摘要
目的评价不成熟粒细胞(IG)和高荧光强度淋巴细胞(HFLC)对ICU中脑出血患者不同程度感染的区分能力,探讨其对血流感染的诊断能力。方法回顾分析脑科ICU病房脑出血住院患者64例,包含19例未感染患者(NOI),27例局部感染患者(LCI)和18例血流感染患者(BSI),并以同期健康体检中心体检合格的121名健康人作为对照组(HC)。血培养同时利用全自动血细胞分析仪Sysmex XE-5000检测了外周血HFLC和IG,采用免疫比浊法和免疫荧光法分别检测了CRP和PCT,此外还采用微生物快速动态检测系统检测了1,3-β-D葡聚糖(1,3-β-DG)和脂多糖(LPS)。比较各组差异及各指标间的相关性。应用受试者工作曲线(ROC)评价HFLC和IG对血流感染的诊断能力。利用Logistic回归分析建立HFLC、IG、CRP、PCT联合检测模型,以评估其对脑出血患者血流感染的诊断能力。结果 NOI组[(0.0556±0.0041)×10^9/L,(0.0114±0.0057)×10^9/L]、LCI组[(0.0857±0.0103)×10^9/L,(0.0102±0.0063)×10^9/L]、BSI组[(0.1503±0.0208)×10^9/L,(0.0255±0.0047)×10^9/L]的IG和HFLC水平均显著高于HC组[(0.0113±0.0035)×109/L,(0.0011±0.0024)×109/L](P<0.05);BSI组两参数水平显著高于LCI组(P<0.05)。三组间CRP水平差异无统计学意义(P>0.05)。BSI组PCT水平(11.96±11.56)ng/mL显著高于NOI组(0.72±0.47)ng/mL和LCI组(2.82±4.68)ng/mL(P<0.05)。IG和HFLC诊断BSI的ROC曲线下面积为分别为0.725(0.580,0.869)、0.708(0.555,0.860),灵敏度分别为100%和57.1%,特异度分别为42.2%和77.8%。HFLC与1-3-β-DG相关(r=0.346,P<0.05),而IG与PCT相关(r=0.284,P<0.05)。Logistic回归分析得到Logistic回归方程为P=1/(1+e-3.22+0.12HFLC+0.75PCT),诊断BSI的ROC曲线下面积达到0.871(0.766,0.977),敏感度增加到85.7%,特异度为75.6%。结论 IG和HFLC对血流感染的检测具有一定的价值。IG提供一定的阴性诊断价值,而HFLC则提供一定的阳性诊断价值。HFLC与PCT联合检测可以显著提高对血流感染的诊断能力,有利�
Objective To evaluate the value of immature granulocytes(IG)and high fluorescence lymphocytes(HFLC)in differentiating the invasiveness and severity of infection for cerebral hemorrhage patients in intensive care units(ICUs),and to explore the ability of HFLC and IG for diagnosing bloodstream infection(BSI).Methods Blood samples were collected from 64 cerebral hemorrhage patients,including 19 non-infection patients(NOI),27 local infection patients(LCI)and 18 BSI patients,and 121 healthy controls(HC).These specimens were collected as blood culture was ordered.Peripheral blood HFLC and IG were analyzed with Sysmex XE-5000.The levels of C reactive protein(CRP)and Procalciton(PCT)were measured with turbidimetrie immunoassay kit and immune-fluorescent kit respectively.Microbiology Kinetic Rapid Reader system was used to detect 1-3-β-D Glucan(1,3-β-DG)and lipopolysaccharide(LPS)levels.The diagnostic values of HFLC and IG in BSI were evaluated with the Receiver Operator Characteristics(ROC)analysis.The value of IG and HFLC in addition to conventional infection markers(PCT and CRP)in diagnosing BSI was evaluated with Logistic analysis.Results IG and HFLC levels in NOI group [(0.0556±0.0041)×10^9/L,(0.0114±0.0057)×10^9/L],LCI infection[(0.0857±0.0103)×10^9/L,(0.0102±0.0063)×10^9/L]and BSI group[(0.1503±0.0208)×10^9/L,(0.0255±0.0047)×10^9/L]were all higher significantly than in HC group[(0.0113±0.0035)×10^9/L,(0.0011±0.0024)×10^9/L](P<0.05).IG,HFLC and PCT levels in BSI group were higher significantly than in NOI group and LCI group(P<0.05).CRP levels in the three groups have no significant differences(P>0.05).The areas under curve(AUC)-ROC of IG and HFLC for diagnosing BSI were 0.725(0.580,0.869)and 0.708(0.555,0.860),and the corresponding sensitivity were 100% and 57.1%,while the specificity were 42.2% and77.8%.HFLC and IG was respectively correlated with 1,3-β-DG(r=0.346,P<0.05)and PCT(r=0.284,P<0.05).After logistic analysis,model P=1/(1+e-3.22+0.12 HFLC+0.75 PCT)were constructed,and the AUC-ROC of the
作者
李春艳
杜振华
刘锦
LI Chun-yan;DU Zhen-hua;LIU Jin(Tianjin Medical University Eye Hospital Laboratory Medicine,Tianjin 300190,China;Affiliated Hospital of Logistics Collate of The Chinese People's Armed Police Forces,TianjiTi 300162,China)
出处
《中国实验诊断学》
2020年第2期194-198,共5页
Chinese Journal of Laboratory Diagnosis
