淋巴细胞与单核细胞比值、C反应蛋白与前白蛋白比值检测对甲型流感病毒重症感染婴幼儿的临床价值

Clinical value of detecting lymphocyte to monocyte ratio and C-reactive protein to prealbumin ratio in infants with severe influenza A virus infection

目的 探讨淋巴细胞与单核细胞比值(LMR)、C反应蛋白与前白蛋白比值(CRP/PA)预测甲型流感病毒重症感染婴幼儿的临床价值。方法 选取2019年1月至2022年12月泰安市妇幼保健院儿内科住院的婴幼儿甲型流感病毒感染重症组(192例)、轻症组(187例)及健康对照者(393例),检测其血常规、CRP及PA水平,计算中性粒细胞/淋巴细胞比值(NLR)、LMR、血小板/淋巴细胞比值(PLR)、系统免疫炎症指数(SII)、CRP/PA。采用受试者工作特征(ROC)曲线和Logistic回归分析LMR、CRP/PA对甲型流感病毒重症感染的诊断及预测价值。结果 与对照组和轻症组比较,重症组NLM、PLR、SII、CRP/PA均显著升高,LMR显著降低(分别为1.09、88.07、310.75、0.05和3.90,P<0.05)。与对照组相比,轻症组CRP/PA显著升高,LMR显著降低(分别为0.04和6.31,P<0.05)。ROC曲线显示,诊断重症感染时,CRP/PA的特异度最高,为96.1%,LMR、CRP/PA联合检测的灵敏度、ROC曲线下面积(AUC)均优于单项检测(分别为88.5%、0.941)。LMR、CRP/PA联合检测对轻症与重症感染鉴别诊断的灵敏度、特异度和AUC均优于单项检测(分别为76.4%、60.2%、0.707)。校正年龄、性别及NLM、PLR、SII后,CRP/PA的升高与LMR的降低与甲型流感病毒感染独立相关,并区分轻症和重症。结论 甲型流感病毒感染患儿CRP/PA升高与LMR降低,还有助于区分轻症和重症,可为预测感染严重程度的指标,LMR、CRP/PA联合分析对轻重症感染的鉴别诊断具有重要价值。

Objective To investigate the clinical value of lymphocyte to monocyte ratio(LMR)and C-reactive protein to prealbumin ratio(CRP/PA)in predicting severe influenza A virus infection in infants.Methods Infants hospitalized in the Department of Pediatrics of Tai′an Women and Children Health Care Hospital with influenza A virus infection from January 2019 to December 2022,including a severe group(192 cases),a mild group(187 cases),and healthy controls(393 cases)were selected.Their blood routine,CRP and PA levels were detected and neutrophil to lymphocyte ratio(NLR),LMR,platelet to lymphocyte ratio(PLR),systemic immunoinflammatory index(SII),CRP/PA were calculated.Receiver operating characteristic(ROC)curve and Logistic regression were used to analyze the diagnostic and predictive value of LMR and CRP/PA for severe influenza A virus infection.Results Compared with control group and mild group,NLM,PLR,SII and CRP/PA in severe disease group were significantly increased,while LMR was significantly decreased(1.09,88.07,310.75,0.05 and 3.90,respectively,P<0.05).Compared with the control group,the mild group exhibited a significant increase in CRP/PA and a significant decrease in LMR(0.04 and 6.31,respectively,P<0.05).ROC curve showed that when diagnosing severe infections,CRP/PA had the highest specificity at 96.1%,and the sensitivity and area under ROC curve(AUC)of the combined detection of LMR and CRP/PA were superior to individual detections(88.5%and 0.941,respectively).Combined detection of LMR and CRP/PA for distinguishing between mild and severe infections showed higher sensitivity,specificity,and AUC compared to individual detections(76.4%,60.2%,and 0.707,respectively).After adjusting for age,sex,and NLM,PLR,and SII,the increased CRP/PA and decreased LMR were independently associated with influenza A virus infection and can distinguish between mild and severe cases.Conclusion The increase of CRP/PA and the decrease of LMR in infants infected with influenza A virus can also help to distinguish mild and severe cases,and can be used as an indicator to predict the severity of infection.The combined analysis of LMR,CRP/PA is of great value in the differential diagnosis of mild and severe infections.