儿童传染性单核细胞增多症热程延长预测指标的探究

Predictive indicators of a prolonged course of fever in children with infectious mononucleosis

目的探究传染性单核细胞增多症(IM)患儿热程>7 d的相关预测指标。方法回顾性分析西安市儿童医院2018年1月至2020年10月收治的IM患儿163例的临床资料。根据热程将患儿分为热程>7 d组(55例)及热程≤7 d组(108例)。分析两组患儿入院时临床表现及实验室指标是否存在差异,通过logistic回归模型分析患儿热程延长的影响因素,采用受试者工作曲线(ROC曲线)评估指标对于热程>7 d的预测价值。结果IM患儿病程中多数热程为7 d(21.5%),热程>7 d组与热程≤7 d组IM患儿的临床表现差异均无统计学意义(均P>0.05)。热程>7 d组IM患儿血常规中白细胞计数[(15.97±7.60)×10^(9)/L]、单核细胞比例[7.75(4.93,10.75)%]、天门冬氨酸氨基转移酶(AST)[53.00(22.00,91.50)U/L]、抑制性T细胞(Ts细胞)比例[70.00(57.00,75.00)%]均高于热程≤7 d组[(15.21±5.29)×10^(9)/L、5.40(3.40,9.60)%、40.00(30.00,63.75)U/L、63.50(55.00,70.75)%](t=-5.10、Z=-2.31、-2.26、-2.12,均P<0.05)。热程>7 d组IM患儿辅助性T细胞(Th细胞)比例[13.00(9.00,17.00)%]、Th/Ts细胞比值[0.19(0.12,0.30)%]均低于热程≤7 d组[16.00(12.25,20.75)%、0.26(0.18,0.37)%](Z=2.44、2.48,均P<0.05)。多因素logistic回归分析表明Ts细胞比例升高(OR=0.96,95%CI 0.922~0.978,P<0.05)是IM患儿热程延长的影响因素。绘制ROC曲线显示,Ts细胞比例的曲线下面积(AUC)为0.637,临界值为67.5%,敏感度为61.3%,特异度为64.3%。结论热程较长的IM患儿机体发生了更严重的免疫反应。Ts细胞比例>67.5%可作为预测IM患儿热程>7 d的危险因素。

Objective To explore the relevant predictive indicators of fever course>7 days in children with infectious mononucleosis.Methods The clinical data of 163 children with infectious mononucleosis who received treatment in Xi'an Children's Hospital from January 2018 to October 2020 were retrospectively analyzed.According to the heat duration,the children were divided into the fever course>7 days group(n=55)and the fever course≤7 days group(n=108).The clinical manifestations and laboratory indexes on admission were compared between the two groups.A logistic regression model was used to analyze the influential factors of fever course in children.A receiver operating curve was used to evaluate the predictive value of heat course>7 days for infectious mononucleosis.Results The majority of children with infectious mononucleosis had a heat course of 7 days(21.5%).There were no significant differences in clinical manifestations between the fever course>7 days group and the fever course≤7 days group(all P>0.05).Neutrophil count,the proportion of monocytes,aspartate aminotransferase,and the proportion of suppressor T(Ts)cells in the fever course>7 days group were(15.97±7.60)×10^(9)/L,7.75(4.93,10.75)%,53.00(22.00,91.50)U/L,70.00(57.00,75.00)%,respectively,which were significantly higher than(15.21±5.29)×10^(9)/L,5.40(3.40,9.60)%,40.00(30.00,63.75)U/L,63.50(55.00,70.75)%in the fever course≤7 days group(t=-5.10,Z=-2.31,Z=-2.26,Z=-2.12,all P<0.05).The proportion of helper T(Th)cells and the ratio of Th/Ts cells in the fever course>7 days group were 13.00(9.00,17.00)%and 0.19(0.12,0.30)%,respectively,which were significantly lower than 16.00(12.25,20.75)%,0.26(0.18,0.37)%in the fever course≤7 days group(Z=2.44,2.48,both P<0.05).Multivariate logistic regression analysis showed that the increased proportion of Ts cells(OR=0.96,95%CI 0.922-0.978,P<0.05)was an influential factor of the prolonged course of fever.The area under the receiver operating characteristic curve of the proportion of Ts cells was 0.637.The cut-off value,sensitivity,and specificity were 67.50%,61.3%,and 64.3%,respectively.Conclusion Children with infectious mononucleosis with a longer heat course have more severe immune responses.The proportion of Ts cells>67.5%can be used as a risk factor for the fever course>7 days in children with infectious mononucleosis.