切换至 "中华医学电子期刊资源库"
高级检索
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) ›› 2019, Vol. 13 ›› Issue (01) : 28 -32. doi: 10.3877/cma.j.issn.1674-1358.2019.01.006

所属专题： 文献；

论著

白细胞形态学和中性粒细胞碱性磷酸酶在手足口病合并感染患儿诊疗中的应用
梁崇1,†(), 丘春东2, 李燕妮1, 梁珍1, 甘宁1, 陈恺1, 赵风华1, 何新发1   
  1. 1. 537000　玉林市，玉林市红十字会医院检验科
    2. 537000　玉林市，玉林市第一人民医院
  • 收稿日期:2018-07-13 出版日期:2019-02-15
  • 通信作者: 梁崇
  • 基金资助:
    玉林市科学研究与技术开发计划项目(No.玉市科20171629)

Application of white blood cell morphology combined with neutrophil alkaline phosphatase in the diagnosis and treatment of children with hand, foot and mouth disease complicated with infection

Chong Liang1,†(), Chundong Qiu2, Yanni Li1, Zhen Liang1, Ning Gan1, Kai Chen1, Fenghua Zhao1, Xinfa He1   

  1. 1. Department of Clinical Laboratory, Hospital of Yulin Red Cross Society Guangxi, Yulin 537000, China
    2. Yulin First People’s Hospital, Yulin 537000, China
  • Received:2018-07-13 Published:2019-02-15
  • Corresponding author: Chong Liang
  • About author:
    Correspanding author: Liang Chong, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

梁崇, 丘春东, 李燕妮, 梁珍, 甘宁, 陈恺, 赵风华, 何新发. 白细胞形态学和中性粒细胞碱性磷酸酶在手足口病合并感染患儿诊疗中的应用[J]. 中华实验和临床感染病杂志(电子版), 2019, 13(01): 28-32.

Chong Liang, Chundong Qiu, Yanni Li, Zhen Liang, Ning Gan, Kai Chen, Fenghua Zhao, Xinfa He. Application of white blood cell morphology combined with neutrophil alkaline phosphatase in the diagnosis and treatment of children with hand, foot and mouth disease complicated with infection[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2019, 13(01): 28-32.

目的

探讨白细胞（WBC）形态学和中性粒细胞碱性磷酸酶（NAP）染色积分值在儿童手足口病（HFMD）合并感染诊疗中的应用价值。

方法

选取2017年1月至2017年10月于玉林市红十字会医院儿科门诊及住院的150例儿童作为研究对象，根据检查结果及病情分为正常对照组、单纯HFMD组及HFMD合并感染组，每组各50例。所有病例均采用一次性EDTA扩凝真空采血管，按常规静脉采血1～2 ml，同时做血涂片2张，1张用于瑞氏染色，另1张血片干燥后用10%甲醛固定30 s，按NAP试剂盒说明书进行染色，由细胞室工作人员在显微镜下鉴别WBC形态学变化并计数NAP阳性率和积分。

结果

正常对照组患儿NAP阳性率为（23.58 ± 11.89）%，积分为（28.18 ± 13.82）；单纯HFMD组患儿NAP阳性率为（22.8 ± 10.49）%，积分为（26.92 ± 11.9）；HFMD合并感染组患儿NAP阳性率为（77.96 ± 8.99）%，积分为（332.7 ± 58.42）；HFMD合并感染抗感染治疗后组NAP阳性率为（22.38 ± 10.54）%，积分为（27.74 ± 12.16）；HFMD合并感染组分别与正常对照组、单纯HFMD组、HFMD合并感染抗感染治疗后NAP阳性率比较，差异均有统计学意义（t = 25.80、28.23、28.37，P均< 0.001）；HFMD合并感染组分别与正常对照组、单纯HFMD组、HFMD合并感染抗感染治疗后NAP积分比较，差异均有统计学意义（t = 35.87、36.27、36.14，P均< 0.001）；其余各组NAP阳性率和积分两两比较，差异均无统计学意义（P均> 0.05）。正常对照组、单纯手足口病组、手足口病合并感染组患儿异型淋巴细胞、中毒颗粒、空泡变性细胞、杜勒小体比例差异均有统计学意义（H = 81.9939、129.1737、117.5489、89.4793，P均< 0.001）；手足口病合并感染抗感染治疗前后患儿异常淋巴细胞、中毒颗粒、空泡变性细胞和杜勒小体比例差异有统计学意义（U = 8.2967、8.6138、8.6318、5.4355，P均< 0.001）。

结论

白细胞形态学检查和NAP阳性率及积分观察HFMD合并感染患儿疾病发生发展及对疾病诊断、预后监测均具有重要临床意义。

关键词: 手足口病, 白细胞形态学, 中性粒细胞碱性磷酸酶, 积分
Objective

To investigate the value of white blood cell (WBC) morphology and neutrophil alkaline phosphatase (NAP) staining score in the diagnosis and treatment of hand, foot and mouth disease (HFMD) complicated with infection.

