外周血NLR、PLR和MPVLR水平对儿童难治性肺炎支原体肺炎的预测价值

Predictive values of neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio and mean platelet volume-to-lymphocyte ratio in children with refractory Mycoplasmal pneumoniae pneumonia

目的分析外周血中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)和平均血小板体积/淋巴细胞比值(MPVLR)水平对儿童难治性肺炎支原体肺炎(RMPP)的预测价值。方法本研究为病例对照研究,采用非随机抽样的方法选取西安市儿童医院2022年8月至2023年8月收治的359例肺炎支原体肺炎(MPP)患儿为研究对象。根据临床表现不同将患儿分为RMPP组(103例)和普通MPP组(256例)。收集并比较2组患儿的临床资料,包括性别、年龄、身体质量指数、热程、临床表现(有无气促、胸痛、呼吸困难、低氧血症)、病变是否累积双侧肺、有无合并肺不张,以及入院后首次检测的实验室指标[白细胞计数、C反应蛋白(CRP)、降钙素原、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、丙氨酸转氨酶、NLR、PLR和MPVLR]。采用逐步法行多因素logistic回归分析儿童RMPP发生的影响因素。绘制受试者操作特征曲线分析NLR、PLR、MPVLR对儿童RMPP的预测价值。结果普通MPP组男152例,女104例,年龄(4.21±1.02)岁;RMPP组男58例,女45例,年龄(6.63±1.86)岁。RMPP组患儿年龄、热程、白细胞计数、CRP、IgA、IgM、NLR、PLR、MPVLR均高于普通MPP组,差异均有统计学意义(均P<0.001)。2组患儿性别、身体质量指数、有气促、胸痛、呼吸困难、低氧血症者占比、病变累积双侧肺者占比、合并肺不张者占比、降钙素原、丙氨酸转氨酶比较,差异均无统计学意义(均P>0.05)。多因素logistic回归分析结果显示,年龄增长(OR=1.492,95%CI:1.051~2.118)、热程延长(OR=1.634,95%CI:1.182~2.259)、白细胞计数升高(OR=2.051,95%CI:1.197~3.514)、CRP升高(OR=2.607,95%CI:1.544~4.402)、IgA升高(OR=1.813,95%CI:1.203~2.732)、IgM升高(OR=1.962,95%CI:1.294~2.975)、NLR升高(OR=2.275,95%CI:1.441~3.592)、PLR升高(OR=2.357,95%CI:1.506~3.689)、MPVLR升高(OR=2.831,95%CI:1.672~4.793)是儿童RMPP发生的独立危险因素(均P<0.05)。受试者操作特征曲线分析显示NLR、PLR、MPVLR预测儿童RMPP的曲线下面积分别为0.866(95%CI:0.815~0.916)、0.932(95%CI:0.900~0.963)、0.938(95%CI:0.902~0.975)。结论NLR、PLR、MPVLR对儿童RMPP均具有一定预测价值。

ObjectiveTo analyze the predictive values of peripheral blood neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and mean platelet volume-to-lymphocyte ratio(MPVLR)in children with refractory Mycoplasmal pneumoniae pneumonia(RMPP).MethodsThis was a case-control study involving 359 children with Mycoplasmal pneumoniae pneumonia(MPP)admitted to Xi′an Children′s Hospital from August 2022 to August 2023 selected by non-random sampling method.The children were divided into RMPP group(103 cases)and common MPP group(256 cases)according to the presence of RMPP or not.Clinical data were collected and compared between groups,including gender,age,body mass index,course of fever,clinical manifestations(shortness of breath,chest pain,dyspnea,hypoxemia),involvement on both lungs,atractasis,and laboratory indicators on admission(white blood cell count[WBC],C-reactive protein[CRP],procalcitonin,immunoglobulin A[IgA],immunoglobulin M[IgM],alanine transaminase,NLR,PLR,and MPVLR).Stepwise multivariate logistic regression was used to analyze the influencing factors of RMPP in children.Receiver operator characteristic(ROC)curve was drawn to analyze the predictive values of NLR,PLR and MPVLR for RMPP in children.ResultsThere were 152 males and 104 females in the common MPP group,with a mean age of 4.21±1.02 years.There were 58 males and 45 females in the RMPP group,with a mean age of 6.63±1.86 years.The age,course of fever,WBC,CRP,IgA,IgM,NLR,PLR,and MPVLR in the RMPP group were significantly higher than those of the common MPP group(all P<0.001).There were no significant differences in gender,body mass index,proportion of patients with shortness of breath,chest pain,dyspnea,hypoxemia,involvement on both lungs,atractasis,procalcitonin and alanine transaminase between groups(all P>0.05).Multivariate logistic regression analysis showed that advanced age(OR=1.492,95%CI:1.051-2.118),prolonged course of fever(OR=1.634,95%CI:1.182-2.259),higher WBC(OR=2.051,95%CI:1.197-3.514),higher CRP(OR=2.607,95%CI:1.544-4.402),higher IgA(OR=1.813,95%CI:1.203-2.732),higher IgM(OR=1.962,95%CI:1.294-2.975),higher NLR(OR=2.275,95%CI:1.441-3.592),higher PLR(OR=2.357,95%CI:1.506-3.689),and higher MPVLR(OR=2.831,95%CI:1.672-4.793)were independent risk factors for RMPP in children(all P<0.05).ROC curve analysis showed that the area under the curve of NLR,PLR,and MPVLR for predicting RMPP in children was 0.866(95%CI:0.815-0.916),0.932(95%CI:0.900-0.963),and 0.938(95%CI:0.902-0.975),respectively.ConclusionNLR,PLR and MPVLR all have predictive value for pediatric RMPP.