CRP/PA联合nCD64指数评估儿童支原体肺炎病情严重程度及预后的价值

Value of CRP/PA combined with nCD64 index in assessing the severity and prognosis of mycoplasma pneumonia in children

目的分析C反应蛋白与前白蛋白比值(CRP/PA)联合中性粒细胞CD64(nCD64)指数评估儿童支原体肺炎(MPP)病情严重程度及预后的价值。方法回顾性分析常州市妇幼保健院2023年3月至12月间收治的98例MPP患儿的临床资料,根据患者病情严重程度将其分为轻症患儿(60例)和重症患儿(38例)。患儿均行常规治疗,7d后根据预后结局将其分为预后良好组(72例)与预后不良组(26例)。比较不同病情严重程度患儿的CRP/PA、nCD64指数,分析其与患儿病情严重程度的关系;比较不同预后结局患儿临床相关资料,分析患儿预后的影响因素;采用受试者工作特征(ROC)曲线下面积(AUC)分析CRP/PA、nCD64指数对患儿预后的预测价值。结果重症患儿CRP/PA[(1.05±0.21)vs(0.77±0.15)]、nCD64指数[(4.11±0.82)vs(2.96±0.59)]均高于轻症患儿(均P<0.05)。Pearson分析显示,CRP/PA、nCD64指数与临床肺部感染评分(CPIS)均呈正相关(r=0.587、0.574,均P<0.05)。单因素分析显示,预后不良组年龄[(4.81±0.96)岁vs(6.67±1.33)岁]小于预后良好组,病情严重程度为重症占比[65.38%(17/26)vs29.17%(21/72)]、合并并发症占比[46.15%(12/26)vs18.06%(13/72)]、CRP/PA[(1.23±0.25)vs(0.74±0.15)]、nCD64指数[(4.48±0.89)vs(3.02±0.61)]均高于预后良好组(均P<0.05)。二元logistic回归分析显示,病情严重程度(OR=4.251,95%CI:1.682~10.742)、CRP/PA(OR=3.857,95%CI:1.886~7.887)、nCD64指数(0OR=3.161,95%CI:1.382~7.228)是患儿预后的影响因素(均P<0.05)。ROC曲线显示,CRP/PA、nCD64指数及二者联合预测患儿预后的灵敏度分别为76.90%、73.10%、88.50%,特异度分别为73.60%、72.20%、90.30%,AUC分别为0.809、0.794、0.923(均P<0.001)。结论CRP/PA、nCD64指数与MPP患儿病情严重程度呈显著正相关,且是患儿预后的影响因素,临床通过联合检测CRP/PA、nCD64指数对患儿预后有较好的预测价值。

Objective To analyze the value of C-reactive protein to prealbumin ratio(CRP/PA)combined with neutrophil CD64(nCD64)index in evaluating the severity and prognosis of mycoplasma pneumonia(MPP)in children.Methods The clinical data of 98 children with MPP admitted to Changzhou Maternal and Child Health Hospital from March to December 2023 were retrospectively analyzed.According to the severity of the patients,they were divided into mild children(60 cases)and severe children(38 cases).After 7 days of routine treatment,the patients were divided into good prognosis group(72 cases)and poor prognosis group(26 cases).The CRP/PA and nCD64 indices of children with different severity of disease were compared,and the relationship between CRP/PA and severity of disease was analyzed.The clinical data of children with different prognosis outcomes were compared,and the influencing factors of prognosis were analyzed.The area under receiver operating characteristic(ROC)curve(AUC)was used to analyze the prognostic value of CRP/PA and nCD64 index.Results CRP/PA[(1.05±0.21)vs(0.77±0.15)]and nCD64 index[(4.11±0.82)vs(2.96±0.59)]in severe children were higher than those in mild children(all P<0.05).Pearson analysis showed that CRP/PA and nCD64 index were positively correlated with clinical pulmonary infection score(CPIS)(r=0.587,0.574,all P<0.05).Univariate analysis showed that the age of the poor prognosis group[(4.81±0.96)years vs(6.67±1.33)years]was smaller than that of the good prognosis group.The severity of the disease was severe[65.38%(17/26)vs 29.17%(21/72)],complicated complications[46.15%(12/26)vs 18.06%(13/72)],CRP/PA[(1.23±0.25)vs(0.74±0.15)]and nCD64 index[(4.48±0.89)vs(3.02±0.61)] were higher than those in good prognosis group(all P<0.05).Binary logistic regression analysis showed that the severity of disease(OR=4.251,95%CI:1.682-10.742),CRP/PA(OR=3.857,95%CI:1.886-7.887),nCD64 index(OR=3.161,95%Cl:1.382-7.228)were prognostic factors(all P<0.05).ROC curve showed that the sensitivity and specificity of CRP/PA,nCD64 index and their combination in predicting prognosis were 76.90%,73.10%and 88.50%,respectively,and 73.60%,72.20%and 90.30%,respectively.The AUC values were 0.809,0.794 and 0.923(all P<0.001).Conclusions CRP/PA and nCD64 index are significantly positively correlated with the severity of MPP in children,and they are the influencing factors for the prognosis of children.The combined detection of CRP/PA and nCD64 index has good predictive value for the prognosis of children.