Methods

From January 2017 to October 2017, a total of 150 outpatient and hospitalized children in Hospital of Yulin Red Cross Society Guangxi were selected. According to the examination results and the disease condition, all patients were divided into three groups: normal control group, simple HFMD group and HFMD with infection group, 50 cases in each group. All cases were treated with disposable vacuum blood coagulation EDTA expansion, and blood samples were collected by routine venous blood collection of 1-2 ml, while two blood smears were carried out, one was for Rayleigh staining, the other was fixed with 10% formaldehyde for 30 seconds after drying, and stained according to the instructions of NAP kit. The morphological changes of WBC were identified under microscope and the positive rate and integral of alkaline phosphatase (ALP) in neutrophils were counted by cell room workers.

Results

The positive rate of NAP in children of the control group was (23.58 ± 11.89)% and the score was (28.18 ± 13.82); the positive rate of NAP in children of simple HFMD group was (22.8 ± 10.49)% and the score was (26.92 ± 11.9); the positive rate of NAP in children of HFMD with infection group was (77.96 ± 8.99)% and the score was (332.7 ± 58.42); the positive rate of NAP in children of HFMD with infection for anti-infection treatment group was (22.38 ± 10.54)% and the score was (27.74 ± 12.16), respectively. The positive rate of NAP in HFMD with infection group was significantly higher than the other three groups, with significant differences (t = 25.80, 28.23, 28.37; all P < 0.001). The score of NAP in HFMD with infection group was significantly higher than the other three groups, with significant differences (t = 35.87, 36.27, 36.1374; all P < 0.001). There was no significant difference in positive rate and score of NAP between the other groups pairwise comparison (all P > 0. 05). The rates of abnormal lymphocytes, toxic particles, vacuolar degeneration and Duller bodies among normal control group, simple HFMD group and HFMD with infection group were significantly different (H = 81.9939, 129.1737, 117.5489, 89.4793; all P < 0.001). The rates of abnormal lymphocytes, toxic particles, vacuolar degeneration and Duller bodies in children of HFMD with infection group before and after anti-infection treatment were significantly different (U = 8.2967, 8.6138, 8.6318, 5.4355; all P < 0.001).

Conclusions

WBC morphological examination, positive rate of neutrophil alkaline phosphoric acid staining and integral observation of the occurrence and development of HFMD children with infection were significantly important to disease diagnosis and prognosis monitoring.

