白细胞群落参数在血流感染脓毒症患者中的诊断价值

Diagnostic Value of Cell Population Data for Sepsis in Patients with Bloodstream Infection

摘要: 目的：探讨白细胞群落参数(cell population data, CPD)在血流感染脓毒症中的诊断价值。方法：选取2020年8月~2023年9月淄博市市立医院收治的血流感染脓毒症患者73例，选择同期在该院进行健康体检者60例作为健康对照。比较两组间CPD差异，通过二元Logistic回归分析影响血流感染脓毒症诊断的因素，绘制受试者工作特征(receiver operator characteristic, ROC)曲线，评估相关变量在血流感染脓毒症中的诊断效能，各指标间的相关性采用Spearman相关性分析。根据血培养结果比较革兰阳性菌和革兰阴性菌血流感染脓毒症组间相关指标的差异。根据药敏结果分为耐药菌68例，非耐药菌34例，比较两组间CPD差异。结果：对CPD进行单因素及二元Logistic回归分析，发现单核细胞细胞复杂性(MO-X) (OR = 1.563, P = 0.030)、中性粒细胞侧向散射光分布宽度(NE-WX) (OR = 1.063, P = 0.019)、中性粒细胞的荧光强度分布宽度(NE-WY) (OR = 1.044, P = 0.003)是血流感染脓毒症发生的独立危险因素。对上述独立危险因素进行ROC曲线分析，发现MO-X、NE-WX、NE-WY三指标联合检测对血流感染脓毒症的诊断性能AUC (95% CI)为0.918 (0.874~0.963)，特异度0.933，敏感度为0.781。MO-X和NE-WY与SOFA评分之间存在正相关性(rs = 0.242, 0.305, P = 0.040, 0.009)。PCT在革兰阴性菌血流感染脓毒症组中较革兰阳性菌血流感染脓毒症组显著升高(P < 0.05)。革兰阳性菌血流感染脓毒症组的淋巴细胞荧光分布宽度(LY-WY)比革兰阴性菌血流感染脓毒症组高(P < 0.05)。耐药菌感染组和非耐药菌感染组两组间CPD差异无统计学意义。结论：CPD参数在血流感染脓毒症的诊断方面具有一定价值，在区分革兰阳性菌和革兰阴性菌感染方面也存在一定潜力。

Abstract: Objective: To investigate the diagnostic value of cell population data (CPD) in patients with sepsis caused by bloodstream infection. Methods: A total of 73 patients with bloodstream infection-associated sepsis admitted to Zibo Municipal Hospital between August 2020 and September 2023 were enrolled. Sixty healthy individuals who underwent physical examinations during the same period were included as controls. Differences in CPD parameters between the two groups were compared. Binary Logistic regression analysis was performed to identify factors associated with the diagnosis of bloodstream infection sepsis. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic performance of relevant variables of bloodstream infection sepsis. Correlations among various indicators were analyzed using Spearman correlation analysis. According to blood culture results, differences in related parameters between Gram-positive and Gram-negative bacterial bloodstream infection sepsis were compared. Based on antimicrobial susceptibility testing, patients were classified into 68 drug-resistant and 34 non-drug-resistant bacterial infection groups, and differences in CPD were compared between the two groups. Results: Univariate and binary Logistic regression analyses of CPD identified MO-X (OR = 1.563, P = 0.030), NE-WX (OR = 1.063, P = 0.019), and NE-WY (OR = 1.044, P = 0.003) as independent risk factors for bloodstream infection sepsis. ROC curve analysis of the above independent risk factors revealed that the combined detection of MO-X, NE-WX, and NE-WY for the diagnosis of bloodstream infection-associated sepsis had an AUC (95% CI) of 0.918 (0.874~0.963), with a specificity of 0.933 and sensitivity of 0.781. MO-X and NE-WY were positively correlated with the SOFA score (rs = 0.242 and 0.305, respectively; P = 0.040 and 0.009). Procalcitonin (PCT) levels were significantly higher in patients with Gram-negative bacterial bloodstream infection sepsis than in those with Gram-positive bacterial bloodstream infection sepsis (P < 0.05). LY-WY was significantly higher in the Gram-positive bacterial group than in the Gram-negative bacterial group (P < 0.05). No significant differences in CPD parameters were observed between the drug-resistant and non-drug-resistant bacterial infection groups. Conclusion: CPD parameters have diagnostic value in bloodstream infection sepsis and show potential utility in differentiating between Gram-positive and Gram-negative bacterial infections.