CN110031614A - A kind of system for distinguishing active tuberculosis and latent tuberculosis - Google Patents
A kind of system for distinguishing active tuberculosis and latent tuberculosis Download PDFInfo
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- CN110031614A CN110031614A CN201910430977.XA CN201910430977A CN110031614A CN 110031614 A CN110031614 A CN 110031614A CN 201910430977 A CN201910430977 A CN 201910430977A CN 110031614 A CN110031614 A CN 110031614A
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- G—PHYSICS
- G01—MEASURING; TESTING
- G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
- G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
- G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
- G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
- G01N33/5005—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells
- G01N33/5008—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics
- G01N33/5044—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics involving specific cell types
Abstract
The present invention relates to a kind of systems for distinguishing active tuberculosis and latent tuberculosis, belong to medical science.The system includes automatic whole blood analyser VCS, data acquisition module, data processing module, data analysis module and data outputting module, and is sequentially connected；The data acquisition module is used to acquire the parameter of automatic whole blood analyser VCS；Data processing module data collecting module collected to data calculated, formula is as follows: the data processing module will treated that data are transmitted to data analysis module is analyzed and judged, the data outputting module is exported according to the result of analysis.The present invention can be quick, convenient and fast differentiation active tuberculosis and latent tuberculosis infects situation, auxiliary improves diagnosis efficiency, more reasonable management patient, and does not need to increase additional reagent and consumptive material, without increasing extra-pay.
Description
Technical field
The invention belongs to medical sciences, are related to a kind of system for distinguishing active tuberculosis and latent tuberculosis.
Background technique
Research of the neutrophil leucocyte parameter in bacterium infection
VCS technology can detecte the form of the generations such as shift to left caused by acute bacterial infection and reactive neutrophil leucocyte
Learn variation.The VCS parameter of neutrophil leucocyte, especially neutrophil leucocyte average external volume (MNV) and its standard deviation (MNV-SD) are anti-
The heterogeneity of the variability or neutrophil leucocyte of having reflected neutrophil leucocyte size sharply increases in acute bacterial infection.MNV
It is more more obvious than local infection raising in general infection with MNV-SD, even if relatively low in normal or leucocyte in leucocyte
Patient in and general infection MNV and MNV-SD be higher than local infection.Meanwhile reacting cytoplasmic granule and nuclear structure
Neutrophil leucocyte light scattering value is significantly reduced compared with healthy control group, prompts have shift to left.Area is shown under ROC curve
The area under the curve (AUC is 0.87 and 0.85 respectively) that MNV and MNV-SD is obtained is significantly greater than c reactive protein (AUC=0.63),
Band form nucleus (AUC=0.73) and neutrophil leucocyte absolute counting (AUC=0.74), these indexs are shown for diagnosing acute bacterial
Sexuality dye, MNV and MNV-SD have higher sensitivity and specificity.Similar neutrophil morphology change in newborn and
In the septicemia of the elderly equally there is also.The MNV and MNV-SD of neutrophil leucocyte VCS parameter also have in bacterium infection after surgery
Correlative study.It is well known that postoperative infection is a serious medical problem, it can postpone postoperative recovery, increase
Institute's expense, medical expense lead to increasing for the death rate.Therefore, diagnosis postoperative infection is most important for correct management patient.It is non-
Infection hyperneocytosis and fever are common phenomenons of postoperative period, however traditional parameter, such as white blood cell count(WBC) or body
Temperature measurement is not enough to complete detection infection.Systemic inflammatorome reaction its essence of syndrome be due to caused by operation wound, although
It does not infect, the release of various inflammatory cytokines can also be caused and lead to fever and/or leukocytosis.
Studies have shown that compared with the patient being uninfected by, the significant increase of MNV and MNV-SD of post-operative bacterial infected patient
(respectively 157.5 ± 7.0vs149.2 ± 4.4 and 26.5 ± 3.3vs22.2 ± 2.4；Term of reference MNV:137-153；MNV-
SD:16.9-22.0).Although WBC and neutrophil leucocyte percentage also increased after operation, the patient for being uninfected by and infecting
Between there is no statistical difference (15.4 ± 2.4vs.16.2 ± 3.04；P=0.115) and (84.5% ± 3.1vs85.6% ±
3.4；P=0.08).The sensibility and specificity of MNV and NDW is respectively (90.3% and 88.4%) and (88.3% and 76.3%)
Arneth's count (29.0% and 88.1%) and c reactive protein (83.8% are substantially better than for bacterium infection after predicting surgical
With 56.6%), but with Procalcitonin Concentrations quite (87.1% and 90.5%).These observation results are especially significant, show these
Neutrophil leucocyte CPD has potential clinical application valence in terms of distinguishing post-operative bacterial infection with systemic inflammatory response syndrome
Value.The dynamic change that CPD parameter is observed in the process of disease will become very significant.
