外周血淋巴细胞指标在儿童难治性支原体肺炎中的诊断价值

Diagnostic value of peripheral blood lymphocyte markers in children with refractory mycoplasma pneumonia

目的探讨外周血淋巴细胞指标在儿童难治性肺炎支原体肺炎(RMPP)中的诊断价值。方法选取2021年1月—2022年1月在湖州师范学院附属第一医院住院并确诊为RMPP的患儿30例为观察组,另选取同期在该院就诊的普通型肺炎支原体肺炎(GMPP)患儿40例为对照组,所有患儿入院后均进行外周血淋巴细胞指标检测。比较两组患儿临床特征和外周血淋巴细胞指标,并绘制受试者工作特征(ROC)曲线,分析特异性外周血淋巴细胞指标对儿童难治性支原体肺炎的诊断价值。结果观察组患儿肺实变发生率[83.33%(25/30)]、胸腔积液发生率[86.67%(26/30)]及住院时间长[(13.68±3.22)d]均高于对照组[2.50%(1/40)、2.50%(1/40)、(8.45±2.36)d],差异均有统计学意义(χ^(2)=47.997、51.254,t=7.847,均P<0.05)。两组患儿外周血CD3^(+)百分比、CD4^(+)百分比、CD8^(+)百分比、CD19^(+)百分比及CD56^(+)百分比比较,差异均无统计学意义(均P>0.05)。观察组患儿外周血CD3^(+)绝对计数[(1548.40±158.04)个/μl]、CD4^(+)绝对计数[(605.83±73.45)个/μl]及CD19^(+)绝对计数[(456.33±40.26)个/μl]均低于对照组[(1826.50±205.30)个/μl、(736.56±81.47)个/μl及(403.94±32.94)个/μl],观察组CD56^(+)绝对计数[(582.43±51.26)个/μl]高于对照组[(513.85±48.81)个/μl],差异均有统计学意义(t=6.170、6.926、5.813及5.694,均P<0.05)。绘制ROC曲线,结果显示,CD3^(+)、CD4^(+)、CD19^(+)及CD56^(+)绝对计数预测RMPP的曲线下面积(AUC)均≥0.7,均具有一定的预测价值,其中联合预测的AUC值最高。结论外周血CD3^(+)、CD4^(+)、CD19^(+)及CD56^(+)绝对计数对RMPP均具有一定的预测价值,联合检测可作为预测RMPP发生的良好指标。

Objective To explore the diagnostic value of peripheral blood lymphocyte index in children with refractory mycoplasma pneumoniae pneumonia(RMPP).Methods From January 2021 to January 2022,30 children hospitalized in the First Affiliated Hospital of Huzhou University and diagnosed as RMPP were selected as the observation group,and 40 children with common mycoplasma pneumoniae pneumonia(GMPP)in the same period were selected as the control group.All children were tested for peripheral blood lymphatic cell indexes after admission.The clinical characteristics and peripheral blood lymphocyte indexes of the two groups of children were compared,and the ROC curve was drawn to analyze the diagnostic value of specific peripheral blood lymphocyte indexes in children with refractory mycoplasma pneumonia.Results The incidence of lung consolidation,pleural effusion and long hospital stay in the observation group were 83.33%(25/30),86.67%(26/30)and(13.68±3.22)days,which were significantly higher than those in the control group[2.50%(1/40),2.50%(1/40)and(8.45±2.36)days],the difference wwere statistically significant(x=47.997,51.254,t=7.847,all P<0.05).The percentage of peripheral blood lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD19^(+),CD56^(+))in the two groups were not significantly diferent(all P>0.05).Peripheral blood CD3^(+)in the observation group(1548.40±158.04)/μl,CD4^(+)(605.83±73.45)/μl,CD19^(+)(456.33±40.26)/μl,The absolute count was lower than the control group's peripheral blood CD3^(+)(1826.50±205.30)/μl,CD4^(+)(736.56±81.47)/μl,CD19^(+)(403.94±32.94)/μl,the absolute count of CD56^(+)(582.43±51.26)/μl in the observation group was significantly higher than that in the control group(513.85±48.81)/μl,the difference wwere statistically significant(t=6.170,6.926,5.813,5.694,all P<0.05).The ROC curve was drawn,and the results showed that the area under the curve(AUC)of RMPP predicted by CD3^(+),CD4^(+),CD19^(+),and CD56^(+)absolute counts was≥0.7,all of which had certain predictive value,and the AUC value of joint prediction was the highest.Conclusion The absolute count of peripheral blood lymphocytes(CD3+,CD4^(+),CD19+,CD56^(+))has a certain predictive value for RMPP.The combined detection of the above indicators can be used as a good indicator to predict the occurrence of RMPP.