血清ADA、LDH及外周血淋巴细胞亚群比例联合检测对传染性单核细胞增多症的诊断价值

doi:10.3969/j.issn.1673-8640.2020.09.006

摘要/Abstract

摘要：

目的探讨血清腺苷脱氨酶（ADA）、乳酸脱氢酶（LDH）、外周血CD4⁺/CD8⁺比值和CD19⁺B淋巴细胞百分比联合检测对传染性单核细胞增多症（IM）的诊断价值。方法选取78例IM患儿（实验组）,以同期体检的80名健康儿童作为正常对照组,88例支气管肺炎或急性上呼吸道感染患儿作为疾病对照组。采集实验组和疾病对照组初诊时的血样本。分别采用过氧化物酶法和速率法检测血清ADA和LDH的水平,采用流式细胞仪检测外周血CD4⁺/CD8⁺比值和CD19⁺B淋巴细胞百分比。采用直线相关分析法分析实验组血清ADA与LDH水平的相关性和外周血CD4⁺/CD8⁺比值与CD19⁺B淋巴细胞百分比的相关性。采用受试者工作特征（ROC）曲线评估各指标单独和联合检测诊断IM的效能。结果实验组血清ADA和LDH均高于疾病对照组和正常对照组（P<0.01）,且二者呈正相关（r=0.445,P<0.01）。实验组CD4⁺/CD8⁺比值和CD19⁺B淋巴细胞百分比均低于疾病对照组和正常对照组（P<0.01）,且二者呈正相关（r=0.681,P<0.01）。血清ADA、LDH、外周血CD4⁺/CD8⁺比值和CD19⁺B淋巴细胞百分比诊断IM的曲线下面积分别为0.983、0.911、0.992和0.986。各指标联合检测诊断IM的AUC为0.998。结论血清ADA、LDH和外周血淋巴细胞亚群比例联合诊断IM的敏感性与特异性较高,有利于IM的早期诊断。

关键词: 腺苷脱氨酶, CD4⁺/CD8⁺比值, 传染性单核细胞增多症

Abstract:

Objective To investigate the diagnostic role of combined detection of serum adenosine deaminase（ADA）and lactate dehydrogenase（LDH） and CD4⁺/CD8⁺ ratio and CD19⁺B lymphocyte percentage in peripheral blood in infectious mononucleosis（IM）. Methods A total of 78 children with IM were enrolled as experimental group,80 healthy children were enrolled as healthy control group,and 88 children with bronchopneumonia or acute upper respiratory tract infection were enrolled as disease control group. Blood specimens of children from experimental group and disease control group were collected at the first visit. Serum levels of ADA and LDH were determined by peroxidase method and rate method,and the CD4⁺/CD8⁺ ratio and the percentage of CD19⁺B lymphocyte in peripheral blood were determined by flow cytometry. Linear correlation analysis was used to analyze the correlation of serum ADA and LDH levels in IM group and the correlation of peripheral blood CD4⁺/CD8⁺ ratio and CD19⁺B lymphocyte percentage. Receiver operating characteristic（ROC） curve analysis was used,and diagnostic efficiency was evaluated. Results Serum ADA and LDH in experimental group were higher than those in control groups（P<0.01）,and there was a positive correlation between them（r=0.445,P<0.01）. The CD4⁺/CD8⁺ ratio and the percentage of CD19⁺B lymphocyte in experimental group were lower than those in control groups（P<0.01）,and there was a positive correlation between them（r=0.681,P<0.01）. The areas under curves of ADA,LDH,CD4⁺/CD8⁺ ratio and the percentage of CD19⁺B lymphocyte were 0.983,0.911,0.992 and 0.986,respectively. The area under curve of the combined detection was 0.998. Conclusions There are high sensitivity and specificity of the combined detection of serum ADA and LDH and the percentage of peripheral blood lymphocyte subsets in diagnosing IM,and it is beneficial for the early diagnosis of IM.

Key words: Adenosine deaminase, CD4⁺/CD8⁺ ratio, Infectious mononucleosis

中图分类号:

R446.1

张莉, 朱红胜, 马钧, 金一, 沈东华. 血清ADA、LDH及外周血淋巴细胞亚群比例联合检测对传染性单核细胞增多症的诊断价值[J]. 检验医学, 2020, 35(9): 881-884.

ZHANG Li, ZHU Hongsheng, MA Jun, JIN Yi, SHEN Donghua. Diagnostic role of combined detection of serum ADA and LDH and the percentage of lymphocyte subsets in peripheral blood in infectious mononucleosis[J]. Laboratory Medicine, 2020, 35(9): 881-884.

图/表 6

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组别	例数	ADA	LDH
实验组	78	54.29±16.09	493.69±115.15
疾病对照组	88	22.01±6.69^*	309.31±74.52^*
正常对照组	80	15.53±2.80^*	239.35±23.66^*
F值		339.800	214.213
P值		0.00	0.00

组别	例数	ADA	LDH
实验组	78	54.29±16.09	493.69±115.15
疾病对照组	88	22.01±6.69^*	309.31±74.52^*
正常对照组	80	15.53±2.80^*	239.35±23.66^*
F值		339.800	214.213
P值		0.00	0.00

组别	例数	CD4⁺/CD8⁺ 比值	CD19⁺B淋巴细胞百分比/%
实验组	78	^0.31±0.18	^4.46±2.53
疾病对照组	88	1.58±0.66^*	21.89±9.63^*
正常对照组	80	1.73±0.57^*	19.85±6.66^*
F值		178.238	147.150
P值		0.00	0.00

组别	例数	CD4⁺/CD8⁺ 比值	CD19⁺B淋巴细胞百分比/%
实验组	78	^0.31±0.18	^4.46±2.53
疾病对照组	88	1.58±0.66^*	21.89±9.63^*
正常对照组	80	1.73±0.57^*	19.85±6.66^*
F值		178.238	147.150
P值		0.00	0.00

诊断指标	曲线下面积	95%可信区间	特异性/%	敏感性/%	最佳临界值	阳性预测值/%	阴性预测值/%
ADA	0.983	0.956~0.989	96.87	95.12	35.2 U/L	94.0	97.5
LDH	0.911	0.878~0.951	88.75	81.71	402 U/L	78.8	90.4
CD4⁺/CD8⁺比值	0.992	0.973~1.000	99.37	97.56	0.65	98.8	98.8
CD19⁺B细胞百分比	0.986	0.956~0.998	96.25	96.34	9.2%	92.9	98.1
联合诊断	0.998	0.974~1.000	98.86	99.92		98.7	100.0