失代偿期肝硬化并发败血症患者外周血白细胞VCS参数变化及其临床价值分析

doi:10.3969/j.issn.1672-5069.2021.05.007

摘要/Abstract

摘要： 目的探讨失代偿期肝硬化并发败血症患者外周血白细胞体积(V)、电导率(C)和散射(C)参数变化及其临床应用价值。方法 2017年6月～2020年6月我院诊治的失代偿期乙型肝炎肝硬化患者130例,其中发生败血症39例,普通感染组46例,未感染45例。使用COULTER LH 750/LH 755全自动血液分析仪检测外周血中性粒细胞平均体积MNV)、中性粒细胞平均电导率(MNC)、中性粒细胞平均散射率(MNS),单核细胞平均体积(MMV)、单核细胞平均电导率(MMC)、单核细胞平均散射率(MMS),淋巴细胞平均体积(MLV)、淋巴细胞平均电导率(MLC)和淋巴细胞平均散射率(MLS),应用受试者工作特征曲线(ROC)分析各指标诊断败血症的效能。结果败血症组中性粒细胞MNV和MNC分别为(149.5±9.8)和(148.6±9.6),显著高于普通感染组【(144.3±8.9)和(144.6±8.6),P<0.05】或未感染组【(139.9±7.6)和(140.8±7.1),P<0.05】;败血症组单核细胞MMV为(179.6±11.3),显著高于普通感染组【(170.3±10.6),P<0.05】或未感染组【(165.3±8.6),P<0.05】;败血症组淋巴细胞MLV为(90.1±5.1),显著高于普通感染组【(87.8±4.6),P<0.05】或未感染组【(84.1±4.3),P<0.05】;ROC分析结果显示,MNV、MMV、MLV、APACHE II和SOFA各单指标诊断失代偿期肝硬化患者发生败血症的AUC分别为0.756、0.768、0.681、0.796和0.794,而各指标联合诊断的AUC达到0.847,其诊断效能最高(P<0.05)。结论应用外周血白细胞VCS参数诊断失代偿期肝硬化患者发生败血症具有较好的效能,临床上可以选择应用。

关键词: 肝硬化, 败血症, 白细胞体积, 电导率, 散射率, 诊断

Abstract: Objective The aim of this study was to explore the implication of peripheral blood leukocyte volume (V), conductivity (C) and scattering (C) parameters in patients with decompensated liver cirrhosis and sepsis. Methods 130 patients with decompensated liver cirrhosis including complicated sepsis in 39, other common infection in 46 and non-infected in 45, were admitted to our hospital between June 2017 and June 2020. The mean neutrophil volume (MNV), mean neutrophil conductivity (MNC)and mean neutrophil scattering (MNS), mean monocyte volume (MMV), mean monocyte conductivity (MMC) and mean monocyte scattering (MMS), and mean lymphocyte volume (MLV), mean lymphocyte conductivity (MLC) and mean lymphocyte scattering (MLS) were detected. The receiver’s operating characteristic (ROC) was applied to evaluate the diagnostic efficacy of these indicators for sepsis occurrence. Results The neutrophil MNV and MNC were (149.5±9.8) and(148.6±9.6), both significantly higher than in infected or in non-infected patients; theMMV was (179.6±11.3), significantly higher than in infected or in non-infected patients; the MLV was (90.1±5.1), much higher than in infected or in non-infected patients; theROC analysis showed than the AUC of MNV, MMV, MLV, APACHE II and SOFA in diagnosing sepsis in cirrhotics were 0.756, 0.768, 0.681, 0.796 and 0.794, while the combination of the five reached to 0.847, having the best diagnostic efficacy (P<0.05). Conclusion The peripheral blood leukocyte VCS parameters have a good diagnostic efficacy for sepsis in patients with decompensated liver cirrhosis, which warrants further clinical investigation.

Key words: Liver cirrhosis, Sepsis, White blood cell volume, Electrical conductivity and scattering

武琼, 孙洋, 刘娜, 张锦. 失代偿期肝硬化并发败血症患者外周血白细胞VCS参数变化及其临床价值分析[J]. 实用肝脏病杂志, 2021, 24(5): 633-636.

Wu Qiong, Sun Yang, Liu Na, et al. Implication of peripheral blood leukocyte VCS parameters in patients with decompensated liver cirrhosis and sepsis[J]. Journal of Practical Hepatology, 2021, 24(5): 633-636.

