摘要
目的分析中性粒细胞/淋巴细胞比率(NLR)、淀粉样蛋白A(SAA)和CD19^(+)水平对传染性单核细胞增多症(IM)合并肝损害患儿病情程度及预后评估的价值。方法选择2020年1月-2021年12月南通大学附属海安医院儿科收治IM患儿110例,根据丙氨酸氨基转移酶(ALT)和/或天冬氨酸氨基转移酶(AST)水平,分成肝损害组58例和非肝损害组52例;肝损害组再根据ALT和AST水平分成轻、中、重度肝损害3个亚组,根据总胆红素(TBil)是否升高分成非黄疸和黄疸2个亚组;并选择同期健康体检儿童45例列入健康对照组。检测NLR、ALT、AST、TBil、SAA、腺苷脱氨酶(ADA)、CD19^(+)和EBV-DNA载量。比较3组受试者及肝损伤患儿不同亚组间的NLR、SAA和CD19^(+)水平;Pearson分析肝损害组NLR、SAA、CD19^(+)水平与肝功能异常时间、ADA和EBV-DNA载量的相关性;绘制ROC曲线分析NLR、SAA、CD19^(+)水平及3项联合检测对IM合并肝损害的评估效能。结果NLR和CD19^(+)水平比较,肝损害组<非肝损害组<健康对照组;SAA水平比较,肝损害组>非肝损害组>健康对照组(F=18.539,32.681,56.427,P均<0.001)。肝损害组中NLR和CD19^(+)水平比较,重度亚组<中度亚组<轻度亚组;SAA水平比较,重度亚组>中度亚组>轻度亚组(F=13.376,17.648,19.274,P均<0.001);黄疸亚组NLR和CD19^(+)水平低于无黄疸亚组,SAA水平高于无黄疸亚组(t=6.985,7.562,7.318,P均<0.01)。Pearson分析显示,肝损害组NLR、CD19^(+)水平与肝功能异常时间、ADA和EBV-DNA载量呈负相关(NLR:r=-0.587,-0.549,-0.604;CD19^(+):r=-0.614,-0.651,-0.687,P均<0.001),SAA水平与肝功能异常时间、ADA和EBV-DNA载量呈正相关(r=0.634,0.718,0.693,P均<0.001)。ROC曲线显示,NLR、SAA、CD19^(+)水平单独及三者联合检测评估IM患儿肝损害的AUC分别为0.735、0.824、0.769和0.928,三者联合检测高于任一单项检测的效能(Z=7.253,7.809,6.975,P均<0.001)。结论NLR、SAA和CD19^(+)水平检测对IM合并肝损害患儿的病
Objective To analyze the value of neutrophil/lymphocyte ratio(NLR),amyloid A(SAA)and CD19^(+) levels in evaluating the severity and prognosis of children with infectious mononucleosis(IM)complicated with liver damage.Methods Selected from January 2020 to December 2021,110 children with IM who were admitted to the Pediatrics Department of Haian Hospital Affiliated to Nantong University were divided into liver groups according to the levels of alanine aminotransferase(ALT)and/or aspartate aminotransferase(AST).There were 58 cases in the damage group and 52 cases in the non-hepatic damage group;the liver damage group was further divided into 3 subgroups of mild,moderate and severe liver damage according to the levels of ALT and AST,and divided into non-jaundice and jaundice according to whether the total bilirubin(TBil)increased.2 subgroups;and 45 healthy children were selected to be included in the healthy control group during the same period.Detection of NLR,ALT,AST,TBil,SAA,adenosine deaminase(ADA),CD19^(+) and EBV DNA loads.The levels of NLR,SAA and CD19^(+) were compared among the three groups of subjects and different subgroups of children with liver injury;Pearson analyzed the correlation between the levels of NLR,SAA,CD19^(+) and the time of abnormal liver function,ADA and EBV-DNA load in the liver injury group The ROC curve was drawn to analyze the NLR,SAA,CD19^(+) levels and the evaluation performance of the three combined detection in IM complicated with liver damage.Results Comparison of NLR and CD19^(+)levels,liver damage group<non-hepatic damage group<healthy control group,comparison of SAA levels,liver damage group>non-hepatic damage group>healthy control group(F=18.539,32.681,56.427,all P<0.001).Comparison of NLR and CD19^(+)levels in liver damage group,severe subgroup<moderate subgroup<mild subgroup,SAA level comparison,severe subgroup>moderate subgroup>mild subgroup(F=13.376,17.648,19.274,Both P<0.001);the levels of NLR and CD19^(+)in the jaundice subgroup were lower than those in the non-jaundice
作者
苏丽丽
储开东
崔蕾
贲国平
袁伯稳
Su Lili;Chu Kaidong;Cui Lei;Ben Guoping;Yuan Bowen(Department of Pediatrics,Haian Hospital Affiliated to Nantong University,Jiangsu Province,Haian 226600,China)
出处
《疑难病杂志》
CAS
2022年第8期804-808,821,共6页
Chinese Journal of Difficult and Complicated Cases
基金
2021年度中国管理科学研究院重点课题(KJCX11322)。
