中性粒细胞/淋巴细胞比值和热休克蛋白70与热性惊厥患儿早期脑损伤的关系

Relationships between neutrophil/lymphocyte ratio,heat shock protein 70 and early brain injury in children with febrile seizure

目的分析中性粒细胞/淋巴细胞比值(NLR)和热休克蛋白70(HSP70)与热性惊厥患儿早期脑损伤的关系。方法选取2020年5月—2021年5月丽水市中心医院和金华市中心医院收治的100例热性惊厥患儿,根据临床表现分为单纯型组(55例)和复杂型组(45例),另选取门诊收治的高热但无惊厥患儿50例为对照组。检测患儿中性粒细胞和淋巴细胞,计算NLR。采用酶联免疫吸附法检测HSP70水平。采用受试者工作特征(ROC)曲线分析NLR、HSP70鉴别单纯型热性惊厥和复杂型热性惊厥的价值。根据患儿是否并发早期脑损伤,将100例热性惊厥患儿分为早期脑损伤组(18例)和无早期脑损伤组(82例),采用logistic回归分析法分析热性惊厥患儿早期脑损伤的影响因素,采用ROC曲线分析NLR、HSP70预测热性惊厥患儿早期脑损伤的价值。结果单纯型组抽搐持续时间为(4.25±1.23)min,明显少于复杂型组的(12.35±3.52)min,差异有统计学意义(t=15.933,P<0.05)。对照组NLR、HSP70水平分别为(1.69±0.76)和(1.29±0.41)ng/ml,单纯型组NLR、HSP70水平分别为(2.69±0.83)和(1.46±0.45)ng/ml,复杂型组NLR、HSP70水平分别为(3.75±0.93)和(2.72±0.89)ng/ml,3组NLR、HSP70水平比较差异均有统计学意义(均P<0.05)。ROC曲线结果显示:NLR鉴别热性惊厥类型的ROC曲线下面积(AUC)、灵敏度及特异度分别为0.805、91.11%及63.64%;HSP70鉴别热性惊厥类型的AUC、灵敏度及特异度分别为0.904、82.22%和94.55%。早期脑损伤组抽搐持续时间为(12.63±3.66)min,明显多于无早期脑损伤组的(6.86±2.03)min,差异有统计学意义(P<0.05)。早期脑损伤组NLR、HSP70水平分别为(4.15±0.93)和(3.09±0.97)ng/ml,明显高于无早期脑损伤组的(2.95±0.91)和(1.79±0.75)ng/ml,差异均有统计学意义(均P<0.05)。logistic回归分析结果显示:热性惊厥患儿早期脑损伤的影响因素包括抽搐持续时间、NLR、HSP70(均P<0.05)。ROC曲线结果显示:NLR诊断热性惊厥患儿早期脑损伤的AUC、灵敏度及特异度分别为0.830、100.00%及53.66%;HSP70诊断热性惊厥患儿早期脑损伤的AUC、灵敏度及特异度分别为0.853、94.44%及71.95%。结论热性惊厥患儿NLR、HSP70水平异常升高,复杂型热性惊厥患儿NLR、HSP70水平高于单纯型热性惊厥患儿,早期脑损伤患儿NLR、HSP70水平更高,NLR、HSP70在鉴别热性惊厥类型和预测早期脑损伤方面具有较好的价值。

Objective To analyze the relationships between neutrophil/lymphocyte ratio(NLR),heat shock protein 70(HSP70)and early brain injury in children with febrile seizure.Methods A total of 100 children with febrile seizure admitted to Lishui Municipal Central Hospital and Jinhua Municipal Central Hospital from May 2020 to May 2021 were selected.According to their clinical manifestations,they were divided into simple type group(55 cases)and complex type group(45 cases).In addition,50 children with high fever but no seizure were selected as control group,neutrophils and lymphocytes were measured,NLR was calculated,HSP70 level was measured by enzymelinked immunosorbent assay,the value of NLR and HSP70 in distinguishment of simple febrile seizure and complex febrile seizure was analyzed by receiver operating characteristic(ROC)curve;according to whether the children were complicated with early brain injury,100 febrile seizure children were divided into early brain injury group(18 cases)and non-early brain injury group(82 cases).logistic regression analysis was used to analyze the factors affecting early brain injury in febrile seizure children,and ROC curve was used to analyze the value of NLR and HSP70 in prediction of early brain injury in febrile seizure children.Results The duration of seizure in simple type group was(4.25±1.23)minutes,which was significantly shorter than that in complex type group(12.35±3.52)minutes(t=15.933,P<0.05).The levels of NLR and HSP70 in control group were(1.69±0.76)and(1.29±0.41)ng/ml,respectively;the levels of NLR and HSP70 in simple type group were(2.69±0.83)and(1.46±0.45)ng/ml,respectively;the levels of NLR and HSP70 in complex type group were(3.75±0.93)and(2.72±0.89)ng/ml,respectively,the levels of NLR and HSP70 in the three groups were significantly different(all P<0.05).ROC curve showed that the area under ROC curve(AUC),sensitivity,and specificity of NLR in distinguishment of febrile seizure types were 0.805,91.11%,and 63.64%,respectively;AUC,sensitivity,and specificity of HSP70 in distinguishment of febrile seizure types were 0.904,82.22%,and 94.55%,respectively.The duration of seizure in early brain injury group was(12.63±3.66)minutes,which was significantly longer than that in non-early brain injury group(6.86±2.03)minutes(P<0.05).The levels of NLR and HSP70 in early brain injury group were(4.15±0.93)and(3.09±0.97)ng/ml,respectively,which were significantly higher than those in non-early brain injury group[(2.95±0.91)and(1.79±0.75)ng/ml](P<0.05).logistic regression analysis showed that the influencing factors of early brain injury in febrile seizure children included duration of seizure,NLR,and HSP70(P<0.05).ROC curve showed that AUC,sensitivity,and specificity of NLR in diagnosing early brain injury in febrile seizure children were 0.830,100.00%,and 53.66%,respectively;AUC,sensitivity,and specificity of HSP70 in diagnosing early brain injury in febrile seizure children were 0.853,94.44%,and 71.95%,respectively.Conclusion The levels of NLR and HSP70 in children with febrile seizure increase abnormally.The levels of NLR and HSP70 in children with complex febrile seizure are higher than those in children with simple febrile seizure,and the levels of NLR and HSP70 in children with early brain injury are higher.NLR and HSP70 have good value in identifying febrile seizure types and predicting early brain injury.