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目的:探讨全身炎症反应综合征(SIRS)患者中性粒细胞VCS参数的变化及意义。方法:利用Beck-man-CoulterGen.S自动血细胞分析仪的体积、高频传导、激光散射(VCS)技术,测定45例健康体检者(对照组)和121例重症监护病房(ICU)的患者(非SIRS组47例、非感染性SIRS组34例、感染性SIRS组40例)的白细胞总数(WBC)、中性粒细胞百分数(NE%)和NE的体积(NE-V)、浆核比(NE-C)、胞浆颗粒特性(NE-S)及它们各自的平均分布宽度(SD),并用ROC曲线评价各参数监测ICU的患者SIRS病情的敏感性和特异性。结果:ICU的患者WBC、NE%、NE-V、NEV-SD、NEC-SD、NES-SD明显高于对照组,而NE-C、NE-S明显下降(P<0.01);SIRS组第2、4、6天的WBC与NE%和第4、6天的NEV-SD及第6天的NE-V均高于非SIRS组相应的时间点,而NE-S明显降低(P<0.01或P<0.05);SIRS组的患者在进入ICU的第2天与第4、6天NE-V、NES-SD差异有统计学意义;非感染性SIRS组的NEV-SD、NEC-SD、NES-SD、NE-S和感染性SIRS组除NE-C外的NE-VCS参数与非SIRS组均差异有统计学意义(P<0.01或P<0.05),且以感染性SIRS组的WBC、NE-V、NE-S、NEV-SD、NEC-SD的变化最显著;评价患者非SIRS与SIRS的病情,NE-VCS参数的ROC曲线下面积明显高于WBC和NE%。结论:中性粒细胞VCS参数在ICU的患者不同病情中可发生明显的变化,其变化随着病情的加重而更加显著;NE-VCS参数对评价SIRS病情的敏感性和特异性优于WBC和NE%。
Objective: To investigate the changes and significance of neutrophil VCS parameters in patients with systemic inflammatory response syndrome (SIRS). Methods: Using Beck-Man-Coulter Gen. Automated Hematology Analyzer, the volume, high frequency transmission and laser light scattering (VCS) techniques were used to determine the serum levels of 45 healthy subjects (control group) and 121 patients with intensive care unit (ICU) (WBC), neutrophil percentage (NE%) and NE volume (NE-V) in 47 non-SIRS patients, 34 noninfectious SIRS patients and 40 infective SIRS patients, (NE-C), cytoplasmic granules (NE-S) and their average distribution width (SD). The ROC curve was used to evaluate the sensitivity and specificity of each parameter in monitoring ICU patients with SIRS. Results: The WBC, NE%, NE-V, NEV-SD, NEC-SD and NES-SD in ICU patients were significantly higher than those in control group The WBC and NE% on days 2, 4 and 6 and NEV-SD on day 4 and 6 and NE-V on day 6 were significantly higher than those on non-SIRS, while NE-S was significantly lower (P <0.01 (P <0.05 or P <0.05). There was significant difference in NE-V and NES-SD between the 2nd and 4th and 6th day after entering the ICU in the SIRS group. The NEV-SD, NEC- The NE-VCS parameters in NE-S, NE-S and infectious SIRS groups were significantly different from those in non-SIRS group (P <0.01 or P <0.05) , NE-V, NE-S, NEV-SD and NEC-SD. The area under ROC curve of NE-VCS parameters was significantly higher than that of WBC and NE% in evaluating non-SIRS and SIRS patients. CONCLUSIONS: The neutrophil VCS parameters may be significantly changed in patients with ICU, and the changes are more significant with the severity of the disease. The sensitivity and specificity of NE-VCS parameters in evaluating the SIRS condition are better than that of WBC and NE%.