儿童大叶性肺炎早期血清炎症因子诊断的价值分析

Analysis of the value of detection of serum inflammatory factors in the early diagnosis of lobar pneumonia in children

目的探讨外周血清炎症因子检测对儿童大叶性肺炎早期的诊断价值。方法选取156例大叶性肺炎早期患儿作为观察组,选取同期173例支气管肺炎患儿作为对照组。比较两组细菌感染与非细菌感染患儿的一般资料(性别、年龄)及病程5 d内的血常规[白细胞计数(WBC)、中性粒细胞计数(NEU)、NEU百分比、淋巴细胞计数(LYM)、LYM百分比、单核细胞计数(MONO)、血小板计数(PLT)、红细胞计数(RBC)、血红蛋白(Hb)、C反应蛋白(CRP)、中性粒细胞/淋巴细胞计数比值(NLR)、淋巴细胞/单核细胞计数比值(LMR)、血小板/淋巴细胞计数比值(PLR)]检查结果。将有显著统计学差异的指标运用Logistic回归模型进行多因素分析,并通过绘制受试者工作特征曲线(ROC曲线)计算曲线下面积,评价NLR、CRP检测对大叶性肺炎早期诊断的临床价值。结果两组细菌感染患儿的性别、WBC、MONO、PLT、RBC、Hb、LMR、PLR比较,差异无统计学意义(P>0.05)。观察组细菌感染患儿的年龄3.00(2.33,4.75)岁、NEU 10.67(7.26,17.67)×10^(9)/L、NEU百分比72.64(65.43,82.83)%、CRP 78.07(47.44,133.85)mg/L、NLR 4.30(2.89,7.69)均高于对照组的2.38(1.44,3.00)岁、10.04(5.60,11.73)×10^(9)/L、66.10(52.24,74.53)%、48.47(20.45,71.57)mg/L、2.87(1.51,4.69),LYM 2.46(1.42,3.42)×10^(9)/L、LYM百分比17.33(10.67,22.79)%均低于对照组的2.95(2.13,4.42)×10^(9)/L、23.27(14.99,34.22)%,差异有统计学意义(P<0.05)。两组非细菌感染患儿性别、WBC、MONO、PLT、RBC、Hb、LMR比较,差异无统计学意义(P>0.05)。观察组非细菌感染患儿的年龄4.00(2.52,7.00)岁、NEU 4.46(3.72,6.58)×10^(9)/L、NEU百分比61.90(53.63,70.01)%、PLR 116.91(81.92,151.52)、NLR 2.46(1.61,3.66)均高于对照组的2.75(1.67,4.00)岁、4.01(2.92,5.39)×10^(9)/L、53.44(45.40,64.90)%、101.33(68.17,143.68)、1.72(1.13,2.86),LYM 2.00(1.53,2.92)×10^(9)/L、LYM百分比25.20(19.23,33.25)%、CRP 3.83(10.94,21.55)mg/L均低于对照组的2.37(1.74,3.26)×10^(9)/L、31.90(22.94,40.75)%、5.78(2.24,13.75)mg/L,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:CRP是细菌感染、非细菌感染大叶性肺炎发生的危险因素(OR=1.032、1.018,P<0.05)。细菌感染患儿中CRP的ROC曲线下面积为0.702,敏感度为68.75%,特异度为60.94%;非细菌感染患儿中CRP的ROC曲线下面积为0.602,敏感度为67.03%,特异度为51.38%。结论外周血清炎症因子检测在儿童大叶性肺炎早期诊断与支气管肺炎鉴别诊断中有一定的临床应用价值。

Objective To discuss the value of detection of serum inflammatory factors in the early diagnosis of lobar pneumonia in children.Methods A total of 156 children with lobar pneumonia in the early stage were selected as the observation group,and 173 children with bronchopneumonia during the same period were selected as the control group.Comparison was made on the general information(gender,age)and results of routine blood test[white blood cell count(WBC),neutrophil count(NEU),NEU percentage,lymphocyte count(LYM),LYM percentage,monocyte count(MONO),platelet count(PLT),red blood cell count(RBC),hemoglobin(Hb),C-reactive protein(CRP),neutrophil-lymphocyte ratio(NLR),lymphocyte-monocyte ratio(LMR),platelet-lymphocyte ratio(PLR)]within 5 d of disease course between two groups of patients with bacterial infection and non-bacterial infection.Logistic regression model was used for multivariate analysis of indicators with significant statistical differences,and the area under the curve was calculated by drawing receiver operating characteristic curve(ROC curve)to evaluate the clinical value of detection of NLR and CRP in the early diagnosis of lobed pneumonia.Results There was no statistically significant difference in terms of gender,WBC,MONO,PLT,RBC,Hb,LMR,PLR between the two groups of patients with bacterial infection(P>0.05).In the observation group,patients with bacterial infection had age of 3.00(2.33,4.75)years old,NEU of 10.67(7.26,17.67)×10^(9)/L,NEU percentage of 72.64(65.43,82.83)%,CRP of 78.07(47.44,133.85)mg/L,NLR of 4.30(2.89,7.69),which were higher than those of 2.38(1.44,3.00)years old,10.04(5.60,11.73)×10^(9)/L,66.10(52.24,74.53)%,48.47(20.45,71.57)mg/L,2.87(1.51,4.69)of patients with bacterial infection in the control group;LYM of 2.46(1.42,3.42)×10^(9)/L and LYM percentage of 17.33(10.67,22.79)%of patients with bacterial infection in the observation group were lower than those of 2.95(2.13,4.42)×10^(9)/L and 23.27(14.99,34.22)%in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in gender,WBC,MONO,PLT,RBC,Hb,LMR between the two groups of patients with non-bacterial infection(P>0.05).In the observation group,patients with non-bacterial infection had age of 4.00(2.52,7.00)years old,NEU of 4.46(3.72,6.58)×10^(9)/L,NEU percentage of 61.90(53.63,70.01)%,PLR of 116.91(81.92,151.52),NLR of 2.46(1.61,3.66),which were higher than those of 2.75(1.67,4.00)years old,4.01(2.92,5.39)×10^(9)/L,53.44(45.40,64.90)%,101.33(68.17,143.68),1.72(1.13,2.86)of patients with non-bacterial infection in the control group;LYM of 2.00(1.53,2.92)×10^(9)/L,LYM percentage of 25.20(19.23,33.25)%and CRP of 3.83(10.94,21.55)mg/L of non-bacterial infection patients in the observation group were lower than those of 2.37(1.74,3.26)×10^(9)/L,31.90(22.94,40.75)%,5.78(2.24,13.75)mg/L of non-bacterial infection patients in the control group;the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that CRP was a risk factor for bacterial infection and non-bacterial lobular pneumonia(OR=1.032,1.018;P<0.05).The area under ROC curve of CRP in patients with bacterial infection was 0.702,the sensitivity was 68.75%,and the specificity was 60.94%.The area under ROC curve of CRP in patients with non-bacterial infection was 0.602,the sensitivity was 67.03%,and the specificity was 51.38%.Conclusion Detection of NLR and CRP of peripheral blood has certain clinical application value in the early diagnosis of lobar pneumonia in children.