参考文献

[1]Martin Mateos R, Albillos A. Sepsis in patients with cirrhosis awaiting liver transplantation: new trends and management. Liver Transpl, 2019,25(11):1700-1709.
[2]Simonetto DA, Piccolo Serafim L, Gallo de Moraes A, et al. Management of sepsis in patients with cirrhosis: current evidence and practical approach. Hepatology, 2019,70(1):418-428.
[3]Son J, ChoiS, Huh JW, et al. The quick sepsis-related organ failure score has limited value for predicting adverse outcomes in sepsis patients with liver cirrhosis. Korean J Intern Med,2020 ,35(4):861-872.
[4]Piano S, Bartoletti M, Tonon M, et al. Assessment of sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections. Gut, 2018,67(10):1892-1899.
[5]Khan RA, Khan NA, Bauer SR, et al. Association between volume of fluid resuscitation and intubation in high-risk patients with sepsis, heart failure, end-stage renal disease, and cirrhosis. Chest, 2020,157(2):286-292.
[6]Hensley MK, Deng JC. Acute on chronic liver failure and immune dysfunction: a mimic of sepsis. Semin Respir Crit Care Med, 2018,39(5):588-597.
[7]Arora P, Gupta PK, Lingaiah R,et al. Volume, conductivity, and scatter parameters of leukocytes as early markers of sepsis and treatment response. J Lab Physic, 2019,11(1):29-33.
[8]European Association for the Study of the Liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol, 2018 ,69(2):406-460.
[9]Shankar-Hari M, Phillips GS, Levy ML, et al. Sepsis definitions task force. Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA,2016,315(8):775-787.
[10] 韩利娜,周芳芳,罗群,等.简化的肾脏病膳食改良试验与慢性肾脏病流行病学合作研究组肾小球滤过率评估公式在失代偿期肝硬化患者中的应用.中华肝脏病杂志,2019(3):213-215.
[11] 张冠华,王民,王岚,等.208例肝硬化合并感染患者的临床特点和相关因素分析.中华内科杂志,2018,57(2):118-122.
[12] 崔宏,高琴琴,杨楠木,等.肝硬化患者腹腔感染的病原菌分布与耐药性分析.中华医院感染学杂志,2018,28(1):40-43.
[13] 韦玲,谢会忠,翁敬飚,等.失代偿期肝硬化患者医院感染危险因素和病原学特点探讨.中华医院感染学杂志,2017,27(21):4842-4845.
[14] 王艺璇,李炜,程丹颖,等.乙型肝炎失代偿期肝硬化患者肠道菌群特征.中华实验和临床感染病杂志(电子版),2019,13(2):110-116.
[15] 王园园,钱湘云,居玲玲,等.失代偿期乙型肝炎肝硬化患者负性情绪调查分析.中华现代护理杂志,2017,23(26):3400-3404.
[16] 金月红,陈卫昌,严苏.肝脏面积与腹部面积比评估肝硬化失代偿期患者85例的预后.中华消化杂志,2017,37(8):547-549.
[17] 韩焕钦,欧进军,冯冰,等.尿IGFBP7和TIMP-2在失代偿期乙型肝炎肝硬化急性肾损伤中的应用价值.中华肝脏病杂志,2020,28(9):760-765.
[18] 韦玲,谢会忠,翁敬飚,等.肝硬化失代偿期患者并发血流感染病原学特点和预后探究.中华医院感染学杂志,2017,27(19):4382-4385.
[19] 邢莹,屈晨雪,王美玲,等.白细胞群落参数用于骨髓移植后造血重建的预测评估.中华医学杂志,2015,95(28):2282-2284.
[20] Kulkarni JD, Pai SA. Apoptotic lymphocytes on peripheral smear and positional parameter values (VCS data) can suggest a diagnosis of infectious mononucleosis. Infect Dis (Lond), 2019 ,(6):467-470.
[21] Shen T, Gu D, Zhu Y, et al. The VCS parameters: Potential hematological indicators for predicting antituberculosis drug-induced neutropenia. Clin Chim Acta, 2016 ,459:147-149.
[22] Shen T, Gu D, Zhu Y, et al. The value of eosinophil VCS parameters in predicting hepatotoxicity of antituberculosis drugs. Int J Lab Hematol, 2016,38(5):514-519.
[23] Virk H, Varma N, Naseem S, et al. Utility of cell population data (VCS parameters) as a rapid screening tool for Acute Myeloid Leukemia(AML) in resource-constrained laboratories. J Clin Lab Anal,2019,33(2):e22679.
[24] Zhou N, Liu L, Li D, et al. VCS parameters of neutrophils, monocytes and lymphocytes may indicate local bacterial infection in cancer patients who accepted cytotoxic chemotherapeutics. Eur J Clin Microbiol Infect Dis,2016 ,35(1):41-48.
[25] Abiramalatha T, Santhanam S, Mammen JJ, et al .Utility of neutrophil volume conductivity scatter (VCS) parameter changes as sepsis screen in neonates. J Perinatol,2016,36(9):733-738.