中性粒细胞碱性磷酸酶活性在发热待查诊断中的价值

发布时间：2018-02-08 17:12

本文关键词： 中性粒细胞碱性磷酸酶发热待查诊断感染性疾病　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨外周血及骨髓涂片中性粒细胞碱性磷酸酶积分和阳性率在发热患者诊断及鉴别诊断中的临床意义,同时分析NAP与其他炎性指标在感染性疾病诊断中的相关性与差异。方法:选取2015年8月1日至2016年10月30日期间发热待查患者402例,所有患者发热时均常规进行血NAP活性检测,分组配对分析,其中感染组患者同时进行白细胞计数(WBC)、中性粒细胞分类计数(NC)、血沉(ESR)、超敏C-反应蛋白(hs-CRP)的检测,结果进行差异及相关性分析;同时选取2014年9月1日到2016年10月30日期间发热待查患者180例,对其骨髓片行NAP染色,并对结果进行比较分析。结果:NAP活性检测结果在外周血和骨髓涂片中具有良好的相关性。在感染组中,细菌、真菌感染亚组,NAP活性明显高于病毒、结核、不典型病原体感染组,P0.01;各炎症指标的阳性率比较:hs-CRP最高,NAP和ESR次之,WBC和NC相对较低,P0.01,其中NAP与hs-CRP呈低中度相关,与ESR、WBC、NC无明显相关性;在结缔组织病组中,成人斯蒂尔病NAP活性最高,明显高于动脉炎、血管炎、类风湿性关节炎,P0.01;类风湿性关节炎NAP活性最低,但与其他结缔组织病亚组比较,差异无统计学意义,P0.05;在血液系统疾病组中,骨髓受侵犯的B细胞淋巴瘤患者NAP活性降低,骨髓未侵犯者NAP活性升高;骨髓未侵犯的淋巴瘤中,B细胞淋巴瘤NAP活性增高较T细胞淋巴瘤明显,P0.01。慢性粒细胞白血病NAP活性较其他慢性骨髓增殖性疾病明显减低,P0.01。结论:NAP活性检测结果在血和骨髓中相关性良好,在发热待查诊断和鉴别诊断中具有一定的指导意义。
[Abstract]:Objective: to investigate the clinical significance of neutrophil alkaline phosphatase score and positive rate in peripheral blood and bone marrow smear in the diagnosis and differential diagnosis of fever. Meanwhile, the correlation and difference between NAP and other inflammatory markers in the diagnosis of infectious diseases were analyzed. Methods: from August 1st 2015 to October 30th 2016, 402 patients with fever were selected. The blood NAP activity was detected routinely in all patients with fever. The WBC count, neutrophil classification count, ESR, hypersensitive C-reactive protein hs-CRP were detected in the infected group at the same time. The difference and correlation were analyzed. From September 1st 2014 to October 30th 2016, 180 patients with fever were selected and their bone marrow slices were stained with NAP. The results were compared and analyzed. Results there was a good correlation between the blood and bone marrow smears. In the infected group, the activity of nap in bacteria and fungi infected subgroup was significantly higher than that in the virus, tuberculosis, tuberculosis. In atypical pathogen infection group, the positive rate of each inflammatory index was higher than that of ESR and nap, followed by NAP and NC. The correlation between NAP and hs-CRP was low and moderate, and there was no significant correlation between NAP and hs-CRP, and in connective tissue disease group, the positive rate of NAP and ESR was lower than that of NAP, and the positive rate of NAP and NC was lower than that of NAP and ESR, but there was no significant correlation between NAP and hs-CRP, but there was no significant correlation between NAP and hs-CRP. The activity of NAP in adult patients with Steele's disease was the highest, which was significantly higher than that in arteritis, vasculitis and rheumatoid arthritis (P 0.01). The activity of NAP in rheumatoid arthritis was the lowest, but compared with other connective tissue disease subgroups. There was no significant difference (P 0.05). In the group of hematological diseases, the activity of NAP was decreased in the patients with B-cell lymphoma, but the activity of NAP was increased in the patients with non-invasion of bone marrow. The NAP activity of B cell lymphoma was significantly higher than that of T cell lymphoma. The NAP activity of chronic myeloid leukemia was significantly lower than that of other chronic bone marrow proliferative diseases. Has a good correlation with bone marrow, It has certain guiding significance in the diagnosis and differential diagnosis of fever.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R441.3

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