NLR、MLR与儿童传染性单核细胞增多症的相关性研究

Study on relationships of NLR and MLR with infectious mononucleosis in children

目的探讨中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)与传染性单核细胞增多症(IM)的相关性。方法选取2017年9月至2020年8月西北大学附属医院/西安市第三医院收治的150例初诊IM患儿(观察组)及同期来院健康体检的60例儿童(对照组)为研究对象,比较两组首次血常规检测结果中的NLR、MLR,采用Spearman相关分析各指标间的相关性,并绘制受试者工作特征(ROC)曲线分析各指标对IM的诊断价值。结果观察组的NLR水平低于对照组,MLR水平高于对照组,差异均有统计学意义(U值分别为-2.730、-2.926,P<0.01);应用ROC曲线分析,NLR和MLR的曲线下面积分别为0.62(0.54~0.69)和0.63(0.55~0.70),差异均有统计学意义(P<0.05);NLR诊断的敏感度为39%,特异度为87%;MLR诊断的敏感度为46%,特异度为81%;NLR和MLR越低,丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和谷氨酰转肽酶(GGT)的表达水平越高(NLR:r值分别为-0.453、-0.466、-0.492,MLR:r值分别为-0.326、-0.216、-0.379,P<0.01);患儿年龄与ALT和GGT的表达水平呈正相关关系(r值分别为0.279、0.396,P<0.01)。结论 NLR和MLR检测可作为辅助诊断IM的血清学标志物,IM患儿NLR和MLR越低、年龄越大,肝脏损伤越重。

Objective To investigate relationships of neutrophil to lymphocyte ratio(NLR) and monocyte to lymphocyte ratio(MLR) with infectious mononucleosis(IM) in children.Methods A total of 150 patients who were diagnozed with IM and treated in Xi′an NO.3 Hospital/The Affiliated Hospital of Northwest University from September 2017 to August 2020 were selected as observation group, and 60 healthy children who received physical examination in the same period were selected as the control group.NLR and MLR in the first blood routine examination of the children were compared between the two groups.Spearman correlation was used to analyze correlations between the two indexes.And receiver operating characteristic(ROC) curve was drawn to analyze diagnostic values of the two indexs for IM.Results The serum level of NLR of the patients in the observation group was significantly lower than that in the control group, while the serum level of MLR of the patients in the observation group was significantly higher than that in the control group(U=-2.730 and-2.926 respectively, both P< 0.01).ROC curve analysis showed that the areas under the curve of NLR(95%CI) and MLR(95%CI) were 0.62(0.54-0.69) and 0.63(0.55-0.70) respectively, and the differences were statistically significant(both P<0.05).The sensitivity and specificity of NLR for diagnosis of IM were 39% and 87% respectively, and the sensitivity and specificity of MLR for diagnosis of IM were 46% and 81% respectively.The lower the NLR and MLR levels, the higher the expression levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST) and glutamyl transpeptidase(GGT)(for NLR: r=-0.453,-0.466 and-0.492 respectively, all P<0.01;for MLR:r=-0.326,-0.216 and-0.379 respectively, all P<0.01).Age was positively correlated with the expression levels of ALT and GGT(r=0.279 and 0.396 respectively, both P<0.01).Conclusion NLR and MLR could be used as serological markers for the diagnosis of IM.The lower the NLR and MLR levels and the older the children with IM,the more severe the liver damage of them.