Research of the lymphocyte parameter in virus infection
Virus infection is capable of the activation of induction of lymphocyte, and undifferentiated lymphopoiesis and antibody, cell factor/
The secretion of lymphokine.T cell and a small amount of antibody are mainly relied on to antiviral immune response.Cytotoxic T cell exists
Kill role important in playing the part of in the cell of virus infection.Some cell factors, including gamma interferon and tumor necrosis factor
It is all from cytotoxic T cell secretion.Thus inference, the lymphocyte of activation are not only morphologic change, it with
Lymphocyte under normal quiescent condition is compared, and with the increase of volume, the internal structure of cell is also changed correspondingly, these changes
Can used VCS technology detected.
It has been reported that the CPD parameter of lymphocyte shows significantly to become in virus B hepatitis (HBV) patient
Change.Including raised lymphocyte volume (LV:94.2 ± 4.1vs 87.7 ± 2.9；Term of reference: 81.9-93.5), lymph is thin
Cell space accumulates standard deviation (LV-SD:20.1 ± 3.9vs14.5 ± 1.3；Term of reference: 11.9-17.1), reduction has lymphocyte
Conductivity (LC:101.1 ± 8.1vs107.6 ± 4.5；Term of reference: 98.6-116.6).These data be shown in HBV patient with
HBV carrier, which compares, significant change.There is also packets equally in various other virus infections for the reduction of LV, LV-SD and LC
Include Epstein-Barr virus, hepatitis A virus, hepatitis type B virus, Hepatitis C Virus, herpesviral, cytomegalovirus, human herpes
Virus, dengue fever virus and human immunodeficiency virus, these variations show that lymphocyte CPD parameter is striven to hepatitis type B virus
It is not special, but it is suitable for all virus infections.Based on above research, it is thin that researcher proposes a simplified lymph
Born of the same parents' CPD formula, referred to as lymph index, its calculation formula is: lymph index=LV x LV-SD ÷ LC.Lymph index is in various diseases
(15.3 ± 1.8vs10.9 ± 1.0, P < 0.001 are dramatically increased in poison compared with Normal group；Term of reference: 9.0-12.9)
Only has slight raising (11.3 ± 1.1) in acute bacterial infection.When Cut-off >=12.92 of lymph index, diagnosis disease
The sensibility of poison infection is 91.7%, and specificity is 97.2%.Therefore the potential hematological indices of judging viral infection may be used as.
Application of the monocyte CPD parameter in various infection
The monocyte recycled in blood equally plays very important effect in fighting various infection.Early stage research table
The bright standard deviation by monocyte volume and lymphocyte volume obtains a formula, is named as the malaria factor (D=VS
(lymphocytes) * VSD (monocytes)/100) to obtain the sensitivity of Malaria Diagnosis be 96.9%, specificity is
82.5%, the stability of each parameter is especially good, even if with portion sample by test repeatedly, its variation in one month by a definite date
Coefficient also only has 4%.Then, there is researcher to verify above-mentioned formula, obtain helminth (tertian fever) in detection peripheral blood
Sensitivity be 98%, specificity is 94%, and the above research all confirms monocyte parameter, and lymphocyte parameter is for diagnosing malaria
Disease diagnostic with higher.There are also studies have shown that lymphocyte average external volume, monocyte average external volume and its standard deviation
Plasmodium and dengue fever can be distinguished from other fever diseases by merging mean hemoglobin concentration and neutrophil leucocyte percentage
Infection, clever lightness and specificity can achieve 85.1% and 91.4% respectively.In addition, in conjunction with platelet count, lymphocyte
The sensitivity that average external volume standard deviation and conductivity identify plasmodium is 90.4%, specificity 88.6%, in conjunction with blood platelet meter
The standard deviation of number, cent lymphocytes and lymphocyte conductivity identifies the clever lightness of dengue fever and specificity is respectively 81%
With 77.1%.Monocyte parameter in malaria infection other than changing, the monokaryon in acute hepatitis b virus infection
The case where significant changes of cell CPD, equally can also see in lymphocyte relevant parameter.
