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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (06) : 565 -569. doi: 10.3877/cma.j.issn.1674-1358.2018.06.009

所属专题： 文献；

论著

外周血白细胞计数、淋巴细胞百分比和C-反应蛋白与呼吸道病毒检出率的相关性
杨思园1, 顾红岩2, 崔蓉2, 李辉3, 李丽3, 马成杰1, 汤云霞1, 于凤婷1, 王凌航3,†()   
  1. 1. 100015　北京，首都医科大学附属北京地坛医院感染中心实验室
    2. 100016　北京，清华大学第一附属医院呼吸科
    3. 100015　北京，首都医科大学附属北京地坛医院感染病急诊
  • 收稿日期:2018-03-19 出版日期:2018-12-15
  • 通信作者: 王凌航
  • 基金资助:
    北京市卫生系统高层次卫生技术人才培养计划(No. 2015-3-109); 北京市医院管理局重点医学专业发展计划-新发突发传染病(No. ZYLX201602); 国家科技重大专项-急性呼吸道传染病病原谱和流行规律及重要病原变异变迁特征研究(No. 2017ZX10103004)

Correlation of peripheral white blood cell, lymphocyte percentage and C-reactive protein with the detection rate of respiratory viral pathogens

Siyuan Yang1, Hongyan Gu2, Rong Cui2, Hui Li3, Li Li3, Chengjie Ma1, Yunxia Tang1, FengTing Yu1, Linghang Wang3,†()   

  1. 1. The Laboratory of Infectious Diseases Centre, Capital Medical University, 100015 Beijing, China
    2. Department of Respiratory Medicine, the First Hospital of Tsinghua Universiry, Beijing 100016, China
    3. Emergency Department, Beijing Ditan Hospital, Capital Medical University, 100015 Beijing, China
  • Received:2018-03-19 Published:2018-12-15
  • Corresponding author: Linghang Wang
  • About author:
    Corresponding author: Wang Linghang, Email:
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引用本文：

杨思园, 顾红岩, 崔蓉, 李辉, 李丽, 马成杰, 汤云霞, 于凤婷, 王凌航. 外周血白细胞计数、淋巴细胞百分比和C-反应蛋白与呼吸道病毒检出率的相关性[J]. 中华实验和临床感染病杂志(电子版), 2018, 12(06): 565-569.

Siyuan Yang, Hongyan Gu, Rong Cui, Hui Li, Li Li, Chengjie Ma, Yunxia Tang, FengTing Yu, Linghang Wang. Correlation of peripheral white blood cell, lymphocyte percentage and C-reactive protein with the detection rate of respiratory viral pathogens[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(06): 565-569.

目的

回顾性分析外周血白细胞计数（WBC）、淋巴细胞百分比（LYN%）和C-反应蛋白（CRP）与呼吸道病毒检出率的相关性。

方法

收集2016年11月至2017年12月首都医科大学附属北京地坛医院收治的103例呼吸道感染者自动巢式多重聚合酶链式反应（PCR）系统呼吸道病毒检测结果、一般资料、临床和其他实验室资料，根据患者病毒检出情况分为未检出组和检出组，对两组患者的病原学和WBC、LYN%、CRP进行统计学分析。

结果

103份鼻咽拭子标本中呼吸道病毒检出率为62.14%（64/103），其中甲型流感病毒检出阳性率最高，为26.21%（27/103）；检出组患者咳嗽例数显著多于未检出组（χ2 = 12.898、P < 0.001），发病天数少于未检出组（t =－2.727、P = 0.008），CRP水平低于未检出组（t =－1.897、P = 0.016）；根据C-反应蛋白值将患者分为3组：≤ 10 mg/L组、10～50 mg/L组和> 50 mg/L组，各组患者病毒检出率差异有统计学意义（χ2 = 10.448、P = 0.005），其中C-反应蛋白≤ 10 mg/L组病毒检出率最高，为77.50%（31/40）；受试者工作特征曲线（ROC）分析发现WBC、LYN%和CRP曲线下面积分别为0.565、0.593和0.678，当CRP的Cut-off值为18.2 mg/L时，敏感度和特异度分别为73.3%和64.2%。

结论

通过自动巢式多重PCR可检出多种呼吸道病毒。当呼吸道感染者早期表现以咳嗽、发热为主，或WBC、LYN%、CRP水平均不高时呼吸道病毒检出的可能性高，可进一步选择自动巢式多重PCR进行呼吸道病毒检测。

关键词: 外周血白细胞计数, 淋巴细胞百分比, C-反应蛋白, 自动巢式多重PCR, 呼吸道病毒
Objective

To investigate the correlation between the detection rate of respiratory viral pathogens with automated nested multiplex PCR system and the infectious indexes such as peripheral white blood cell (WBC), lymphocyte percentage (LYN%) and C-reactive protein (CRP), retrospectively.

