失代偿期肝硬化并发败血症患者外周血白细胞VCS参数变化及其临床价值分析

Implication of peripheral blood leukocyte VCS parameters in patients with decompensated liver cirrhosis and sepsis

目的探讨失代偿期肝硬化并发败血症患者外周血白细胞体积(V)、电导率(C)和散射(C)参数变化及其临床应用价值。方法2017年6月~2020年6月我院诊治的失代偿期乙型肝炎肝硬化患者130例,其中发生败血症39例,普通感染组46例,未感染45例。使用COULTER LH 750/LH 755全自动血液分析仪检测外周血中性粒细胞平均体积MNV)、中性粒细胞平均电导率(MNC)、中性粒细胞平均散射率(MNS),单核细胞平均体积(MMV)、单核细胞平均电导率(MMC)、单核细胞平均散射率(MMS),淋巴细胞平均体积(MLV)、淋巴细胞平均电导率(MLC)和淋巴细胞平均散射率(MLS),应用受试者工作特征曲线(ROC)分析各指标诊断败血症的效能。结果败血症组中性粒细胞MNV和MNC分别为(149.5±9.8)和(148.6±9.6),显著高于普通感染组【(144.3±8.9)和(144.6±8.6),P<0.05】或未感染组【(139.9±7.6)和(140.8±7.1),P<0.05】;败血症组单核细胞MMV为(179.6±11.3),显著高于普通感染组【(170.3±10.6),P<0.05】或未感染组【(165.3±8.6),P<0.05】;败血症组淋巴细胞MLV为(90.1±5.1),显著高于普通感染组【(87.8±4.6),P<0.05】或未感染组【(84.1±4.3),P<0.05】;ROC分析结果显示,MNV、MMV、MLV、APACHE II和SOFA各单指标诊断失代偿期肝硬化患者发生败血症的AUC分别为0.756、0.768、0.681、0.796和0.794,而各指标联合诊断的AUC达到0.847,其诊断效能最高(P<0.05)。结论应用外周血白细胞VCS参数诊断失代偿期肝硬化患者发生败血症具有较好的效能,临床上可以选择应用。

Objective The aim of this study was to explore the implication of peripheral blood leukocyte volume(V),conductivity(C)and scattering(C)parameters in patients with decompensated liver cirrhosis and sepsis.Methods 130 patients with decompensated liver cirrhosis including complicated sepsis in 39,other common infection in 46 and non-infected in 45,were admitted to our hospital between June 2017 and June 2020.The mean neutrophil volume(MNV),mean neutrophil conductivity(MNC)and mean neutrophil scattering(MNS),mean monocyte volume(MMV),mean monocyte conductivity(MMC)and mean monocyte scattering(MMS),and mean lymphocyte volume(MLV),mean lymphocyte conductivity(MLC)and mean lymphocyte scattering(MLS)were detected.The receiver’s operating characteristic(ROC)was applied to evaluate the diagnostic efficacy of these indicators for sepsis occurrence.Results The neutrophil MNV and MNC were(149.5±9.8)and(148.6±9.6),both significantly higher than[(144.3±8.9)and(144.6±8.6),P<0.05]in infected or[(139.9±7.6)and(140.8±7.1),P<0.05]in non-infected patients;theMMV was(179.6±11.3),significantly higher than[(170.3±10.6),P<0.05]in infected or[(165.3±8.6),P<0.05]in non-infected patients;the MLV was(90.1±5.1),much higher than[(87.8±4.6),P<0.05]in infected or[(84.1±4.3),P<0.05]in non-infected patients;theROC analysis showed than the AUC of MNV,MMV,MLV,APACHE II and SOFA in diagnosing sepsis in cirrhotics were 0.756,0.768,0.681,0.796 and 0.794,while the combination of the five reached to 0.847,having the best diagnostic efficacy(P<0.05).Conclusion The peripheral blood leukocyte VCS parameters have a good diagnostic efficacy for sepsis in patients with decompensated liver cirrhosis,which warrants further clinical investigation.