象和C反应蛋白特点研究

Research on Features of Hemogram and C Reactive Protein of Suspected Flu Cases

目的寻找流感疑似病例血象和C反应蛋白(CRP)的规律性变化,判断对流感疑似病例早期诊断、治疗选择、鉴别诊断、预后判断的意义。方法采用SYSMEX XE-2100型血细胞分析仪和飞测Ⅲ荧光免疫分析仪对该院2014年11月—2015年2月、2015年11月—2016年2月流感高发季节收治的门诊及住院78例初诊流感疑似病例的白细胞、中性粒细胞绝对值、红细胞、血红蛋白、单核细胞、血小板、CRP进行统计学分析,此为研究组,并对上述观察指标跟踪随访1周;与80名同期健康查体的健康人设为对照组进行对照;通过指血涂片瑞氏-吉姆萨染色镜检对中性粒细胞、异型淋巴细胞形态及比值进行对比分析。结果白细胞总数初诊时多减少或正常,减少占20.51%,正常占65.38%,增高占14.19%,此改变多在1周后恢复,初诊时白细胞改变与随访1周时的变化及与对照组比较差异有统计学意义(P<0.05),而1周后检测数值与对照组差异无统计学意义(P>0.05);单核细胞多在1周内持续增高,绝对值分别为(0.41±0.32)×10~9/L,(0.52±0.42)×10~9/L,二者差异无统计学意义(P>0.05),而与对照组的(0.21±0.31)×10~9/L比较,差异有统计学意义(P<0.05);初诊时CRP明显升高,平均为19.23 mg/L,1周后随病情好转明显下降,平均为9.34 mg/L,二者差异有统计学意义(P<0.05),1周后检测数值仍高于对照组的7.26 mg/L,但二者差异无统计学意义(P>0.05);绝大多数病例初诊时血中出现异型淋巴细胞,占96.2%,但比例多<5%(占69.2%),>10%者仅占3.8%,异性淋巴检出率也多在1周减少,二者差异有统计学意义(P<0.05)。结论通过动态血象和CRP观察可以对流感疑似病例的早期诊断、鉴别诊断、预后判断有辅助作用,该检测技术方法简单易普及,检测时间短,花费少,值得在各级医院,特别是基层医院作为流感的早期诊断及动态观察指标推广应用。

Objective To se arch for th e reg u la r ch ang es of hemogram an d c re ac tiv e p ro te in of susp e c ted flu cases thusdetermining the signif icance to the early diagnos is , treatment select ion, different ial diagnosis and prognosis determina-tion of suspected flu cases. Methods The white ce ll , ab solute v alue of n eu tro p h i ls , red blood c e l ls , hemoglobin, mono-cytes, platelets and CRP of 78 cases of pat ients from November 2014 to February 2015 and from November 2015 to February 2016 were s tat is t ically analyzed by the SYSMEX XE-2100 blood cel l analyzer and fly ch em i lum in escen ceimmunoassay device, and these cases were used as the research group, and the above indicators were followed up for 1 week, 80 cases of heal thy physical examination people at the same period were selected as the control group, and the neutrophi le granulocyte and atypical lymphocytes shape and ratio were compared and analyzed. Results The total n um -ber of white cel l decreased or was normal, respectively account ing for 20.51% and 65.38%, and increas ing accounted for 14.19% and recovered af ter 1 week, and there were stat is t ical differences in the changes of whi te cel l and changes at 1-week fol low-up between the two groups（P〈0.05） , af ter 1 week, there was no stat is t ical difference in the tes t value between the two groups （P〉0.05）, and the monocyte continuously increased in 1 week, and the absolute value was re-spectively （0.41±0.32）x109/L and （0.52±0.42）x109/L, and there was no s tat is t ical difference between the two（P〉0.05） , and there was stat is t ical difference between the observation group and the control group（0.21±0.31）x109/L（P〈0.05）, and the CRP obviously increased, 19.23 mg/L on average, and obviously decreased with the improvement of diseases af ter 1 week, 9.34mg/L on average, and there was stat is t ical difference （P〈0.05）, af ter 1 week, the tes t value was higher than that in the control group （7.26 mg/L）, but there was no stat is t ical di f ference（P〉0.05） , and most cases were with atypical lymphocyte, account ing for 96.2%, but the ratio was more than 5%, account ing for 69.2%, 〉10% only accounted for 3.8%, and the tes t rate of atypical lymphocytes decreased af ter 1 week, and the difference was s tat is t ical ly signif icant between the two （P〈0.05）. Conclusion The d ynamic hemogram an d CRP observa tion has a n ad ju n c t iv e effect on th eearly diagnos is , dif ferent ial diagnos is and prognosis determinat ion of flu suspected cases , and the method, as the early diagnosis and dynamic observation index, is simple with short tes t time and low cost, which is worth promotion and ap-pl icat ion in hospi tals at al l levels, especial ly in the primary hospi tal .