白细胞衍生性指标在儿童肺炎严重程度及预后评估中的应用观察

Application of leukocyte-derived indicators in the evaluation of severity and prognosis of pneumonia in children

目的 分析白细胞衍生性指标在儿童肺炎严重程度及预后评估中的应用价值。方法 选取2022年1月至2023年1月本院收治的60例肺炎患儿,根据肺炎严重指数(PSI)评分将其分为低危组(25例)、中危组(21例)和高危组(14例)。采集患儿静脉血,检测3组患儿外周血乳酸脱氢酶(LDH)、降钙素原(PCT)、白细胞介素-6(IL-6)水平、C-反应蛋白(CRP)及血常规,计算中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)。采用Pearson相关系数分析上述指标与临床肺部感染评分(CPIS)之间的相关性。于出院时评估患儿预后效果,并根据评估结果将患儿分为预后良好组(47例)和预后不良组(13例),比较2组上述指标差异;采用多因素回归分析上述指标与儿童肺炎严重程度相关性;并应用受试者工作特征(ROC)曲线分析LDH、IL-6、CRP、NLR、PLR在儿童肺炎预后评估中的价值。结果 中、高危组LDH、PCT、IL-6、CRP、NLR、PLR、MLR及CPIS评分均高于低危组(P<0.05),高危组LDH、PCT、IL-6、CRP、NLR、PLR、MLR及CPIS评分均高于中危组(P<0.05);肺炎患儿血清LDH、PCT、IL-6、CRP、NLR、PLR、MLR水平与CPIS评分均呈正相关(r=0.625、0.429、0.358、0.413、0.676、0.465、0.645,P<0.05);预后良好组LDH、PCT、IL-6、CRP、NLR、PLR、MLR水平均低于预后不良组(P<0.01);多因素回归分析显示,LDH、IL-6、CRP、NLR以及PLR水平升高是影响儿童肺炎预后的独立危险因素(P<0.05);LDH、IL-6、CRP、NLR、PLR及联合检测在预测肺炎患儿预后方面效能较高,其中LDH预测效能最高。结论 LDH、PCT、IL-6、CRP、NLR、PLR、MLR水平与肺炎患儿病情严重程度呈正相关,LDH、IL-6、CRP、NLR、PLR水平升高是影响肺炎患儿预后的独立危险因素,应早期监测上述指标,以改善患儿预后。

Objective To analyze the application value of leukocyte-derived indicators in evaluating the severity and prognosis of pneumonia in children.Methods Sixty children with pneumonia admitted to our hospital were selected from January 2022 to January 2023 and were divided into low-risk group(n=25),moderate-risk group(n=21)and high-risk group(n=14)according to the pneumonia severity index(PSI)score.Venous blood of children was collected,and the levels of peripheral blood lactate dehydrogenase(LDH),procalcitonin(PCT),interleukin-6(IL-6),C-reactive protein(CRP)and blood routine were detected among the three groups.The neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and lymphocyte-to-monocyte ratio(LMR)were calculated.Pearson correlation coefficient was used to analyze the correlation between the above indicators and clinical pulmonary infection score(CPIS).The prognosis effect of children was evaluated at discharge,and the children were classified into good prognosis group(n=47)and poor prognosis group(n=13)by means of the evaluation results,and the differences in the above indicators were compared.Multivariate regression analysis was used to analyze the correlation between the above indicators and the severity of pneumonia in children.Receiver operating characteristic(ROC)curve was applied to analyze the value of LDH,IL-6,CRP,NLR and PLR in prognosis evaluation of pneumonia in children.Results The levels of LDH,PCT,IL-6,CRP,NLR,PLR and MLR and score of CPIS in moderate-risk group and high-risk group were higher than those in low-risk group,and the above levels and score were higher in high-risk group than those in moderate-risk group(P<0.05).Serum levels of LDH,PCT,IL-6,CRP,NLR,PLR,and MLR in children with pneumonia were positively correlated with CPIS score(r=0.625,0.429,0.358,0.413,0.676,0.465,0.645,P<0.05).The levels of LDH,PCT,IL-6,CRP,NLR,PLR,and MLR were lower in good prognosis group than those in poor prognosis group(P<0.01).Multivariate regression analysis showed that increased levels of LDH,IL-6,CRP,NLR and PLR were independent risk factors for the prognosis of children with pneumonia(P<0.05).LDH,IL-6,CRP,NLR,PLR and combined detection had high efficiency in predicting the prognosis of children with pneumonia,and LDH had the highest predictive efficiency.Conclusion The levels of LDH,PCT,IL-6,CRP,NLR,PLR and MLR are positively correlated with severity of pneumonia in children.The increased levels of LDH,IL-6,CRP,NLR and PLR are independent risk factors affecting the prognosis of children with pneumonia.It is necessary to perform early monitoring of the above indicators so as to improve the prognosis of children.