Related change of the neutrophil leucocyte in other clinical diseases
What it is due to the reaction of leucocyte community parameter is cell interior structure feature, thus it is envisioned that any possible change is outer
The disease of all blood leukocytes forms may all influence the value of leucocyte community parameter.Studies have shown that in the disease of various blood dyscrasias
In disease, apparent change is all had occurred in the correlation of leucocyte community parameter, for example, myelodysplastic syndrome, acute marrow
It is leukaemia, chronic monocytic leukemia, lymphadenia exception.And non-blood disease is such as, vitamin B12 lacks
It is weary, the influence etc. of parenteral fat emulsion.In addition malignant tumor chemotherapy may change cellular morphology and influence the knot of cell CPD
Fruit.
As shown in Figure 1, being the flow diagram of related art.This research is a retrospective study, by sample
This amount is small and the very big limitation of range of choice.These limitations may cause the diagnosis energy of excessively high the studied parameter of estimation of incorporation deviation
Power.The Clinical practicability of monocyte VCS parameter is further verified therefore, it is necessary to more massive prospective cohort study.
Summary of the invention
In view of this, the purpose of the present invention is to provide a kind of systems for distinguishing active tuberculosis and latent tuberculosis.
In order to achieve the above objectives, the invention provides the following technical scheme:
A kind of system for distinguishing active tuberculosis and latent tuberculosis, including the acquisition of automatic whole blood analyser VCS, data
Module, data processing module, data analysis module and data outputting module, and be sequentially connected；
The data acquisition module is used to acquire the parameter of automatic whole blood analyser VCS；
The parameter of acquisition includes monocyte average external volume MMV in leucocyte community parameter, monocyte average external volume
Standard deviation MMV-SD, monocyte average conductivity MMC, monocyte senior middle school angular light scattering M-UMALS, the scattering of middle angular light
The low middle angular light scattering M-LMALS of M-MALS, monocyte and monocyte low angle light scatter M-LALS, and monocyte is axial
Light loss measures M-AL2；
The data processing module data collecting module collected to data calculated, formula is as follows:
Monocyte exponent m onocyte Index=(MMV*MMC)/M-LMALS
The data processing module will treated that data are transmitted to data analysis module is analyzed and judged, activity lung
Tuberculosis ATB term of reference: 227-280, latent tuberculosis infects LTBI term of reference: 322-400；
The data outputting module is exported according to the result of analysis.
The beneficial effects of the present invention are: the differentiation active tuberculosis and latency knot that the present invention can be quick, convenient and fast
Core infection conditions, auxiliary improve diagnosis efficiency, more reasonably manage patient, and do not need to increase additional reagent and consumptive material,
Without increasing extra-pay.
Other advantages, target and feature of the invention will be illustrated in the following description to a certain extent, and
And to a certain extent, based on will be apparent to those skilled in the art to investigating hereafter, Huo Zheke
To be instructed from the practice of the present invention.Target of the invention and other advantages can be realized by following specification and
It obtains.
Detailed description of the invention
To make the objectives, technical solutions, and advantages of the present invention clearer, the present invention is made below in conjunction with attached drawing excellent
The detailed description of choosing, in which:
Fig. 1 is existing the relevant technologies flow chart；
Fig. 2 is this system structure chart；
Fig. 3 is embodiment data graphs.
Specific embodiment
Illustrate embodiments of the present invention below by way of specific specific example, those skilled in the art can be by this specification
Other advantages and efficacy of the present invention can be easily understood for disclosed content.The present invention can also pass through in addition different specific realities
The mode of applying is embodied or practiced, the various details in this specification can also based on different viewpoints and application, without departing from
Various modifications or alterations are carried out under spirit of the invention.It should be noted that diagram provided in following embodiment is only to show
Meaning mode illustrates basic conception of the invention, and in the absence of conflict, the feature in following embodiment and embodiment can phase
Mutually combination.
Wherein, the drawings are for illustrative purposes only and are merely schematic diagrams, rather than pictorial diagram, should not be understood as to this
The limitation of invention；Embodiment in order to better illustrate the present invention, the certain components of attached drawing have omission, zoom in or out, not
Represent the size of actual product；It will be understood by those skilled in the art that certain known features and its explanation may be omitted and be in attached drawing
It is understood that.
