距离Coulter原理被发现,已经近半个多世纪.运用该原理设计的全自动电子方法主要用于微粒包括血细胞在内的计数和体积测量.虽然分类计数方面有了许多进展,但就全血细胞计数(CBC)本身而言,其基本参数仍然相对稳定.近年来血细胞分析仪在技术和方法学上有许多显著的改进.例如PLT计数,一些仪器现在可以加人抗体进行检测.另一个进展是网织红细胞计数,通过荧光法和细胞化学法使其计数更为准确.

目的 探讨感染性疾病患者中性粒细胞VCS参数的变化及其临床意义.方法 利用Backman-Coulter LH-750自动血细胞分析仪的细胞体积、高频电流传导、激光散射(VCS)技术,测定320例健康者和280例感染者的白细胞总数及中性粒细胞体积(NEV)、浆核比例(NEC)、胞浆颗粒特性(NEs)参数.结果 与健康组比较,感染组中性粒细胞NEV增大,NEC,NES下降;对照组40名患者治疗前后,随着感染消除NEV下降,NEC,NES增大.结论 感染可使外周血中性粒细胞NEV增大,NEC,NES下降,故监测中性粒细胞VCS值可预示感染,是观察疗效的一组重要的参数.

目的 探讨急性细菌感染性疾病、心脑血管意外及大手术后等常见应激性疾病患者中性粒细胞体积、浆核复杂性的变化及临床意义.方法 利用自动血细胞分析仪的VCS技术,测定125例血培养阳性的细菌感染性疾病患者、64例急发性心脑疾病患者、66例大手术后患者及69名健康对照者的WBC计数、中性粒细胞(NE)值和NE的体积(NEV)、电导率(NEC)、光散射性(NES),及各自的平均分布宽度(NEVSD、NECSD、NESSD),并采用ROC曲线分别评价各参数的敏感度和特异度.结果 急性细菌感染组NEV、NES、NEVSD分别为154.3±15.2、135.7±9.9、26.8±4.2,大手术后组分别为147.2±8.9、141.5±7.7、23.0±2.8,急发性心脑疾病组分别为144.9±5.2、146.0±5.0、19.6±1.6,健康对照组分别为139.7±4.6、145.0±3.8、18.2±1.3,差异有统计学意义(F值分别为17.650、38.122、54.604,P均 Abstract： Objective To investigate the variety and clinical value of the neutrophil volume and cytoplasm-nucleus complex in patients with bacterial infection, cardiovascular or cerebrovascular accident and major surgery operation. Methods 125 patients with bacterial infection, 64 patients with acute cardiovascular or cerebrovascular accident, 66 patients after major surgery operation and 69 normal subjects were selected in the study. Total WBC counts (WBC), percentage of neutrophils (NE), and the VCS parameters of neutrephils including the mean channels of cell volume ( NEV), conductivity ( NEC), light scatter(NES) and the SD of these parameters( NEVSD, NECSD, NESSD)were measured by automatic blood cell analyzing instrument. The sensitivity and specificity of the WBC, NE and the VCS parameters of neutrophils were analyzed with receive operating characteristic (ROC) curve. Results The levels of NEV, NES and NEVSD in acute bacterial infection group were 154.3 ± 15.2, 135.7 ± 9.9, 26.8 ± 4.2 respectively. The levels of NEV, NES and NEVSD in post major surgery operation group were 147.2±8.9, 141.5 ± 7.7, 23.0 ± 2. 8 respectively. The levels of NEV, NES and NEVSD in acute cardiovascular or cerebruvascular accident group were 144.9 ± 5. 2, 146.0 ±5.0, 19. 6±1.6 respectively. The levels of NEV, NES and NEVSD in healthy control group were 139.7±4.6, 145.0±3.8, 18.2±1.3 respectively. The differences of these parameters among these groups had statistical significance ( F = 17. 650, 38. 122, 54. 604,P<0. 05). And the changes of NEV, NES and NEVSD in bacterial infection group were most obvious among those three groups. The levels of NEV, NES and NEVSD were 146.5±9.5, 144.3 ± 9.4, 21.3 ± 3.3 respectively in stress diseases groups which included acute cardiovascular or cerebrovascular accident group and post major surgery operation group. The differences of these parameters between stress diseases group and acute bacterial infection group had statistical significance ( t = - 2.840, 7.533, - 8.999,P<0.01). The areas under the ROC curve of NEVSD, NEC, NES and NECSD were 0.893, 0. 845, 0. 833 and 0. 849 respectively. The sensitivity of 83. 3% and specificity of 82. 0% could be achieved by selecting the cut-off equal to or greater than 24. 0. Conclusions The variety of neutrophil volume, nuclear size and cytoplasmic granularity changed obviously in patients with acute bacterial infection and common stress diseases, and the variety in acute bacterial infection is more obvious than that in common stress diseases. The sensitivity and specificity of VCS parameters of neutrophils are higher than those of WBC or NE for predicting infection, and the NEVSD is the most predictable indicator of acute bacterial infection.

