目的 探讨白细胞计数(white blood cells,WBC)、C反应蛋白(C-reactive protein,CRP)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、降钙素原(procalcitonin,PCT)、白介素 6(interleukin-6,IL-6)、血沉(erythrocyte sedimentation rate,ESR)、乳酸脱氢酶(lactate dehydrogenase,LDH)以及外周血涂片手工分类计数等指标在儿科早期肺炎支原体肺炎(mycoplasma pneumoniae,MPP)和细菌性肺炎中的诊断价值.方法 回顾性选取2022年1月至2023年6月首都医科大学附属北京友谊医院通州院区儿科收治的患儿210例为研究对象,其中MPP组患儿85例,细菌性肺炎组患儿125例.比较两组患儿基线资料、血清学指标及外周血手工分类结果,通过Logistic回归模型筛选与患儿MPP鉴别相关的影响因素,并采用ROC曲线分析相关因素在MPP鉴别诊断中的价值.结果 细菌性肺炎组在WBC、CRP、PCT、IL-6、NLR、外周血杆状核粒细胞百分比水平显著高于MPP组,而LDH在细菌性肺炎组中明显低于MPP组(均P＜0.05),对有显著性差异的相关指标代入Logistic回归模型分析显示,患儿LDH水平的升高是肺炎支原体肺炎的危险因素(OR=1.005,95％CI 1.000～1.010),与MPP感染呈正相关,而CRP、外周血杆状核粒细胞百分比水平的增高与MPP的感染呈负相关.LDH、CRP、杆状核粒细胞百分比诊断MPP的ROC曲线下面积(area under the curve,AUC)分别为0.757、0.796和0.883,其诊断灵敏度分别为78.6％、75.8％、81.5％,特异性分别为75.8％、85.7％、86.9％.以中性杆状核粒细胞百分比截断点为8.5时,AUC取得最大结果.结论 结合患儿LDH、CRP、中性杆状核粒细胞百分比的结果可协助临床对MPP及细菌性肺炎提供鉴别诊断,具有较好的临床应用价值.
The Evaluation of LDH,CRP and Percentage of Neutrophils in Differential Diagnosis of Pediatric Mycoplasma Pneumonia and Bacterial Pneumonia
Objective To investigate the diagnostic value of white blood cells(WBC),C-reactive protein(CRP),neutrophil to lymphocyte ratio(NLR),procalcitonin(PCT),interleukin-6(IL-6),erythrocyte sedimentation rate(ESR),lactate dehydrogenase(LDH)and manual classification count of peripheral blood smears in early pediatric mycoplasma pneumoniae(MPP)and bacterial pneumonia.Methods A total of 210 children admitted to the Department of Pediatrics of Tongzhou Hospital,Beijing Friendship Hospital Affiliated to Capital Medical University from January,2022 to June,2023 were selected as the study objects,including 85 children in MPP group and 125 children in bacterial pneumonia group.Baseline data,serological indexes and manual classification of peripheral blood were compared between the two groups.The influencing factors related to MPP identification were identified by logistic regression model,and the value of related factors in MPP differential diagnosis was analyzed by ROC curve.Results Levels of WBC,CRP,PCT,IL-6,NLR and peripheral blood rod-like granulocyte in bacterial pneumonia group were significantly higher than those in MPP group,while LDH in bacterial pneumonia group was significantly lower than that in MPP group(P＜0.05).The relevant indexes with significant differences were analyzed by logistic regression model.The results showed that the increase of LDH level in children was a risk factor for mycoplasma pneumoniae pneumonia(OR=1.005,95％CI 1.000-1.010)and it was positively correlated.The increase of CRP and percentage of peripheral blood rod granulocyte was negatively correlated with MPP infection.The area under the curve(AUC)of LDH,CRP and percentage of rod granulocyte in the diagnosis of MPP were 0.757,0.796 and 0.883,respectively,and the diagnostic sensitivities were 78.6％,75.8％and 81.5％,respectively.The specificities were 75.8％,85.7％and 86.9％,respectively.The AUC achieved the maximum results when the percentage of neutrophilic granulocyte was 8.5.Conclusion The combination of LDH,CRP and neutrophilic granulocyte percentage can assist in the differential diagnosis of MPP and bacterial pneumonia,and the combined application has a good clinical application value.
NETL
NSTL
万方数据
维普