Key words: Hand, foot and mouth disease, Leukocyte morphology, Neutrophil alkaline phosphatase, Score
表1 外周血片NAP积分标准表
定性 积分标准 各类细胞计数（个） 积分计算
－ 无阳性反应沉淀物 n1 0 × n1
＋ 仅少数浅灰色颗粒<1/4浆面积 n2 1 × n2
2＋ 反应较强，灰棕色，密片状颗粒占1/2浆面积 n3 2 × n3
3＋ 反应更强，棕黑色密片状颗粒占3/4浆面积 n4 3 × n4
4＋ 反应最强，棕黑色团块状充满甚至遮敝细胞核上 n5 4 × n4
表2 各组患儿NAP阳性率和NAP积分（ ± s）
组别 例数 NAP阳性率（%） NAP积分（分）
正常对照组 50 23.58 ± 11.89 28.18 ± 13.82
单纯手足口病组 50 22.8 ± 10.49 26.92 ± 11.9
手足口病合并感染组 50 77.96 ± 8.99 332.7 ± 58.42
F值 ? 215.362 664.210
P值 ? <0.001 <0.001
表3 手足口病合并感染组患儿抗感染治疗前后NAP阳性率和积分（ ± s）
组别 例数 NAP阳性率（%） NAP积分（分）
治疗前 50 77.96 ± 8.99 332.7 ± 58.42
治疗后 50 22.38 ± 10.54 27.74 ± 12.16
t值 ? 28.370 36.140
P值 ? <0.001 <0.001
图1 油镜观察手足口病患者白细胞异常形态（瑞氏染色，× 100）
表4 各组患儿WBC形态学异常比例[%，M（P25，P75）]
组别 例数 异型淋巴细胞 中毒颗粒 空泡变性 杜勒小体
正常对照组 50 0（0，3.75） 0（0，0） 0（0，1.75） 0（0，0）
单纯手足口病组 50 4（2.0，5.75） 0（0，0） 3（2.0，4.0） 0（0，0）
手足口病合并感染组 50 7（6.0，8.0） 40（34.25，46.50） 17.5（15.0，22.0） 3（2.0，4.0）
H值 ? 81.9939 129.1737 117.5489 89.4793
P值 ? <0.001 <0.001 <0.001 <0.001
表5 手足口病合并感染抗感染治疗前后WBC形态学异常比例[%，M（P25，P75）]
组别 例数 异型淋巴细胞 中毒颗粒 空泡变性 杜勒小体
治疗前 50 7（6.0，8.0） 40（34.25，46.50） 17.5（15.0，22.0） 3（2.0，4.0）
治疗后 50 2（2.0，3.0） 2（2.0，3.0） 2（1.0，2.0） 0（0.0，1.0）
U值 ? 8.2967 8.6138 8.6138 5.4355
P值 ? <0.001 <0.001 <0.001 <0.001
[1]
Huang Y, Deng T, Yu S, et al. Effect of meteorological variables on the incidence of hand, foot, and mouth disease in children: a time-series analysis in Guangzhou, China[J]. BMC Infect Dis,2013,13(1):134.
[2]
Kashyap RR, Kashyap RS. Hand, foot and mouth disease--a short case report[J]. J Clin Exp Dent,2015,7(2):336-338.
[3]
Long L, Xu L, Xiao Z, et al. Neurological complications and risk factors of cardiopulmonary failure of EV-A71-related hand, foot and mouth disease[J]. Epidemiol Infect,2016,6(1):23444.
[4]
Keawcharoen J. Hand, foot and mouth disease[J]. Thai J Vet Med,2012,42(3):225-257.
[5]
Banta J, Lenz B, Pawlak M, et al. Notes from the field: outbreak of hand, foot and mouth disease caused by Coxsackievirus A6 among basic military trainees--Texas, 2015[J]. MMWR Morb Mortal Wkly Rep,2016,65(26):678-680.
[6]
Feder HM, Bennett N, Modlin JF, et al. Atypical hand, foot, and mouth disease: a vesiculobullous eruption caused by Coxsackie virus A6[J]. Brit Dent J,2014,14(1):83-86.
[7]
Gaunt E, Harvala H, Osterback R, et al. Genetic characterization of human coxsackievirus A6 variants associated with atypical hand,foot and mouth disease: a potential role of recombination in emergence and pathogenicity[J]. J Gen Viro,2015,96(5):1067-1079.
[8]
Vuorinen T, Osterback R, Kuisma J, et al. Epididymitis caused by Coxsackievirus A6 in association with hand, foot, and mouth disease[J]. J Clini Microb,2014,52(12):4412-4413.
[9]
Li T, Yang Z, Liu X, et al. Hand-foot-and-mouth disease epidemiological status and relationship with meteorolgical variables in Guangzhou, Southern China, 2008-2012[J]. Revista do Instituto de Medicina Tropical de São Paulo,2014,56(6):533-539.
[10]
Huang X, Wei H, Wu S, et al. Epidemiological and etiological characteristics of hand, foot and mouth disease in Henan, China, 2008-2013[J]. Sci Rep,2015,5(1):8904.
[11]
Han J, Xu S, Zhang Y, et al. Hand, foot and mouth disease outbreak caused by Coxsackievirus A6, China, 2013[J]. J Infect,2014,69(3):303-305.
[12]