Methods

From November 2016 to December 2017, a total of 103 nasopharyngeal swabs and clinical data from patients with respiratory infection were collected in Beijing Ditan Hospital, Capital Medical University. The pathogens were detected by automated nested multiplex PCR system, and the results was statistically analyzed.

Results

The rate of detection among 103 nasopharyngeal swabs was 62.14% (64/103), and influenza virus had the highest positive rate of 26.21% (27/103). Compared with the virus detected group, the number of patients with cough was significantly larger (χ2 = 12.898, P < 0.001), the period was shorter (t =-2.727, P = 0.008), and the CRP level was lower (t =-1.897, P = 0.016), with significant differences. Patients were divided into three groups according to C-reactive protein value: ≤ 10 mg/L group, 10-50 mg/L group and > 50 mg/L group; the virus detection rate among groups with different CRP levels was significantly different (χ2 = 10.448, P = 0.005), and the highest detection rate was 77.50% (31/40) for the group with CRP ≤ 10 mg/L. The analysis of the subjects’ working characteristics curve (ROC) showed that the area of WBC, LYN% and CRP under the curve were 0.565, 0.593 and 0.678, respectively. When the Cut-off value of CRP was 18.2 mg/L, the sensitivity and specificity were 73.3% and 64.2%, respectively.

Conclusions

Automated nested multiplex PCR system could identify multiple viral respiratory pathogens in short period. When patients with respiratory tract infection characterized by cough and fever in the early stage, or levels of WBC, LYN% and CRP were not high, respiratory tract viral infection may be detected, clinicians could furtherly choose automated nested multiplex PCR system to identify the pathogen.

Key words: Peripheral blood count, C-reactive protein, Detection, Automated nested multiplex polymerase chain reaction, Respiratory virial pathogens
表1 呼吸道病毒检出组和未检出组患者的临床资料
临床资料 检出组（64例） 未检出组（39例） 统计量 P值
性别[例（%）] ? ? χ2 = 0.067 0.795
? 男 23（35.93） 20（51.28） ? ?
? 女 41（64.06） 19（48.72）
年龄（±s，岁） 39.91 ± 14.97 41.38 ± 15.83 t =－0.476 0.635
发病天数（±s，d） 2.23 ± 1.47 2.93 ± 1.44 t =－2.727 0.008
发热[例（%）] 53（82.81） 36（92.31） χ2 = 1.86 0.173
最高体温（±s，℃） 38.29 ± 0.79 38.68 ± 0.94 t =－2.257 0.026
咳嗽[例（%）] 46（71.88） 14（35.90） χ2 = 12.898 < 0.001
流涕[例（%）] 26（40.63） 11（28.21） χ2 = 1.624 0.203
咽痛[例（%）] 26（40.63） 18（46.15） χ2 = 0.303 0.582
图1 呼吸道感染者病原学检出分布
表2 呼吸道病毒检出组和未检出组患者WBC、LYN%和CRP水平（±s）
组别 例数 WBC（× 109/L） LYN%（%） CRP（mg/L）
检出组 64 7.29 ± 2.90 24.09 ± 24.09 22.95 ± 49.98
未检出组 39 6.23 ± 3.20 19.90 ± 12.43 40.66 ± 38.39
t值 ? 1.587 1.549 －1.897
P值 ? 0.116 0.125 0.016
表3 不同CRP水平患者呼吸道病毒检出率
组别 例数 病毒检出例数 检出率（%）
CRP ≤ 10 mg/L组 40 31 77.50
CRP 10～50 mg/L组 45 27 60.00
CRP > 50 mg/L组 18 6 33.33
图2 WBC、LYN%和CRP判断呼吸道病毒感染的ROC曲线
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