外周血NLR,PLR和LMR水平分析在儿童流感病毒与疱疹性咽峡炎感染鉴别诊断中的临床意义

Clinical Significance of Peripheral Blood NLR,PLR and LMR Level Analysis in Differential Diagnosis of Influenza Virus Infection and Herpangina in Children

目的探讨外周血全血细胞分析中的三项指标在鉴别儿童流感病毒和疱疹性咽峡炎的临床意义。方法收集2019年11月1日~2020年1月31日商洛市中心医院就诊的有上呼吸道感染症状患儿189例,采用胶体金法检测甲乙流感病毒抗原,采集患儿初诊时外周血进行全血细胞分析。研究组纳入甲型流感85例,乙型流感43例。对照组纳入甲乙流感病毒阴性的疱疹性咽峡炎患儿61例。分别比较三组之间中性粒细胞和淋巴细胞计数比值(NLR)、血小板和淋巴细胞计数比值(PLR)、淋巴细胞和单核细胞计数比值(LMR)水平,并对结果进行统计学分析。结果流感组与对照组的三项感染指标水平比较,差异均有统计学意义(F=11.51,13.00和29.37,均P<0.05)。进一步对甲流组和乙流组进行比较,两组之间的NLR,PLR和LMR水平差异有统计学意义(均P<0.05)。三项感染指标的ROC曲线下面积(area under the curve,AUC)分别为0.723,0.837和0.725,当NLR截点为3.77时,灵敏度和特异度分别为60%和73%;PLR截点为147.83时,灵敏度和特异度分别为71.1%和80%;LMR截点为2.57时,灵敏度和特异度分别为71.8%和65%。结论在甲乙型流感病毒感染与疱疹性咽峡炎的辅助鉴别诊断中PLR优于NLR和LMR两项指标。

Objective To investigate the clinical significance of three indicators in peripheral blood pancytophase analysis in the identification of influenza virus and herpetic pharyngitis in children.Methods 189 infected children with symptoms of upper respiratory tract infection admitted to the Central Hospital of Shangluo City from November 1,2019 to January 31,2020 were collected.Colloidal gold method was used to detect influenza A and B virus antigens,and peripheral blood was collected for whole blood cell analysis at the time of initial diagnosis.The study group included 85 cases of influenza A and 43 cases of influenza B.The control group included 61 children with herpetic pharyngitis but influenza virus A and B test-negative.Among the three groups,the neutrophil to lymphocyte count ratio(NLR),platelet to lymphocyte count ratio(PLR)and lymphocyte to monocyte count ratio(LMR)were compared,and the results were statistically analyzed.Results The levels of three infection indicators in the influenza group and the control group were all significantly different(F=11.51,13.00 and 29.37,all P<0.05).Further comparison was made between the A and B groups,and the levels of NLR,PLR and LMR between the two groups were statistically significant(all P<0.05).The area under curve(AUC)of the ROC about three inflammatory indicators were 0.723,0.837and 0.725,respectively.When the NLR cut-off point was 3.77,the sensitivity and specificity were 60%and 73%,respectively.When the PLR cut-off point was 147.83,the sensitivity and specificity were 71.1%and 80%,respectively,and when the LMR cut-off point was 2.57,the sensitivity and specificity were 71.8%and 65%.Conclusion PLR is superior to NLR and LMR in the auxiliary differential diagnosis of influenza A/B virus infection and herpetic pharyngitis.