The same or similar label correspond to the same or similar components in the attached drawing of the embodiment of the present invention；It is retouched in of the invention
In stating, it is to be understood that if there is the orientation or positional relationship of the instructions such as term " on ", "lower", "left", "right", "front", "rear"
To be based on the orientation or positional relationship shown in the drawings, be merely for convenience of description of the present invention and simplification of the description, rather than indicate or
It implies that signified device or element must have a particular orientation, be constructed and operated in a specific orientation, therefore is described in attached drawing
The term of positional relationship only for illustration, is not considered as limiting the invention, for the ordinary skill of this field
For personnel, the concrete meaning of above-mentioned term can be understood as the case may be.
As shown in Fig. 2, for a kind of system for distinguishing active tuberculosis and latent tuberculosis, including automatic whole blood analyser
VCS, data acquisition module, data processing module, data analysis module and data outputting module, and be sequentially connected；
The data acquisition module is used to acquire the parameter of automatic whole blood analyser VCS；
The parameter of acquisition includes that monocyte average external volume (MMV) in leucocyte community parameter, monocyte are averaged body
Product standard deviation (MMV-SD), monocyte average conductivity (MMC), senior middle school's angular light scattering (M-UMALS), middle angular light scattering
(M-MALS), low middle angular light scattering (M-LMALS) and low angle light scattering (M-LALS), axial light loss measure (M-AL2)；
The data processing module data collecting module collected to data calculated, formula is as follows:
Monocyte exponent m onocyte Index=(MMV*MMC)/M-LMALS
The data processing module will treated that data are transmitted to data analysis module is analyzed and judged, activity lung
Tuberculosis ATB term of reference: 227-280, latent tuberculosis infects LTBI term of reference: 322-400；
The data outputting module is exported according to the result of analysis.
This method sensitivity with higher, specificity and accuracy, and it is easy to operate, without expensive detector
Device is suitble to clinical expansion.
(molecule is two comparison among groups, and tuberculosis group is significantly higher than the parameter of latent group, and denominator is two comparison among groups, tuberculosis group
The parameter of substantially less than latent group)
Research method:
This research has chosen certain city's public health medical treatment central movable lunger 97, (average age
49.8±14.5；Male/female: 53/44), and 113 (average ages: 50.2 ± 17.7 of certain hospital latent tuberculosis infects person；
And 101 (ages: 51.9 ± 19.1 of physical examination of healthy population male/female: 48/65)；Male/female: 51/50).As shown in Figure 3.
It is included in grouping and exclusion criteria:
Active tuberculosis patient is included in " diagnosis of pulmonary tuberculosis standard WS 288-2017 " [43]: the antiacid dye of Sputum culturing, phlegm
At least one is positive for color, molecular diagnosis, and X-ray findings of chest meets tuberculosis iconography lesion, and selected case is that first visit is suffered from
Person, no antituberculotic treatment history.
Latent tuberculosis patient is included in standard are as follows: gamma interferon release experiment (IGRAs) is positive, sputum smear and tuberculosis point
Branch bacillus culture is negative, without associated clinical symptoms lungy, while excluding the patient of Liver and kidney function severely subnormal, suffers from
There is the patient of the immunosuppressor such as patient and the application glucocorticoid of autoimmune disease.
Healthy control group is included in standard are as follows: the physical examination of healthy population of same time to the court's physical examination, no tubercular's contact history, chest
Portion's x-ray is acted normally, and T-SPOT is negative, and liver function, kidney function, hepatitis B, blood routine examination are normal.
Exclusion criteria:
Following crowd is not included in research: age < 18 year old, pregnant woman, inhibition of HIV infection, cancer, autoimmune disease, just
Receive immunosuppressor or receives Anti-TB therapy volunteer.
Leucocyte group VCS Parameter analysis: each equal extracting vein blood 3ml of research object is in EDTAP dipotassium ethylene diamine tetraacetate (EDTA-
K2 it) in anticoagulant vacuum blood collection tube, is mixed by inversion immediately, all samples are completed in 4 hours after acquisition, use UniCel
Coulter DxH800 blood analyser and matched reagent and quality-control product, sample is without blood coagulation and haemolysis.Detection project includes: each white
Population of cells VCS parameter (MMV, MMV-SD, MMC, MMC-SD, M-MALS, M-MALS-SD, M-UMALS,
M-UMALS-SD, M-LMALS, M-LMALS-SD, M-LALS, M-LALS-SD, M-AL2, M-AL2-SD), pass through group
Between difference compare two-by-two and ROC curve under area (area under curve, AUC) analysis assessment its distinguish activity lung knot
The diagnostic of core and latent tuberculosis infects.