目的 探讨应激反应时中性粒细胞（Neg)VCS参数对Neg核象变化和中毒性改变的可靠性。方法 利用Beckman-Coulter Gen.S血液分析仪的体积、高频传导、激光散射（VCS）技术，测定50例健康体检者和130例重症患者应激状态下的WBC、Neg百分数（Neg%）、Neg体积（NegV）、电导率（NegC）、光散射性（NegS）及各自平均分布宽度（SD），镜下观察WBC分类和形态学结果，并采用ROC曲线评价各参数的诊断价值。 结果 与健康对照组相比，重症患者不同程度核左移组及无中毒性改变组、有中毒性改变组的WBC、Neg%和NegV-SD、NegC-SD、NegS-SD明显升高，而NegC、NegS显著下降（P均<0.05)。NegV、NegC、NegV-SD的ROC曲线下面积判断有无核象改变分别为0.799、0.823、0.843，有无中毒性改变分别为0.731、0.754、0.761，均有较好的敏感性和特异性。 结论 重症患者在应激状态下Neg VCS参数均可发生明显改变，以NegV、NegC、NegV-SD对预测其形态学改变的敏感性和特异性最佳。

目的 研究由Beckman-Coulter LH 750全自动血液分析仪分析产生的VCS参数-中性粒细胞体积分布宽度(NDW),是否能作为新的急性细菌感染指标.方法 采用LH750血液分析仪测定124例菌血症患者和129名健康人的NDW值,进行统计学分析.结果 细菌感染组与正常对照组相比NDW值显著增大, 差异有统计学意义(P<0.01),同时见于白细胞数正常或者低于正常的菌血症患者.结论 在辅助诊断细菌感染方面,NDW值其灵敏度和特异度明显高于白细胞总数和中性粒细胞百分比计数.中性粒细胞VCS参数--NDW将有可能作为辅助诊断细菌感染又一实用指标.

