外周血白细胞VCS参数在老年细菌性肺炎诊断中的应用价值

Application of peripheral blood leukocyte VCS parameters in diagnosis of bacterial pneumonia in elderly patients

目的探讨外周血白细胞VCS参数在老年细菌性肺炎诊断中的临床应用价值。方法利用Beckman-Coulter LH780全自动血细胞分析仪检测300例老年细菌性肺炎患者和220例健康对照者的外周血白细胞VCS参数,包括中性粒细胞平均体积(NV)、中性粒细胞平均传导率(NC)、中性粒细胞平均激光散射率(NS),以及它们各自的平均分布宽度(SD);淋巴细胞平均体积(LV)、淋巴细胞平均传导率(LC)、淋巴细胞平均激光散射率(LS),以及它们各自的平均分布宽度(SD)。结果WBC≥10×10^9/L肺炎组和WBC<10×10^9/L肺炎组NV、NV-SD、LV、LV-SD均明显高于健康对照组,NC、LC均低于健康对照组(均P<0.05),WBC≥10×10^9/L肺炎组与WBC<10×10^9/L肺炎组比较,NV和NV-SD明显升高(P<0.05)。肺炎患者NV-SD、LV-SD与C反应蛋白(CRP)呈正相关(r=0.350、0.319,均P<0.05)。ROC曲线分析发现NV-SD和LV-SD诊断价值较高,AUC分别为0.899和0.802,当NV-SD cut-off值为20.52时,其灵敏度和特异度分别为0.839和0.882;当LV-SD cut-off值为13.36时,其灵敏度和特异度分别为0.857和0.676。结论外周血白细胞VCS参数能反映老年细菌性肺炎患者中性粒细胞和淋巴细胞形态学变化,其中NV-SD和LV-SD与CRP呈正相关,在一定程度上能更加灵敏、特异地反应细菌感染。

Objective To assess the clinical application of leukocyte VCS(volume,conductivity,light scatter)parameters in diagnosis of bacterial pneumonia in elderly patients.Methods The leukocyte VCS parameters were determined with Beckman Coulter LH780 heamatology analyzer in 300 elderly patients with bacterial pneumonia and 220 healthy controls,including neutrophil volume(NV),neutrophil conductivity(NC),neutuophil light scatter(NS),lymphocyte volume(LV),lymphocyte conductivity(LC)and lymphocyte light scatter(LS),and their mean standard deriation(SD).Results The levels of NV,NV-SD,LV and LV-SD in pneumonia group were significantly higher than those in healthy control group(P<0.05),and the levels of NC and LC in penumonia group were lower than those in healthy group(P<0.05).The levels of NV and NV-SD in pneumonia group with WBC≥10×10^9/L were significantly higher than those in pneumonia group with WBC<10×10^9/L(P<0.05).NV-SD and LV-SD were positively correlated with CRP(r=0.350,0.319,P<0.05).The area under the ROC curve(AUC)of NV-SD in diagnosis of bacterial pneumonia was 0.899 with a sensitivity of 0.839 and a specificity of 0.882.The AUC of LV-SD was 0.802 with a sensitivity of 0.857 and a specificity of 0.676.Conclusion The parameters of leukocyte VCS can reflect the morphological changes of neutrophils and lymphocytes in the elderly patients with bacterial pneumonia.And the NV-SD and LV-SD may be used as indictors for bacterial infection in elderly patients.