红细胞分布宽度在儿童CAP的诊治及预后中的应用价值

The Values of Red Blood Cell Distribution Width in Diagnosis and Prognosis in Children with CAP

目的:探究红细胞分布宽度(RDW)在儿童CAP的诊治及预后中的应用价值。方法:选取2017年1月-2018年1月在本院进行诊治的226例CAP的患儿为CAP组,并选择同期234例健康儿童为对照组。比较两组外周白细胞计数(WBC)、中性粒细胞百分比、RDW、降钙素原(PCT)、C反应蛋白(CRP)、血清尿素(UREA)及电解质水平,应用ROC曲线分析其取不同cut-off值的诊断价值,应用多因素Logistic回归模型分析CAP严重程度的影响因素。结果:CAP组WBC、RDW和CRP水平均显著高于对照组(P<0.05),两组中性粒细胞百分比、PCT、UREA及电解质水平比较,差异均无统计学意义(P>0.05);ROC曲线显示,RDW、WBC和CRP的AUC分别为0.869、0.786、0.799,其中RDW对CAP的诊断效能均高于WBC和CRP(P<0.05);Youden指数提示RDW、WBC和CRP表达水平诊断CAP的最佳截点分别为14.819 fL、10.589×109/L和4.293 mg/L;RDW、WBC和CRP位于最佳截点时,RDW的准确率、灵敏度、特异度、阳性预测值和阴性预测值均显著高于WBC、CRP(P<0.05);多因素Logistic回归模型显示,RDW是重症CAP的独立相关因素(OR=0.457,P<0.05)。结论:在儿童CAP的诊断中,RDW的灵敏度和特异度高,并对肺炎的预后有一定的参考价值,值得在临床上推广。

Objective：To explore the values of red blood cell distribution width（RDW） in diagnosis and prognosis in children with CAP.Method：A total of 226 children with CAP diagnosed and treated in our hospital from January 2017 to January 2018 were selected as CAP group,and 234 healthy children in the same period were selected as control group.The white blood cell（WBC）,neutrophils percentage,RDW,procalcitonin（PCT）,C reactive protein（CRP）,serum urea（UREA） and electrolyte levels were compared between two groups.The diagnostic value of different cut-off values was analyzed by ROC curve.Multivariate Logistic regression model was used to analyze the influencing factors of CAP severity.Result：The levels of WBC,RDW and CRP in CAP group were significantly higher than those of control group（P〈0.05）,the neutrophils percentage,PCT,UREA and electrolyte levels in two groups were compared,the differences were not statistically significant（P〉0.05）.ROC curves showed that the AUCs of RDW,WBC and CRP were 0.869,0.786 and 0.799 respectively,and the diagnostic efficacy of RDW was higher than that of WBC and CRP（P〈0.05）.Youden index indicated that the best cut-off points for diagnosing CAP were 14.819 fL,10.589×10^9/L and 4.293 mg/L respectively.When RDW,WBC and CRP were located at the optimal cut-off point,the accuracy,sensitivity,specificity,positive predictive value and negative predictive value of RDW were significantly higher than those of WBC and CRP（P〈0.05）.Multivariate logistic regression model showed that RDW was an independent risk factor for severe CAP（OR=0.457,P〈0.05）.Conclusion：The sensitivity and specificity of RDW is high in the diagnosis of CAP in children,and it has a certain reference value for the prognosis of pneumonia.It is worthy of clinical promotion.