支气管肺泡灌洗液中性粒细胞比例对于肺部细菌感染的诊断价值  

Diagnostic value of neutrophil ratio in bronchoalveolar lavage fluid for pulmonary bacterial infection

作　　者：陶毅 王凯飞[2] 宋立成 付晗 宋雨薇 薛少云 解立新[2] TAO Yi;WANG Kaifei;SONG Licheng;FU Han;SONG Yuwei;XUE Shaoyun;XIE Lixin(Chinese PLA Medical School,Beijing 100853,China;College of Pulmonary and Critical Care Medicine,Chinese PLA General Hospital,Beijing 100091,China;Zhangjiakou Pulmonary Hospital,Zhangjiakou 075000,Hebei Province,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院呼吸与危重症医学部,北京100091 [3]张家口市肺科医院,河北张家口075000

出　　处：《解放军医学院学报》2022年第1期36-39,共4页Academic Journal of Chinese PLA Medical School

基　　金：军队后勤科研计划项目(BLB18J008)。

摘　　要：背景下呼吸道感染特别是医院获得性肺炎发病率较高,增加了大量医疗负担,早期诊断对于下呼吸道感染的防治具有重要价值。目的分析肺部细菌感染患者支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)细胞分类特点及BALF中性粒细胞比例对下呼吸道细菌感染的诊断价值。方法纳入2018年1月-2020年12月解放军总医院第一医学中心送检BALF细胞标本141份,按最终临床诊断分为肺部细菌感染组和非细菌感染组,收集病例基本信息、基础疾病、实验室结果、临床诊断等。结果细菌感染组109例,非细菌感染组32例,细菌感染组与非细菌感染组的嗜中性粒细胞比例[47.0(25.7,86.1)%vs 9.6(3.7,26.1)%]、巨噬细胞比例(51.0%±17.3%vs 82.2%±11.1%)、淋巴细胞比例[4.1(2.0,15.1)%vs 5.7(3.8,21.6)%]差异均有统计学意义(P均<0.05)。BALF中性粒细胞比例诊断肺部细菌感染的阈值为25%,敏感度0.844,特异性0.969,ROC曲线下面积为0.899。结论BALF中性粒细胞比例超过25%对肺部细菌感染有较强的提示价值,可结合患者临床症状、影像学特点、既往病史等进行综合诊断。Background High incidence rate of lower respiratory tract infection,especially hospital acquired pneumonia,leads to heavy medical burdens every year.Early diagnosis is essential for the prevention and treatment of lower respiratory tract infection.Objective To analyze the classification characteristics of bronchoalveolar lavage fluid cells in patients with pulmonary bacterial infection and the diagnostic value of neutrophil ratio in bronchoalveolar lavage fluid for lower respiratory tract bacterial infection.Methods Totally 141 bronchoalveolar lavage fluid cell samples sent by the First Medical Center of Chinese PLA General Hospital from January 2018 to December 2020 were included.According to the final clinical diagnosis,they were divided into pulmonary bacterial infection group and non-bacterial infection group.The basic information,primary diseases,laboratory results,clinical diagnosis were also collected.Results There were 109 cases in bacterial infection group and 32 cases in non-bacterial infection group.The bacterial infection group and the non-bacterial infection group had significant differences(all P<0.05)in proportions of neutrophils(47.0[25.7,86.1]%vs 9.6[3.7,26.1]%),macrophages([51.0±17.3]%vs[82.2±11.1]%)and lymphocytes(4.1[2.0,15.1]%vs 5.7[3.8,21.6]%).The threshold of neutrophil ratio in bronchoalveolar lavage fluid for the diagnosis of pulmonary bacterial infection was 25%,with the sensitivity of 0.844,the specificity of 0.969,and the area under the ROC curve of 0.899.Conclusion Neutrophil ratio in bronchoalveolar lavage fluid over 25%is a strong indicator of pulmonary bacterial infection.Patients'clinical symptoms,imaging characteristics and past medical history can be combined for further diagnosis.

关 键 词：支气管肺泡灌洗液 中性粒细胞比例 肺炎 细菌感染 诊断 

分 类 号：R563.1[医药卫生—呼吸系统]