NLR、MLR及RDW在儿童传染性单核细胞增多症中的诊断价值及相关性分析

Diagnostic Value and Correlation Analysis of NLR,MLR and RDW in Children with Infectious Mononucleosis

目的探讨中性粒细胞绝对值/淋巴细胞绝对值比值(neutrophil/lymphocyte ratio,NLR)、单核细胞绝对值/淋巴细胞绝对值比值(monocyte/lymphocyte ratio,MLR)及红细胞分布宽度(red cell distribution width,RDW)在儿童传染性单核细胞增多症中的相关性及诊断价值。方法选取2018年9月~2022年2月就诊于遵义医科大学附属医院儿科161例初治IM患儿作为观察组,同期健康体检90例儿童作为对照组,采用秩和检验比较两组间首次血常规NLR、MLR及RDW,采用Spearman秩相关分析各指标的相关性,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析在IM患儿的诊断价值。结果观察组NLR、MLR水平明显低于对照组(z分别为-10.442、-5.251,P<0.05),RDW水平高于对照组(z=-4.938,P<0.05);应用ROC曲线分析,NLR、MLR及RDW曲线下面积(AUC)分别为0.898(0.853~0.932)、0.700(0.639~0.756)、0.688(0.626~0.745),差异均有统计学意义(P<0.05);NLR、MLR及RDW诊断敏感度分别为83.23%、49.69%、63.98%;诊断特异性分别为91.11%、95.56%、67.78%;NLR越低,ALT、AST、GGT表达越高(r分别为-0.237、-0.261、-0.181,P<0.05),MLR越低,AST及GGT表达越高(r分别为-0.157、-0.186,P<0.05),与ALT无相关性(r=-0.137,P>0.05),RDW与ALT、AST表达呈正相关(r分别为0.178、0.219,P<0.05),与GGT无相关性(r=0.134,P>0.05)。结论NLR、MLR及RDW可能作为辅助诊断IM及反映肝损伤严重程度的新血清学标志物。

Objective To investigate the correlation and predictive diagnostic value of absolute neutrophil/lymphocyte ratio(NLR),absolute monocyte/lymphocyte ratio(MLR)and red blood cell distribution width(RDW),in children with infectious mononucleosis.Methods 161 patients with primary IM attending the pediatric department of the Affiliated Hospital of Zunyi Medical University from September 2018 to February 2022 were selected as the observation group and 90 children with healthy physical examination during the same period were selected as the control group.The rank sum test was used to compare the first blood routine NLR,MLR and RDW between the two groups.Spearman rank correlation was used to analyze the correlation of various indicators.The receiver operating characteristic curve(ROC)was applied to analyze the diagnostic value of IM children.Results The levels of NLR and MLR in the observation group were significantly lower than those in the control group(z values were-10.442,-5.251,P<0.05),and the level of RDW was higher than those in the control group(z=-4.938,P<0.05);using ROC curve analysis,the area under curves(AUC)for NLR,MLR and RDW were 0.898(0.853-0.932),0.700(0.639-0.756)and 0.688(0.626-0.745),respectively;the differences between the two groups were statistically significant(P<0.05).The diagnostic sensitivity of NLR,MLR and RDW were 83.23%,49.69%and 63.98%,respectively;the diagnostic specificity of NLR,MLR and RDW were 91.11%,95.56%and 67.78%,respectively.The lower the NLR,the higher the expression of alt,AST and GGT(r values were-0.237,-0.261,-0.181,P<0.05).The lower the MLR,the higher the expression of AST and GGT(r values were-0.157,-0.186,P<0.05);no significant associations with ALT were observed(r=-0.137,P>0.05).RDW was positively correlated with the expression of ALT and AST(r values were 0.178,0.219,P<0.05);no significant associations with GGT were observed(r=0.134,P>0.05).Conclusion NLR,MLR and RDW can be used as auxiliary diagnostics for IM and new serological markers reflecting the severity of liver injury.