HBV感染者病毒载量与外周血白细胞VCS参数的相关性探讨

Correlative Study between Viral Load of Patients with HBV and VCS Parameters of Peripheral Blood Leukocytes

目的探讨不同病毒载量的HBV感染者外周血白细胞VCS相关参数的变化规律。方法收集2016年9月～2017年5月湘雅医院200例HBV感染者作为实验组,根据其血液中HBV DNA量分为低于检测下限组、低中病毒载量组和高病毒载量组;100例健康体检者作为对照组。采用DXH800血细胞分析仪检测各组血细胞,包括中性粒细胞平均体积(MNV)、中性粒细胞体积分布标准差(MNV-SD)、中性粒细胞平均传导率(MNC)、中性粒细胞传导率分布标准差(MNCSD)、淋巴细胞平均体积(MLV)、淋巴细胞体积分布标准差(MLV-SD)、淋巴细胞平均传导率(MLC)、淋巴细胞传导率分布标准差(MLC-SD)、单核细胞平均体积(MMV)、单核细胞体积分布标准差(MMV-SD)、单核细胞平均传导率(MMC)、单核细胞传导率分布标准差(MMC-SD)以及淋巴指数(Lymph index)等VCS相关参数。组间比较采用t检验,采用受试者工作特征(ROC)曲线并计算曲线下面积(AUC),以评价VCS相关参数的诊断价值。结果 HBV低于检测下限组的MNC,MLV,MLC和MMC;HBV低中病毒载量组的MNC,MLV,MMC,MMC-SD和淋巴指数;HBV高病毒载量组的MNC,MLV,MLV-SD,MLC,MMC和淋巴指数与对照组比较,差异均有统计学意义(t=2.003～5.468,均P<0.05)。MMC在各实验组中曲线下面积为0.669～0.762,敏感度为62.0%～74.0%,特异度为57.1%～87.5%。结论研究发现HBV感染时外周血白细胞VCS参数中的MNC,MMC,MLV,MLC和淋巴指数会发生变化且与HBV DNA载量变化有一定相关性,这些指标可以用于辅助判断HBV感染及复制程度和治疗效果评估。

Objective To study the correlation between different viral load of patients with HBV and VCS parameters of peripheral blood leukocytes. Methods The samples were collected from September 2016 to May 2017 in Xiangya Hospital,200 patients with hepatitis B virus as the observation group and they were divided into three groups including the lower limit detection group,the low viral load group and high viral load group according to the hepatitis B virus load in the blood, 100 healthy subjects as the control group. The peripheral blood samples collected from both groups were detected by DXH800 blood cell analyzer with VCS technology to analyze the VCS parameters, including neutrophil mean volume （MNV）, neutrophil volume distribution standard deviation （MNV-SD）, neutrophil （MNC）, the average transmission rate of neutrophil conductivity distribution of standard deviation （MNC-SD）,the average volume of lymphocyte （MLV）, cell volume distribution standard deviation （MLV-SD）, the average transmission rate, lymphocyte （MLC） ,lymphocyte transmission rate distribution standard deviation （MLC-SD）, the average volume of mononuclear cells （MMV）, mononuclear cell volume distribution standard deviation （MMV-SD）, monocyte average conductivity （MMC） mononuclear cells, conductivity distribution standard deviation （MMC-SD） and lymph node （Lymph index） index. The comparison of the mean of the two groups was applied with t-test. The area under the receiver operating characteristic （ROC） curve （AUC） was used to evaluate the diagnostic value of VCS related parameters. Results Compared with the control group, it was found that the MNC, MLV, MLC and MMC of HBV lower than the detection limit group. MNC, MLV, MMC, MMC-SD and lymph index of HBV lower and middle viral load group. MNC, MLV, MLV-SD, MLC, MMC and lymph index of HBV higher viral load group compared with the control group, the difference was statistically significant （ t= 2.053 - 5. 468, all P〈0.05）. According to the ROC curve of MMC,the AUC was 0. 669-0. 762,the sensitivity was 62.0% -74.0% and the specificity was 57.1% -87.5% in test group. Conclusion The morphology of peripheral blood leukocytes can change when HBV infection occurs. The MNC, MMC, MLV, MLC and lymph index are related to the change of HBV DNA load. The parameters of VCS can be used to assist in judging the degree of HBV replication and evaluating the therapeutic effect.