本文關鍵詞： 中性粒細胞堿性磷酸酶 發(fā)熱待查 診斷 感染性疾病　出處：《浙江大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討外周血及骨髓涂片中性粒細胞堿性磷酸酶積分和陽性率在發(fā)熱患者診斷及鑒別診斷中的臨床意義,同時分析NAP與其他炎性指標在感染性疾病診斷中的相關性與差異。方法:選取2015年8月1日至2016年10月30日期間發(fā)熱待查患者402例,所有患者發(fā)熱時均常規(guī)進行血NAP活性檢測,分組配對分析,其中感染組患者同時進行白細胞計數(WBC)、中性粒細胞分類計數(NC)、血沉(ESR)、超敏C-反應蛋白(hs-CRP)的檢測,結果進行差異及相關性分析;同時選取2014年9月1日到2016年10月30日期間發(fā)熱待查患者180例,對其骨髓片行NAP染色,并對結果進行比較分析。結果:NAP活性檢測結果在外周血和骨髓涂片中具有良好的相關性。在感染組中,細菌、真菌感染亞組,NAP活性明顯高于病毒、結核、不典型病原體感染組,P0.01;各炎癥指標的陽性率比較:hs-CRP最高,NAP和ESR次之,WBC和NC相對較低,P0.01,其中NAP與hs-CRP呈低中度相關,與ESR、WBC、NC無明顯相關性;在結締組織病組中,成人斯蒂爾病NAP活性最高,明顯高于動脈炎、血管炎、類風濕性關節(jié)炎,P0.01;類風濕性關節(jié)炎NAP活性最低,但與其他結締組織病亞組比較,差異無統(tǒng)計學意義,P0.05;在血液系統(tǒng)疾病組中,骨髓受侵犯的B細胞淋巴瘤患者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細胞淋巴瘤NAP活性增高較T細胞淋巴瘤明顯,P0.01。慢性粒細胞白血病NAP活性較其他慢性骨髓增殖性疾病明顯減低,P0.01。結論:NAP活性檢測結果在血和骨髓中相關性良好,在發(fā)熱待查診斷和鑒別診斷中具有一定的指導意義。
[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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R441.3

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