目的 研究白细胞VCS参数在血液细菌感染中的临床应用.方法 采用Coulter LH 750血细胞分析仪检测120例血液细菌感染患者、69例非感染性发热患者、67名健康对照者的中性粒细胞和淋巴细胞的VCS参数,包括中性粒细胞平均体积(MNV)、中性粒细胞体积分布宽度(NDW)、中性粒细胞平均传导率(MNC)、中性粒细胞平均散射值(MNS);淋巴细胞平均体积(MLV)、淋巴细胞体积分布宽度(LDW)、淋巴细胞平均传导率(MLC)、淋巴细胞平均散射值(MLS).将血液细菌感染组根据白细胞总数分为WBC≤10×109/L组和＞10×109/L组;根据中性粒细胞比例分为≥85%组和＜85%组;根据细菌染色分为革兰阳性细菌感染组和革兰阴性细菌感染组.结果 血液细菌感染组的MNV、NDW、MNS、MLV、LDW、MLC、MLS分别为156 ±15、23.31±3.72、137±7、87±12、17.50±3.38、110±5、69±12;非感染性发热组分别为151±8、21.33 ±2.62、132±10、91±4、15.78±1.96、117±4、62±6;健康对照组分别为145±5、18.43±0.93、143±4、84±2、13.30 ±0.76、108±1、62±2;上述各指标在3组间差异均有统计学意义(F值分别为19.295、26.272、32.767、6.226、31.016、23.739、12.662,P＜0.05或＜0.01).WBC≤10×109/L组MNV和NDW分别为152±16、22.19±3.45,WBC＞10×109/L组分别为159±12、25.29±3.43,与健康对照组比较,3组间差异有统计学意义(F值分别为21.575、40.856,P＜0.01).中性粒细胞百分率≥85%组的MNV、NDW分别为159±12、24.88 ±3.74,中性粒细胞百分率＜85%组分别为151±16、21.68±2.29,与健康对照组比较,3组间差异有统计学意义(F值分别为23.76、43.22,P＜0.01).革兰阴性细菌感染组的MNV和NDW分别为157±15、24.25±3.39,革兰阳性细菌感染组分别为153 ±14、21.51±3.78,与健康对照组3组间比较,差异有统计学意义(F值分别为18.74、37.47,P＜0.01).在血液细菌感染诊断中,当NDW的临界值(cut-off值)取20.50时,敏感度为76.7%,特异度为98.3%.结论 VCS参数能反映血液细菌感染时白细胞的形态学变化,其中NDW参数能更加灵敏、特异地反映血液细菌感染. Abstract： Objective To investigate the clinical application of VCS parameters of leukocyte in the detection of blood bacterial infection, Methods The subjects consisted of 120 patients with blood bacterial infection,69 non-infectious fever patients and 67 health controls.The VCS parameters of neutrophil and lymphocyte were examined with Coulter LH 750 hematology analyzer.The parameters examined including mean channel of neutrophil volume(MNV),neutrophil volume distribution width (NDW) ,mean channel of neutrophil conductivity (MNC),mean channel of neutrophil scatter (MNS),mean channel of lymphocyte volme(MLV),lymphocyte volume distfibufion width (LDW),mean channel of lymphocyte conductivity (MLC) and mean channel of lymphocyte scatter (MLS).Additionally,120 blood bacterial infection patients were grouped according to WBC count(WBC≤10×109/L group and WBC＞10×109/L group),neutrophii rate(≥85%group and＜85%group)and bacterial stain(Gram positive bacteria group and Gram negative bacteria group).VCS parameters among these groups were compared.Results The results of blood infection group were as follows:MNV 156±15,NDW 23.31±3.72,MNS 137±7,MLV 87±12,LDW 17.50±3.38.MLC 110±5 and MLS 69±12.The results of non-infectious fever group were as follows:MNV 151±8,NDW 21.33 ±2.62,MNS 132±10,MLV 91±4.LDW 15.78±1.96.MLC 117±4 and MLS 62±6.The results of control group were as follows:MNV145 ±5.NDW 18.43±0.93.MNS 143 ±4,MLV 84±2,LDW 13.30±0.76.MLC 108±1 and MLS 62±2.There were significant diffierences among these three groups (F value were 19.295,26.272,32.767,6.226,31.016,23.739 and 12.662 respectively,P＜0.05 or P＜0.01).In the infection group.the MNV and NDW were 152 ±16 and 22.19±3.45 respectively for WBC≤10×109/L group.159±12 and 25.29±3.43 respectively for WBC＞10×109/L group.They were both significantly different compared with control group (F valRe were 21.575 and 40.856 respectively,P＜0.01).Also in the infection group.the MNV and NDW were 159±12 and 24.88 ±3.74 respectively for neutrophil rate≥85%group.151±16 and 21.68±2.29 respectively for neutrophil rate＜85%group.They were both significantly different compared with control group(F value were 23.76 and 43.22 respectively,P＜0.01).The MNV and NDW were 157±15 and 24.25±3.39 respectively in those cases with gram-negative bacteremia,153±14 and 21.51±3.78 respectively in those cases with gram-positive bacteremia.They were both signifieanfly difierent compared with control group (F value were 18.74 and 37.47 respectively,P＜0.01).With a cut-off value of 20.50 for the NDW,a sensitivity of 76.7%and specificity of 98.3% were achieyed in diagnosing blood hacterial infection.Conclusion The VCS parameters can reflect the morphologic change of leukocyte in blood bacterial infection.Additionally.the NDW can detect blood bacterial infection more sensitively and specifically.