Statistical method
Applied statistics software SPSS25.0 carries out data processing.Measurement data indicates with mean ± standard deviation (Mean ± s),
It is detected first by normality, the data for meeting normal distribution examine the ratio carried out between 2 cell means by Student t
Compared with, significant difference analysis uses Kruskal-Wallis non-parametric test between multiple groups, and P < 0.05 is that difference is statistically significant,
The diagnosis performance of each parameter is assessed by calculating Receiver Operating Characteristics' (ROC) area under a curve.According to youden index
Best cut-off value is selected, i.e., correspondence is fetched when difference maximum between the sensitivity of all the points and 1- specificity on ROC curve
Value.
1 monocyte parameter Mean ± SD interpretation of result of table
Table 2 in active tuberculosis and latent tuberculosis there is the parameter spirit lightness of significant difference and specificity to analyze
1, all parameters are to get (V expression volume, C expression conductivity, S table based on automatic whole blood analyser VCS technology
Show that light scatters), MMV- monocyte average external volume；MMC- monocyte average conductivity；During M-LMALS- monocyte is low
Angular light scattering；
2, collection activity lunger 97, latent tuberculosis infects person 112, healthy by the experiment of early period
It control group 101, with the detection of VCS technology, obtains and distinguishes active tuberculosis and latent tuberculosis diagnostic higher 3
A index, MMV, MMC, M-LMALS establish formula monocyte index (monocyte Index)=(MMV*MMC)/M-
LMALS, area reaches 0.970 under ROC curve.
Finally, it is stated that the above examples are only used to illustrate the technical scheme of the present invention and are not limiting, although referring to compared with
Good embodiment describes the invention in detail, those skilled in the art should understand that, it can be to skill of the invention
Art scheme is modified or replaced equivalently, and without departing from the objective and range of the technical program, should all be covered in the present invention
Scope of the claims in.
Claims (1)
1. a kind of system for distinguishing active tuberculosis and latent tuberculosis, it is characterised in that: including automatic whole blood analyser
VCS, data acquisition module, data processing module, data analysis module and data outputting module, and be sequentially connected；
The data acquisition module is used to acquire the parameter of automatic whole blood analyser VCS；
The parameter of acquisition includes monocyte average external volume MMV in leucocyte community parameter, monocyte average external volume standard
Poor MMV-SD, monocyte average conductivity MMC, monocyte senior middle school angular light scattering M-UMALS, middle angular light scatter M-
The low middle angular light scattering M-LMALS of MALS, monocyte and monocyte low angle light scatter M-LALS, monocyte axial direction light
Loss measurement M-AL2；
The data processing module data collecting module collected to data calculated, formula is as follows:
Monocyte exponent m onocyte Index=(MMV*MMC)/M-LMALS
The data processing module will treated that data are transmitted to data analysis module is analyzed and judged, active tuberculosis
ATB term of reference: 227-280, latent tuberculosis infects LTBI term of reference: 322-400；
The data outputting module is exported according to the result of analysis.
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Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO2021213291A1 (en) * | 2020-04-21 | 2021-10-28 | 贝克曼库尔特公司 | Hematological parameter for viral infection |
| EP3782166B1 (en) * | 2018-04-20 | 2023-08-09 | Beckman Coulter, Inc. | Sepsis infection determination systems and methods |
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| CN104797924A (en) * | 2012-11-30 | 2015-07-22 | 贝克曼考尔特公司 | Tuberculosis screening using CPD data |
| WO2018111536A1 (en) * | 2016-12-14 | 2018-06-21 | Becton, Dickinson And Company | Methods and compositions for obtaining a tuberculosis assessment in a subject |
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2019
- 2019-05-22 CN CN201910430977.XA patent/CN110031614A/en active Pending
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104797924A (en) * | 2012-11-30 | 2015-07-22 | 贝克曼考尔特公司 | Tuberculosis screening using CPD data |
| WO2018111536A1 (en) * | 2016-12-14 | 2018-06-21 | Becton, Dickinson And Company | Methods and compositions for obtaining a tuberculosis assessment in a subject |
Non-Patent Citations (8)
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP3782166B1 (en) * | 2018-04-20 | 2023-08-09 | Beckman Coulter, Inc. | Sepsis infection determination systems and methods |
| WO2021213291A1 (en) * | 2020-04-21 | 2021-10-28 | 贝克曼库尔特公司 | Hematological parameter for viral infection |
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Application publication date: 20190719 |