Yan X, Zhang ZZ, Yang ZH, et al. Clinical and etiological characteristics of atypical hand-foot-and-mouth disease in children from Chongqing, China: A retrospective study[J]. Bio Res Inter,2015,26(8):1-8.
[13]
Lin H, Sun L, Lin J, et al. Protective effect of exclusive breastfeeding against hand, foot and mouth disease[J]. BMC Infect Dis,2014,14(1):645.
[14]
Ventarola D, Bordone L, Silverberg NB, et al. Update on hand-foot-and-mouth disease[J]. Clin Dermatol,2015,33(3):340-346.
[15]
Zhang S, Zhao J. Spatio-temporal epidemiology of hand, foot and mouth disease in Liaocheng City, North China[J]. Exp Ther Med,2015,9(3):811-816.
[16]
Wang ZL, Xia A, Li Y, et al. Socioeconomic burden of hand, foot and mouth disease in children in Shanghai, China[J]. Epidemiol Infect,2016,144(1):138-143.
[17]
Li Y, Zhang J, Zhang X, et al. Modeling and preventive measures of hand, foot and mouth disease (HFMD) in China[J]. Int J Envir Res Pub Heal,2014,11(3):3108-3117.
[18]
Zhang J, Kang Y, Yang Y, et al. Statistical monitoring of the hand, foot and mouth disease in China[J]. Biometrics,2015,71(3):841-850.
[19]
Zhang X, Wang H, Ding S, et al. Prevalence of enteroviruses in children with and without hand, foot and mouth disease in China[J]. BMC Infect Dis,2013,13(1):606.
[20]
Mao Q, Wang Y, Bian L, et al. EV71 vaccine, a new tool to control outbreaks of hand, foot and mouth disease (HFMD)[J]. Expert Rev Vaccines,2016,15(5):599-606.
[1] 骆永芳, 周丹, 曾嘉慧, 田文硕, 朱白沙, 包明稳, 冯文霞, 张宇, 冯程. 床旁肺部超声评估新型冠状病毒肺炎患者肺损伤的价值[J]. 中华医学超声杂志（电子版）, 2022, 19(01): 42-46.
[2] 郝萧, 刘兴莉, 夏小叶, 刁雪芹, 姚美雪. 母亲免疫球蛋白G不规则抗体效价及其效价积分对母婴Rh血型不合新生儿溶血病患儿换血治疗的预测分析[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 677-684.
[3] 黄胜贤, 罗杰平, 陈丽珍, 黄盼柳, 杨兰, 叶潇鸣, 郑利平. 热毒宁联合甘草酸苷对第2期手足口病患儿免疫相关指标的影响[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(05): 567-573.
[4] 闫凯悦, 邓慧玲, 张玉凤, 宋鹤, 陈媛, 席淼. 胰岛素样生长因子-1与手足口病重症化的相关性研究[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(03): 151-157.
[5] 张玉凤, 万涵, 樊华峰, 袁娟, 刘瑞清, 徐鹏飞, 王军, 邓慧玲. 高迁移率族蛋白1在肠道病毒71型手足口病患者中的表达及临床价值[J]. 中华实验和临床感染病杂志(电子版), 2022, 16(01): 9-15.
[6] 崔强华, 余明达, 孙莉. 儿童早期预警评分联合C-反应蛋白和降钙素原动态监测在小儿手足口病分流诊断及转归预测中的应用价值[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(05): 330-336.
[7] 周地佳, 邓慧玲, 张玉凤, 刘平定, 周古翔, 杜嘉仪. 2016至2019年陕西省渭南市手足口病流行病学及病原谱分析[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(03): 177-181.
[8] 张玉凤, 符佳, 王军, 徐鹏飞, 袁娟, 刘瑞清, 唐甜甜, 邓慧玲. 205例手足口病合并惊厥患儿的病原学及临床特征[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(01): 53-59.
[9] 王沐淇, 李亚萍, 冯丹丹, 邓慧玲, 张玉凤, 王文俊, 贾晓黎, 党双锁. 手足口病患儿线粒体抗病毒蛋白和线粒体融合蛋白1表达及其临床意义[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(01): 46-52.
[10] 林军, 李焕兴, 罗槑, 陈竹, 吴桂辉, 曾义岚. 新型冠状病毒肺炎患者肺部超声特征[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(01): 37-45.
[11] 曹应海, 李姗, 雷旭, 钟炎平, 杨军杰, 刘龙, 杨靖, 李健, 李芳, 谭华炳. 肺吸虫病"积分诊断量表"的建立——临床表现联合实验室和影像学检查[J]. 中华实验和临床感染病杂志(电子版), 2020, 14(06): 513-517.
[12] 谢曼芬, 高燕, 蔡晨露, 王肖, 郭会敏. 静注人免疫球蛋白对EV71型感染重症手足口病患儿炎症因子、免疫功能的影响[J]. 中华临床医师杂志(电子版), 2022, 16(02): 136-140.
[13] 李秦. 肢体导联反向法和室性心动过速积分法在鉴别预激性心动过速中的临床价值[J]. 中华临床医师杂志(电子版), 2022, 16(01): 58-61.
[14] 刘秀丽, 梁倩文, 栾艺, 何川疆, 胡慧灵, 段朝晖. RDW、MCV、MCH联合筛查区分缺铁性贫血和地中海贫血携带者的应用价值[J]. 中华临床实验室管理电子杂志, 2022, 10(04): 199-203.
[15] 赵金荣, 王明明, 杨颖. 千金苇茎汤配合血必净注射液对重症肺炎患者的临床疗效[J]. 中华卫生应急电子杂志, 2021, 07(02): 86-89.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号