摘要
目的分析白细胞群落参数(VCS)在抗结核药物治疗过程中的变化,并探讨其在监测抗结核药物致粒细胞下降中的临床价值。方法应用美国Beckman-Coulter LH-750全自动血细胞分析仪检测633例初治肺结核患者用药前、强化期以及500例健康体检者(健康对照组)的外周血常规,记录中性粒细胞绝对值(ANC)、中性粒细胞百分率(NE%)、中性粒细胞平均体积(MNV)、中性粒细胞平均电导率(MNC)、中性粒细胞平均光散射值(MNS)及其相应标准差(SD值),计算用药前、后VCS参数的变化幅度(△VCS)。根据临床症状和实验室检查结果将患者分为病例对照组(489例,血常规指标均正常)和粒细胞下降组(65例,ANC<2.0×10~9/L),以上指标进行组间比较。结果病例对照组患者强化期MNV和MNV-SD较用药前显著升高(t=-2.207、P=0.030,t=-2.030、P=0.043),而MNS显著下降(t=-2.104、P=0.045)。粒细胞下降前1周MNV、MNV-SD、MNS与患者用药前相比,发生更为显著的变化(t=-27.953、9.627、7.724,P均<0.001),而ANC、NE%均无显著性变化(t=2.032、P=0.051,t=1.977、P=0.052)。ANC下降至2.0×10~9/L以下时,△MNV与△ANC水平呈负相关(r=0.868,P<0.001),△MNS则与之呈正相关(r=0.847、P=0.000)。发生粒细胞下降前1周患者MNV、MNV-SD、MNS的ROC曲线下面积分别为0.867、0.778和0.804,均高于ANC(AUC=0.633)和NE%(AUC=0.589),且当MNV的Cut-off值取≥150.05时,其灵敏度以及特异性分别达82.3%和72.5%,诊断性能均优于其他指标。ANC+NE%+MNV+MNV-SD+MNS联合诊断时,其灵敏性和特异度分别高达88.5%和84.2%。结论抗结核药物引起参数MNV、MNV-SD变大,MNS下降,当药物致粒细胞下降时,MNV、MNV-SD、MNS变化更为显著,且发生在粒细胞下降前,与ANC、NE%联合诊断时灵敏度及特异性显著提高。
Objective To investigate the changes of VCS parameters of blood white cells in the process of anti-tuberculosis drugs treatment and its clinical value during monitoring granulocyte decrease induced by anti-tuberculosis drug. Methods Peripheral blood samples collected from 500 healthy controls and 633 patients with tuberculosis were detected for neutrophils absolute value （ANC）, neutrophil （NE%）, neutrophil average volume （MNV）, neutrophil average conductivity （MNC）, neutrophils average values of light scattering （MNS） and its corresponding standard deviation （SD） by the Coulter LH750 hematology analyzer. The neutrophil VCS parameters were detected and VCS variation （AVCS） before and after therapy were calculated, respectively. Patients were divided into control group （489 cases, with normal blood routine indexes） and neutropenia group （65 cases, with ANC 〈 2.0×10^9/L） according to the clinical symptoms and laboratory examination, data analysis between groups were compared, respectively. Results MNV of improved period and MNV-SD of patients in the control group were increased significantly compared with those before treatment （t = 2.207, P = 0.030; t = 2.030, P = 2.030）, but MNS decreased significantly （t = 2.104, P = 2.104）. Compared with the indexes before treatment, MNV of one week before granulocyte decline, MNV-SD and MNS changed significantly （t = 27.953, 27.953, 27.953; all P 〈 0.001）, but the ANC and NE% were with no significant change （t = 2.032, P = 0.051; t = 1.977, P = 0.052）. When ANC dropped to 2.0×10^9/L, △MNV was negatively correlated with AANC （r = 0.868, P 〈 0.001）, but △MNS was positively correlated with AANC （r = 0.847, P = 0.000）. MNV of one week before granulocyte decline, MNV-SD and MNS area under the ROC curve were 0.867, 0.778 and 0.867, respectively, significantly higher than the ANC （AUC = 0.633） and NE% （AUC = 0.589）, and as the MNV Cut-off ≥150.05, the sensitivity and specificity were 82.3% and 82.3%, respectively, this diagnosis method was better than other indicators. When ANC ＋ NE% ＋ MNV ＋ MNV-SD ＋ MNS was taken as joint diagnosis, its sensitivity and speciality rate were 88.5% and 88.5%, respectively. Conclusions Anti-tuberculosis drugs could cause higher MNV and MNV-SD, but decreased MNS; when drug induced granulocyte decrease occure, changes of MNV, MNV-SD and MNS were more significant. The joint diagnosis with the ANC and NE% could make higher sensitivity and specificity before granulocyte decline.
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2017年第1期60-64,共5页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
南通市卫计委青年基金(No.WQ2014064)
关键词
白细胞群落参数(VCS)
中性粒细胞
抗结核药物
粒细胞下降
White blood cells community parameters
Neutrophils
Anti-tuberculosis drugs
Drug- induced neutropenia
