儿童甲、乙型流感病毒感染外周血中性粒细胞/淋巴细胞比值的临床意义

Clinical Significance of Peripheral Blood Neutrophil-to-Lymphocyte Ratio in Influenza A and B Virus Infections in Children

目的探讨外周血全血细胞分析中的四项指标在儿童甲、乙型流感病毒感染中的临床意义。方法回顾性分析2018年1月~2019年1月在北京儿童医院就诊的发热和/或急性呼吸道症状的门诊患儿468例。采用间接免疫荧光法检测血清甲、乙型流感病毒IgM抗体,采用流式细胞计数法进行外周血全血细胞分析。每组按年龄分为<4岁组和≥4岁组。研究组纳入甲型流感患儿138例,乙型流感患儿177例,对照组纳入有呼吸道感染症状但甲、乙型流感病毒阴性的患儿153例。分别比较三组白细胞(white blood cell,WBC)、中性粒细胞(neutrophil,NEU)、淋巴细胞(lymphocyte,LYM)和中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)的水平,并对结果进行统计学分析。结果在<4岁组和≥4岁组中,四项指标与对照组相比差异有统计学意义(<4岁组χ^2=48.721~159.45,≥4岁组χ^2=36.79~93.56,均P<0.001)。<4岁组,四项指标的受试者特征曲线(receiver operator characteristic curve,ROC)的曲线下面积(area under the curve,AUC)分别为0.765,0.904,0.742和0.924,当NLR取临界值1.12时,敏感度为87.8%,特异度为86.3%。≥4岁组,四项指标的ROC-AUC分别为0.823,0.937,0.799和0.977,当NLR取临界值1.65时,敏感度为94.1%,特异度为94.8%。进一步对甲、乙流感组进行比较,<4岁组中,两组之间WBC,NEU和NLR差异有统计学意义(P<0.001)。结论 NLR优于其他三项常规感染指标,有望作为诊断儿童甲、乙流感病毒感染的潜在指标。

Objective To explore the clinical significance of four markers in peripheral complete blood cell count in children with influenza A and B virus infections. Methods 468 pediatric outpatients with fever and/or acute respiratory illness from January 2018 to January 2019 in Beijing Children’s Hospital were studied retrospectively. Influenza A and B virus IgM antibodies were detected by indirect immunofluorescent assay, and peripheral complete blood cell count was analyzed by flow cytometry. Each group was divided into less than four years old and greater than or equal to four years old. Included 138 influenza A patients, 177 influenza B patients as research group and 153 patients with respiratory symptoms but influenza virus A and B test-negative as control group. Compared the white blood cell count(WBC), neutrophil count(NEU), lymphocyte count(LYM) and neutrophil-to-lymphocyte ratio(NLR) among these three groups. Results The levels of four markers in influenza groups were different than those in control group in both age groups, and the difference were statistically significant(in < 4 years old group χ^2=48.721~159.45 and in ≥ 4 years old group χ^2=36.79~93.56, all P<0.001). In < 4 years old age group, the area under the receiver operating characteristic curve(ROC-AUC) for diagnosing influenza infection of four markers were 0.765,0.904,0.742 and 0.924, respectively, when the cutoff value for NLR was 1.12, the sensitivity was 87.8% and the specificity was 86.3%. In ≥ 4 years old age group, the ROC-AUC of four markers were 0.823,0.937,0.799 and 0.977 respectively, when the cutoff value for NLR was 1.65, the sensitivity was 94.1% and the specificity was 94.8%. Furtherly, in < 4 years old age group, WBC, NEU and NLR were significantly different between ininfluenza A and B groups(P<0.001). Conclusion NLR was the better marker than the other three ones, and it may have the potential to serve as an auxiliary diagnostic marker for pediatric influenza A and B virus infections.