目的 探讨中性粒细胞VCS参数在诊断急性细菌感染中的应用价值.方法 利用贝克曼-库尔特五分群(类)血细胞分析仪(LH750)分析112例血培养细菌阳性的急性细菌感染患者和70名成年健康对照者、45例非细菌感染WBC增高组的外周血中性粒细胞平均体积(MNV)、平均高频传导(MNC)、平均激光散射(MNS)参数,以及中性粒细胞的体积分布宽度(NDW),并与传统的WBC计数、WBC分类、细胞形态学、C反应蛋白(CRP)等感染指标进行比较分析.将血液细菌感染组根据WBC总数高低分成A、B、C 3组,A组:WBC 5%时,敏感度为66%)、CRP(cut-off值≥10 mg/L时,敏感度为65%)等感染指标.结论 中性粒细胞的MNV、NDW参数在急性细菌感染时能特异而灵敏地反映粒细胞的形态学变化,是诊断细菌感染的一个客观而又快速经济的指标. Abstract： Objective To investigate the clinical value of mean channel of neutrophil volume (MNV), mean channel of neutrophil conductivity (MNC) and mean channel of neutrophil scatter (MNS) in predicting acute bacterial infection.Methods Peripheral blood samples from 112 patients with positive blood cultures for bacteria,70 healthy subjects and 45 non-infectious subjects with high white blood cell count(WBC) were studied using the Coulter LH 750 hematology analyzer.MNV, MNC, MNS and neutrophil volume distribution width (NDW) were retrospectively analyzed and compared with total WBC, percentage of neutrophils,neutrophil left-shift and CRP.112 blood bacterial infections were grouped according to WBC count (A:WBC ＜11.0×109 /L;B:11.0×109/L≤WBC＜15.0×109 /L;C:WBC≥15.0×109 /L) and neutrophil rate (NE ＜ 0.85 and NE ≥ 0.85 ).Results MNV and NDW increased significantly in septic patients (154.17 ± 10.08,24.36 ± 4.14 ) compared with those of healthy control group (142.09 ± 4.13,19.04 ± 1.97) and non-infectious patients with high WBC group ( 150.63 ± 8.14,20.19 ± 4.73 ).There was statistically significant difference (F value were 20.738 and 28.190 respectively,P ＜ 0.01 ). On the contrary, MNS decreased significantly in septic patients (137.15 ± 7.61 ) compared with that of healthy group (144.51±4.36) and nonspetic patients with high WBC group (142.45±7.11) ,there was significant statistical difference (F=5.217,P＜0.01).The MNV, NDW and MNS of A group were 148.09±5.76,22.39±1.97,140.07±6.11 respectively.The MNV, NDW and MNS of B group were 152.83±5.75,24.14±1.35,141.44±5.35 respectively.The MNV, NDW and MNS of C group were 164.28±6.49,29.42±5.93,134.27±9.61 respectively. There was statistically significant difference compared with healthy group (F value were 24.720,31.642,7.931, P ＜ 0.01).The MNV, NDW and MNS in the group with NE ＜0.85 were 149.17±9.06,22.59±2.73,141.19±4.34 respectively.The MNV, NDW and MNS in the group with NE≥0.85 group were 159.03±10.23,27.64±4.51,135.62 ± 8.95 respectively.There was statistically significant difference compared with healthy group ( F value was 23.970,51.309,19.792,P＜0.01).With a cut-off of 150 for the MNV, a specificity of 90% and sensitivity of 70% were achieved.NDW was associated with neutrophil left-shift (r=0.33,P＜0.01).With a cut-off of 23 for the NDW, a specificity of 100% and a sensitivity of 72% were achieved.The sensitivity of the MNV and NDW was better than total white blood cells count (with a cut-off≥ 11.0×109 /L, the sensitivity was 57% ), percentage of neutrophils( with a cut-off≥0.85, the sensitivity was 44% ) and neutrophil shift to left ( with a cut-off ＞5%, the sensitivity was 66% ) and CRP (with a cut-off ≥10 mg/L, the sensitivity was 65% ).Conclusions The MNV and NDW of the neutrophil can reflect the morphologic change of neutrophil sensitively and specificialy in acute infection. As quantitative, objective and more sensitive parameters, MNV and NDW may have a potential role for predicting the acute bacterial infection.

目的 探讨中性粒细胞体积分布宽度(NDW)在诊断急性细菌性感染中的应用价值.方法 应用Beckman Coulter LH750全自动血细胞分析仪,对80例急性细菌性感染患者的血样进行全血细胞分析,综合白细胞总数、中性粒细胞百分比、中性粒细胞体积分布宽度、显微镜形态学检查等各项指标,与50例正常对照组比较.结果 急性细菌性感染患者NDW数值较正常对照组明显增高(P＜0.01),而且部分急性感染患者白细胞总数＜11.0×109/L,中性粒细胞＜85.0%,但NDW数值却较正常对照组明显增高(P＜0.01),显微镜形态学检查,当NDW＞23.0时,可见不同程度中性粒细胞核左移、中性粒细胞体积大小不等、胞浆内出现中毒颗粒等.结论 NDW可以作为诊断急性细菌性感染比较敏感特异的一个新指标.