摘要
目的探讨外周血复合炎性指标[全身免疫炎症指数(SII)、淋巴细胞与单核细胞比值(LMR)、嗜酸性粒细胞与中性粒细胞比值(ENR)、中性粒细胞与淋巴细胞比值(NLR)]与呼吸道腺病毒(AdV)感染儿童病情严重程度及并发喘息的关系。方法选取2022年6月至2024年5月该院收治的154例呼吸道AdV感染患儿(研究组)和154例体检健康儿童(对照组),根据儿童序贯器官衰竭评分(p-SOFA)将呼吸道AdV感染患儿分为轻度组(86例)和重度组(68例),并根据呼吸道AdV感染患儿是否并发喘息将其分为喘息组(79例)和非喘息组(75例)。检测并比较各组外周血SII、LMR、ENR、NLR,采用Pearson法分析外周血SII、LMR、ENR、NLR与呼吸道AdV感染患儿病情严重程度的相关性。采用单因素和多因素Logistic回归分析影响呼吸道AdV感染患儿并发喘息的因素;绘制受试者工作特征曲线评估外周血复合炎性指标对呼吸道AdV感染患儿病情严重程度及患儿并发喘息的诊断价值。结果重度组外周血SII、ENR、NLR均高于轻度组和对照组(P<0.05),而轻度组外周血SII、ENR、NLR均高于对照组(P<0.05)。重度组外周血LMR低于轻度组和对照组(P<0.05),而轻度组外周血LMR低于对照组(P<0.05)。重度组p-SOFA高于轻度组(P<0.05)。呼吸道AdV感染患儿外周血SII、ENR、NLR与p-SOFA呈正相关(r=0.512、0.439、0.507,P<0.05),LMR与p-SOFA呈负相关(r=-0.436,P<0.05)。SII、LMR、ENR、NLR单独诊断重度呼吸道AdV感染的曲线下面积(AUC)分别为0.785、0.809、0.784、0.834,联合诊断的AUC为0.916,大于各项指标单独诊断(P<0.05)。喘息组SII、ENR、NLR高于非喘息组(P<0.05),LMR低于非喘息组(P<0.05)。小气道病变、高SII、高ENR、高NLR是呼吸道AdV感染患儿并发喘息的危险因素(P<0.05),高LMR是其保护因素(P<0.05)。SII、LMR、ENR、NLR单独诊断呼吸道AdV感染患儿并发喘息的AUC分别为0.778、0.771、0.757、0.805,联合诊断的AUC为0.884,大于各项指标单独诊断(P<0.05)。结论呼吸道AdV感染患儿外周血SII、ENR、NLR升高,LMR降低,与患儿病情严重程度加重及并发喘息密切相关,联合4项指标检测在诊断患儿病情严重程度及并发喘息风险方面具有较高的价值。
Objective To investigate the relationship between peripheral blood composite inflammatory indexes[systemic immune inflammatory index(SII),lymphocyte to monocyte ratio(LMR),eosinophil to neutrophil ratio(ENR),neutrophil to lymphocyte ratio(NLR)]and the severity of respiratory adenovirus(AdV)infection and concurrent wheezing in children.Methods A total of 154 children with respiratory AdV infection(study group)who were admitted to the hospital from June 2022 to May 2024 and 154 healthy children who underwent physical examinations(control group)were selected.Children with respiratory AdV infection were divided into mild group(86 cases)and severe group(68 cases)according to the pediatric sequential organ failure assessment(p-SOFA),and children were divided into wheezing group(79 cases)and non-wheezing group(75 cases)according to whether wheezing occurred in children with respiratory AdV infection.The peripheral blood SII,LMR,ENR and NLR in each group were detected and compared,the correlation between peripheral blood SII,LMR,ENR,NLR and the severity of respiratory AdV infection in children was analyzed by Pearson method.The factors affecting wheezing in children with respiratory AdV infection were analyzed by univariate and multivariate Logistic regression analysis.The diagnostic value of peripheral blood composite inflammatory indexes for the severity of respiratory AdV infection and concurrent wheezing in children was evaluated by drawing the receiver operating characteristic curve.Results The peripheral blood SII,ENR and NLR in severe group were higher than those in mild group and control group(P<0.05),while the peripheral blood SII,ENR and NLR in mild group were higher than those in control group(P<0.05).The peripheral blood LMR in severe group was lower than those in mild group and control group(P<0.05),while the peripheral blood LMR in mild group was lower than that in control group(P<0.05).The p-SOFA in severe group was higher than that in mild group(P<0.05).Peripheral blood SII,ENR and NLR in children with respiratory AdV infection were positively correlated with p-SOFA(r=0.512,0.439,0.507,P<0.05),and LMR was negatively correlated with p-SOFA(r=-0.436,P<0.05).The area under the curve(AUC)of the single detection of SII,LMR,ENR and NLR for diagnosing severe respiratory AdV infection were 0.785,0.809,0.784 and 0.834 respectively,and the AUC of combined detection was 0.916,which was larger than those of single detection(P<0.05).SII,ENR and NLR in wheezing group were higher than those in non-wheezing group(P<0.05),and LMR was lower than that in non-wheezing group(P<0.05).Small airway disease,high SII,high ENR and high NLR were risk factors for wheezing in children with respiratory AdV infection(P<0.05),and high LMR was a protective factor(P<0.05).The AUC of the single detection of SII,LMR,ENR and NLR for diagnosing wheezing in children with respiratory AdV infection were 0.778,0.771,0.757 and 0.805 respectively,and the AUC of combined diagnosis was 0.884,which was larger than those of single detection(P<0.05).Conclusion The peripheral blood SII,ENR and NLR in children with respiratory AdV infection increase,and the LMR decreases,which are closely related to the aggravation of the severity of the disease and the concurrent wheezing.The combined detection of four indexes has high value in the diagnosis of the severity of the disease and the risk of concurrent wheezing.
作者
姜芹
李文松
王君
李玲玲
JIANG Qin;LI Wensong;WANG Jun;LI Lingling(Department of Clinical Laboratory;Department of Paediatrics,Jiaozhou Central Hospital of Qingdao,Qingdao,Shandong 266300,China)
出处
《国际检验医学杂志》
2025年第18期2243-2249,共7页
International Journal of Laboratory Medicine
基金
青岛市科技计划项目(22-3-7-smjk-18-nsh)。
作者简介
姜芹,女,副主任技师,主要从事临床检验方向的研究;通信作者:李玲玲,E-mail:lilingling9168@163.com。
