腺病毒肺炎患儿外周血单核细胞计数变化及其在病情评估中的价值

Changes in peripheral blood monocyte count in children with adenovirus pneumonia and its value in severity assessment

目的探讨腺病毒肺炎(adenovirus pneumonia,AP)患儿外周血单核细胞计数变化及其在病情评估中的价值。方法回顾分析139例AP患儿外周血白细胞分类计数情况,并与61例健康儿童进行比较。结果与对照组相比,AP患儿的单核细胞计数水平较高(P<0.001)。住院初期重症腺病毒肺炎(severe adenovirus pneumonia,SAP)组及普通腺病毒肺炎(general adenovirus pneumonia,GAP)组单核细胞计数均高于对照组(均P<0.05),但SAP组单核细胞计数低于GAP组(P<0.05)。住院后期GAP组单核细胞计数较前下降(P<0.05),而SAP组单核细胞计数下降不显著(P>0.05),SAP组单核细胞计数高于GAP组(P<0.05)。多因素Logistic回归分析结果显示住院初期较低的单核细胞计数是SAP的独立危险因素之一(P=0.004)。住院初期单核细胞计数用于预测SAP的受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)为0.742,最佳截断值为1.05×10^(9)/L,灵敏度为74.3%,特异度为63.5%。结论AP患儿外周血单核细胞计数可呈不同程度升高,SAP病例升高程度不及GAP病例,但下降较后者慢。外周血单核细胞计数可作为评估AP患儿病情进展风险的潜在指标之一。

Objective To explore the changes in peripheral blood monocyte count in children with adenovirus pneumonia(AP)and its value in severity assessment.Methods A retrospective analysis was conducted on the peripheral blood differential leucocyte count of 139 children with AP,and they were compared with 61 healthy children.Results Compared with the control group,the monocyte count in AP patients was higher(P<0.001).In the early stage of hospitalization,the monocyte counts in the severe adenovirus pneumonia(SAP)group and the general adenovirus pneumonia(GAP)group were both higher than that in the control group(both P<0.05),while the monocyte count in the SAP group was lower than that in the GAP group(P<0.05).In the later stage of hospitalization,the monocyte count in the GAP group decreased(P<0.05),while the monocyte count in the SAP group did not decrease significantly(P>0.05),and the monocyte count in the SAP group was higher than that in the GAP group(P<0.05).Multivariate logistic regression analysis showed that a lower monocyte count in the early stage of hospitalization was one of the independent risk factors for SAP(P=0.004).The area under the receiver operating characteristic(ROC)curve(AUC)of monocyte count in the early stage of hospitalization used for the prediction of SAP was 0.742,with an optimal cutoff value of 1.05×10^(9)/L,a sensitivity of 74.3%and a specificity of 63.5%.Conclusions Children with AP may have a varying degree of increase in peripheral blood monocyte count.Compared with children with GAP,children with SAP showed a lower degree of increase in monocyte count,but a slower decrease.Peripheral blood monocyte count can serve as one of the potential indicators for assessing the risk of the progression of AP in children.