摘要
目的 研究外周血异型淋巴细胞比例(ALY)联合EB病毒DNA载量(EBV-DNA)在小儿传染性单核细胞增多症(IM)诊断中的应用.方法 选择 2020 年 3 月—2022 年 3 月龙岩人民医院收治的 62 例IM患儿作为IM组,另外选择同期在龙岩人民医院进行健康体检的 62 例健康儿童作为健康对照组.采用显微镜检测两组患儿外周血ALY、淋巴细胞计数(LYM)、淋巴细胞比例(LYM%);采用实时荧光定量聚合酶链反应(PCR)检测两组EBV-DNA;采用Pearson相关系数分析LYM、LYM%、外周血ALY与EBV-DNA的相关性;绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),考察外周血ALY联合EBV-DNA检测对IM的诊断价值.结果 IM组患儿的外周血ALY、LYM、LYM%以及EBV-DNA水平均明显高于健康对照组[外周血ALY:(25.62±8.31)%比(18.01±4.62)%;LYM(×107/mL):8.35±2.61 比5.54±0.34;LYM%:(50.35±10.36)%比(37.69±6.31)%;EBV-DNA(拷贝/mL):7.85±2.64 比 5.31±1.10;均P<0.05].Pearson相关性分析结果显示,IM组患儿的LYM、LYM%、外周血ALY与EBV-DNA均呈正相关(r值分别为 0.424、0.490、0.632,P值分别为 0.016、0.010、0.008).外周血ALY诊断小儿IM的AUC为 0.773,95%可信区间(95%CI)为 0.680～0.866,敏感度为 48.00%,特异度为 72.00%;EBV-DNA诊断小儿IM的AUC为 0.810,95%CI为 0.718～0.902,敏感度为 60.00%,特异度为 96.00%;外周血ALY与EBV-DNA联合检测诊断小儿IM的AUC最高,为 0.904,95%CI为 0.843～0.964,敏感度为 90.00%,特异度为 92.00%.结论 IM患儿外周血ALY和EBV-DNA均显著增高,二者联合检测能够辅助诊断IM.
Abstract
Objective To study the application of peripheral blood atypical lymphocyte ratio(ALY)combined with EB virus(EBV)DNA load in the diagnosis of infectious mononucleosis(IM)in children.Methods A total of 62 children with IM and 62 healthy children undergoing physical examination in Longyan People's Hospital from March 2020 to March 2022 were enrolled in IM group and healthy control group,respectively.The levels of peripheral blood ALY,lymphocytes count(LYM)and lymphocyte ratio(LYM%)in two groups of children were detected by microscope,and the level of EBV-DNA load was detected by real-time fluorescence quantitative polymerase chain reaction(PCR).The correlation between LYM,LYM%,peripheral blood ALY and EBV-DNA load was analyzed by Pearson correlation coefficient.The receiver operator characteristic(ROC)curve was drawn,the area under ROC curve(AUC)was calculated,and the diagnostic value of peripheral blood ALY combined with EBV-DNA load for IM was analyzed.Results The levels of peripheral blood ALY,LYM,LYM%and EBV-DNA load in IM group were significantly higher than those in healthy control group[peripheral blood ALY:(25.62±8.31)%vs.(18.01±4.62)%;LYM(×107/mL):8.35±2.61 vs.5.54±0.34;LYM%:(50.35±10.36)%vs.(37.69±6.31)%;EBV-DNA load(copies/mL):7.85±2.64 vs.5.31±1.10;all P＜0.05].The results of Pearson correlation analysis showed that the levels of LYM,LYM%and peripheral blood ALY were significantly positively correlated with EBV-DNA load in IM group(r values were 0.424,0.490 and 0.632,P values were 0.016,0.010 and 0.008).The AUC of peripheral blood ALY for diagnosis of IM was 0.773,95%confidence interval(95%CI)was 0.680-0.866,the sensitivity was 48.00%,and the specificity was 72.00%.The AUC of EBV-DNA load for diagnosis of IM was 0.810,95%CI was 0.718-0.902,the sensitivity was 60.00%,and the specificity was 96.00%,respectively.The AUC of combined detection of peripheral blood ALY and EBV-DNA load was the highest,which was 0.904,95%CI was 0.843-0.964,the sensitivity was 90.00%,and the specificity was 92.00%,respectively.Conclusion The peripheral blood ALY and EBV-DNA load are significantly increased in children with IM,which could be applied in the auxiliary diagnosis of IM.
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