【作者】 王倩；

【导师】 俞云松；

【作者基本信息】 浙江大学 ， 内科学（专业学位）， 2017， 硕士

【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,P<0.01;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,P<0.01,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,P<0.01;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,P>0.05;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,P<0.01。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,P<0.01。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。更多还原

【Abstract】 Purpose:To inquire into the clinical value of neutrophil alkaline phosphatase(NAP)in patients with a fever and to discuss the correlation analysis and difference between NAP and the other inflammatory markers in infectious diseases.Methods:We collected vein blood of patients(n=402)and examed NAP activity,at the same time,the number of WBC,NC,ESR and hs-CRP was detected in patients with infectious diseases.Another 180 patients were tested the NAP activity in their bone marrow.Results:NAP activity was highly correlated with peripheral blood and bone marrow smears.In infectious diseases,the NAP activity in bacterial and fungal infection group was significantly higher than that in virus,tuberculosis,atypical pathogen infection,P<0.01.The positive rate of hs-CRP was highest,and it was higher of NAP than WBC and NC,P<0.01.NAP and hs-CRP was correlated moderately.In connective tissue disease,the activity of enzyme in adult still’s disease was higher than other disease,P<0.01.In the blood system diseases,NAP in B cell lymphoma with bone marrow invasion was obviously lower than in B cell lymphoma without bone marrow invasion.And the activity of NAP in B cell lymphoma without bone marrow invasion was obviously higher than it in T cell lymphoma without bone marrow invasion.NAP activity wassignificantly decreased in chronic myeloid leukemia,while it was high in other myeloproliferative diseases,P<0.01.Conclusions:NAP activity was highly correlated with peripheral blood and bone marrow smears and it can be the diagnostic index in the unknown reason fever caused by different diseases.更多还原