摘要
目的 探讨血细胞形态指标在不明原因发热病因诊断中的临床价值.方法 选择 2021 年4月—2023年8月于深圳市坪山区人民医院接受治疗的50例不明原因发热患者作为研究对象,纳入观察组;另外选择同期50例健康体检者纳入对照组.两组均进行血常规检查以及显微镜下血液涂片染色检查,比较血细胞异常情况以及血细胞形态指标水平差异;采用Spearman相关性分析法评估血细胞形态指标与不明原因发热的相关性;绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),评估血细胞形态指标对不明原因发热的诊断价值.结果 血细胞异常情况:观察组的异常细胞率、大细胞性贫血率、小细胞性贫血率、异型淋巴细胞改变率、白细胞改变率均显著高于对照组(异常细胞率:16.00%比 4.00%;大细胞性贫血率:4.12%比 0%;小细胞性贫血率:10.00%比 0%;异型淋巴细胞改变率:24.00%比 4.00%;白细胞改变率:20.00%比 6.00%;均P<0.05).血细胞形态指标:观察组的平均红细胞体积(MCV)、血细胞比容(Hct)、红细胞分布宽度标准差(RDW-SD)水平均显著高于对照组[MCV(fL):89.07±4.24 比 84.25±5.38;Hct:(46.79±3.20)%比(44.68±3.56)%;RDW-SD:(15.29±2.67)%比(12.48±2.30)%;均P<0.05].观察组与对照组的平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)水平比较差异均无统计学意义[MCH(pg):32.20±1.49 比 31.62±1.77;MCHC(g/L):344.81±8.15 比 342.26±6.53;均P>0.05].Spesrman相关性分析表明,MCV、Hct、RDW-SD与不明原因发热均呈正相关(r值分别为0.469、0.454、0.434;均P<0.001).ROC曲线分析结果表明,MCV、Hct、RDW-SD对不明原因发热均有较高的诊断价值[AUC分别为 0.806、0.687、0.759,95%可信区间(95%CI)分别为 0.720～0.893、0.583～0.791、0.665～0.853,均P<0.001].结论 不明原因发热患者的血细胞形态存在差异,通过检测MCV、Hct、RDW-SD可为临床诊断提供可参考依据,辅助指导治疗.
Abstract
Objective To investigate the clinical value of blood cell morphological indexes in the etiological diagnosis of patients with unexplained fever.Methods The 50 patients with unexplained fever who received treatment in Pingshan District People's Hospital of Shenzhen from April 2021 to August 2023 were selected as research objects and included in observation group,and 50 healthy subjects who underwent physical examination during the same period were selected as control group.Blood routine test and microscopic blood smear staining were performed in both groups and the abnormal blood cell conditions and differences in blood cell morphological indicators were compared.Spearman correlation analysis was used to evaluate the correlation between blood cell morphological indicators and unexplained fever.The receiver operator characteristic(ROC)curve was plotted and area under ROC curve(AUC)was calculated to evaluate the diagnostic value of blood cell morphological indicators in the diagnosis of unexplained fever.Results Comparison of blood cell abnormalities:the abnormal cell rate,large cell anemia rate,small cell anemia rate,atypical lymphocyte change rate and white blood cell change rate in observation group were higher than those in control group(abnormal cell rate:16.00%vs.4.00%;large cell anemia rate:4.12%vs.0%;small cell anemia rate:10.00%vs.0%;atypical lymphocyte change rate:24.00%vs.4.00%;white blood cell change rate:20.00%vs.6.00%;all P<0.05).Comparison of blood cell morphological indicators:the levels of mean corpuscular volume(MCV),hematocrit(Hct)and red cell distribution width standard deviation(RDW-SD)in observation group were significantly higher than those in control group[MCV(fL):89.07±4.24 vs.84.25±5.38;Hct:(46.79±3.20)%vs.(44.68±3.56)%;RDW-SD:(15.29±2.67)%vs.(12.48±2.30)%;all P<0.05].There were no significant differences in mean corpuscular hemoglobin(MCH)and mean corpuscular hemoglobin contentration(MCHC)between observation group and control group[MCH(pg):32.20±1.49 vs.31.62±1.77;MCHC(g/L):344.81±8.15 vs.342.26±6.53;both P>0.05].Spearman correlation analysis showed that MCV,Hct and RDW-SD were positively correlated with unexplained fever(r values were 0.469,0.454,0.434,all P<0.001).ROC curve analysis showed that MCV,Hct and RDV-SD had high diagnostic value for unexplained fever[AUC was 0.806,0.687 and 0.759,95%confidence interval(95%CI)was 0.720-0.893,0.583-0.791 and 0.665-0.853,all P<0.001].Conclusions There are differences in blood cell morphology in patients with unexplained fever.The detection of MCV,Hct and RDW-SD could provide reference for clinical diagnosis and auxiliary treatment guidance.
维普
万方数据