血液分析仪多参数预测登革热的研究

doi:10.3969/j.issn.1673-8640.2016.12.014

摘要/Abstract

摘要：

目的研究UniCel DxH 800全自动血液分析仪（简称DxH 800）白细胞（WBC）群落参数（CPD）对登革热临床诊断及鉴别诊断的价值,建立最佳报警阈值。方法选取登革热确诊患者278例、登革热疑似患者（临床症状与登革热相似,但血清学检测结果阴性）106例、健康体检者159名为研究对象。运用DxH 800进行全血细胞计数和WBC分类计数。分析单核细胞和淋巴细胞CPD,利用受试者工作特征（ROC）曲线评价各参数及部分结果对登革热的诊断效率。结果登革热组患者WBC和血小板（PLT）计数相对于登革热疑似患者和健康体检者均显著降低（P<0.05）,单核细胞百分比（MO%）显著增高（P<0.05）,单核细胞大小显著不等,单核细胞体积的标准差（s-V-MO）显著增高（P<0.05）。将登革热患者MO%和s-V-MO 2个变化比较显著的参数综合分析,得到登革因子参数。登革因子能很好地鉴别诊断登革热,与健康体检者鉴别时,ROC曲线下面积（AUC）为0.99,当临界值为29.3时,敏感性为95.7%,特异性为98.7%。与登革热疑似患者鉴别时,AUC为0.824,当临界值为34.8时,敏感性为78.3%,特异性为75.2%。结论登革因子对登革热实验室诊断和鉴别诊断具有临床应用价值。

关键词: 血液分析仪, 登革热, 白细胞群落参数

Abstract:

Objective To investigate white blood cell（WBC） cell population data（CPD） in the diagnosis of dengue by UniCel DxH 800 automatic hematology analyzer,and to establish the optimal cut-off value.Methods A total of 159 healthy subjects,278 dengue patients and 106 suspected dengue patients（they had similar clinical symptoms with dengue patients,but their serological markers were negative） were enrolled. Whole blood count and WBC differential count were determined by DxH 800. Monocyte and lymphocyte CPD were analyzed. Receiver operating characteristic（ROC） curve was used to evaluate diagnosis efficiency. Results WBC and platelet（PLT） counts in dengue group were lower than those in suspected dengue and healthy control groups（P<0.05）,but the percentage of monocyte（MO%）was higher（P<0.05）,there was marked anisocytosis of monocytes and increased monocyte volume standard deviation（s-V-MO）（P<0.05）. Dengue indicator（MO%+s-V-MO） showed the optimal performance with an area under curve（AUC） of 0.99,when the cut-off value was 29.3,the sensitivity was 95.7%,and the specificity was 98.7%,for healthy control group. There was optimal performance with an AUC of 0.824,when the cut-off value was 34.8,the sensitivity was 78.3%,and the specificity was 75.2%,for suspected dengue group. Conclusions Dengue indicator is of significance in the diagnosis and differentiation of dengue.

Key words: Hematology analyzer, Dengue, Cell population data

中图分类号:

R446.1

张丽梅, 林勇平, 徐韫健, 邝美华. 血液分析仪多参数预测登革热的研究[J]. 检验医学, 2016, 31(12): 1073-1077.

ZHANG Limei, LIN Yongping, XU Yunjian, KUANG Meihua. Screening dengue using hematology analyzer with multi-parameters[J]. Laboratory Medicine, 2016, 31(12): 1073-1077.

图/表 6

参考文献 12

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组别	WBC计数（×10⁹/L）	PLT计数（×10⁹/L）	红细胞压积	NE%	LY%	MO%	嗜酸性粒细胞百分比（%）
登革热组	4.69±2.06	140±57.1	0.394±0.043	63.2±15.4	20.0±12.1	15.1±6.1	0.79±1.6
登革热疑似对照组	8.34±4.03	203±83.9	0.410±0.038	68.5±14.5	19.7±11.6	9.6±4.1	1.0±1.5
健康对照组	6.66±1.47	224±62.6	0.375±0.05	54.6±6.77	34.2±6.2	7.6±1.7	2.7±1.7
P1值（登革热组/登革热疑似对照组）	<0.05	<0.05	<0.05	<0.05	>0.05	<0.05	>0.05
P2值（登革热组/健康对照组）	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

组别	WBC计数（×10⁹/L）	PLT计数（×10⁹/L）	红细胞压积	NE%	LY%	MO%	嗜酸性粒细胞百分比（%）
登革热组	4.69±2.06	140±57.1	0.394±0.043	63.2±15.4	20.0±12.1	15.1±6.1	0.79±1.6
登革热疑似对照组	8.34±4.03	203±83.9	0.410±0.038	68.5±14.5	19.7±11.6	9.6±4.1	1.0±1.5
健康对照组	6.66±1.47	224±62.6	0.375±0.05	54.6±6.77	34.2±6.2	7.6±1.7	2.7±1.7
P1值（登革热组/登革热疑似对照组）	<0.05	<0.05	<0.05	<0.05	>0.05	<0.05	>0.05
P2值（登革热组/健康对照组）	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05	<0.05

组别	MN-V-LY	s-V-LY	MN-C-LY	s-C-LY	MN-V-MO	s-V-MO	MN-C-MO	s-C-MO
登革热组	90.2±4.6	16.7±3.1	117±4.5	9.2±3.5	180±8.4	25.4±3.2	127±4.3	5.8±2.4
登革热疑似对照组	88.1±5.3	15.9±2.3	116±4.9	8.3±2.6	178±9.4	22.3±4.0	126±4.8	5.7±1.9
健康对照组	86.7±2.8	13.3±1.2	116±1.1	7.3±1.1	164±3.9	17.1±1.5	126±3.8	5.1±0.9
P1值（登革热组/登革热疑似对照组）	<0.05	<0.05	>0.05	<0.05	>0.05	<0.05	>0.05	>0.05
P2值（登革热组/健康对照组）	<0.05	<0.05	>0.05	<0.05	<0.05	<0.05	>0.05	<0.05

组别	MN-V-LY	s-V-LY	MN-C-LY	s-C-LY	MN-V-MO	s-V-MO	MN-C-MO	s-C-MO
登革热组	90.2±4.6	16.7±3.1	117±4.5	9.2±3.5	180±8.4	25.4±3.2	127±4.3	5.8±2.4
登革热疑似对照组	88.1±5.3	15.9±2.3	116±4.9	8.3±2.6	178±9.4	22.3±4.0	126±4.8	5.7±1.9
健康对照组	86.7±2.8	13.3±1.2	116±1.1	7.3±1.1	164±3.9	17.1±1.5	126±3.8	5.1±0.9
P1值（登革热组/登革热疑似对照组）	<0.05	<0.05	>0.05	<0.05	>0.05	<0.05	>0.05	>0.05
P2值（登革热组/健康对照组）	<0.05	<0.05	>0.05	<0.05	<0.05	<0.05	>0.05	<0.05

CPD	AUC	临界值	敏感性（%）	特异性（%）
WBC	0.796	6.45	67.6	79.4
NE%	0.602	56.2	84.8	31.4
MO%	0.784	11.3	72.2	70.5
PLT	0.785	112	72.5	70.5
MN-V-LY	0.613	87.5	73.6	46.7
s-V-LY	0.575	15.5	63.0	54.3
s-C-LY	0.591	8.39	50.7	67.6
s-V-MO	0.754	23.5	75.6	65.9
登革因子	0.824	34.8	78.3	75.2