淋巴细胞亚群在脑炎诊断中的临床研究

Clinical study of lymphocyte subsets in the diagnosis of encephalitis

目的通过分析病毒性脑炎和细菌性脑炎的血细胞、淋巴细胞,探究淋巴细胞及其亚群在病毒性脑炎和细菌性脑炎中的诊断价值。方法回顾性分析2015-2019年北京天坛医院脑炎患者血细胞和淋巴细胞的百分比和绝对计数,将有意义的指标绘制受试者工作特征曲线(ROC曲线)来验证其诊断效能。结果共收集病毒性脑炎组患者99例,细菌性脑炎21例。病毒性脑炎组的白细胞、中性粒细胞、淋巴细胞、B淋巴细胞、T细胞数和抑制性T淋巴细胞数显著高于细菌性脑炎组,差异有统计学意义(P<0.05);病毒性脑炎组的单核细胞百分比、自然杀伤细胞百分比显著低于细菌性脑炎组,差异有统计学意义(P<0.05)。单个指标诊断效能最好的是B淋巴细胞,ROC曲线下面积(AUC)为0.722。将B淋巴细胞与自然杀伤细胞百分比、T淋巴细胞计数、抑制性T细胞计数、白细胞绝对计数、淋巴细胞绝对计数、单核细胞百分比和中性粒细胞计数8项指标联合联合诊断,AUC为0.873。结论B淋巴细胞、自然杀伤细胞百分比、T细胞数、抑制性T细胞数、白细胞绝对计数、淋巴细胞绝对计数、单核细胞百分比及中性粒细胞计数对于病毒性和细菌性脑炎的鉴别诊断是有意义的,这8项指标的联合诊断效能最好。

Objective To investigate the role of lymphocytes and their subpopulations in viral and bacterial encephalitis by analyzing blood and lymphocytes.Methods The percentage and absolute count of blood cells and lymphocytes in patients with encephalitis in Beijing Tiantan Hospital from 2015 to 2019 were retrospectively analyzed,and the receiver operating characteristic curve(ROC curve)of meaningful indicators was drawn to verify its diagnostic efficacy.Results 99 cases of viral encephalitis and 21 cases of bacterial encephalitis were collected.The number of white blood cells,neutrophils,lymphocytes,B lymphocytes,T cells and inhibitory T lymphocytes in viral meningitis group was significantly higher than that in bacterial encephalitis group,the difference was statistically significant(P<0.05).The percentage of monocyte and percentage of natural killer cells in viral encephalitis was significantly lower than that in bacterial encephalitis,the difference was statistically significant(P<0.05).The best diagnostic efficacy of individual indicators was B lymphocytes,and AUC was 0.722.Combined diagnosis of B lymphocytes with natural killer cell percentages,T lymphocyte count,inhibitory T cell count,white blood cell absolute count,lymphocyte absolute count,monocyte percentage,and neutrophils count,AUC was 0.873.Conclusion B lymphocytes,percentage of natural killer cells,T cell number,inhibitory T cell number,absolute white blood cell count,absolute lymphocyte count,monocyte percentage and neutrophils count are significant for the differential diagnosis of viral and bacterial encephalitis.The combined diagnostic efficacy of these eight indicators is the best.