外周血NLR对IM患儿发生肝损伤风险的预测价值  

Clinical value of the ration of neutrophils to lymphocytes in predicting the liver injury induced by infectious mononucleosis in children

作　　者：孙真真[1] 刘丹丹[2] 王小利[1] 程国平[1] 许德英[1] SUN Zhenzhen;LIU Dandan;WANG Xiaoli;CHENG Guoping;XU Deying(Department of Clinical Laboratory,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471023,China;Department of Pediatrics,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471023,China)

机构地区：[1]河南科技大学第一附属医院检验科,河南洛阳471023 [2]河南科技大学第一附属医院儿科,河南洛阳471023

出　　处：《检验医学与临床》2020年第9期1169-1172,共4页Laboratory Medicine and Clinic

基　　金：国家自然科学基金面上项目(81572794)。

摘　　要：目的探讨初诊传染性单核细胞增多症(IM)患儿外周血中性粒细胞与淋巴细胞比值(NLR)对其发生肝损伤风险的预测价值。方法选取70例住院IM患儿作为研究对象,患儿于入院当日采集空腹静脉血检测全血细胞计数,根据全血细胞计数结果计算得出NLR,并以中位数为临界值,将患儿分为高NLR组(NLR≥0.42)36例和低NLR组(NLR<0.42)34例。所有研究对象进行血清EB病毒(EBV)-DNA载量,丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)、总胆红素(TB)、直接胆红素(DB)和清蛋白水平检测。结果 2016-2018年EBV-DNA检出率分别为1.62%、3.49%、3.99%,呈逐年上升趋势,其中2018年6~15岁患儿检出率为2.18%,在各年龄组中最高。与低载量组患儿相比,中载量组和高载量组患儿NLR降低,LDH、HBDH表达水平升高,差异均有统计学意义(P<0.05);与低载量组相比,高载量组IM患儿清蛋白水平明显降低(P<0.05);两组ALT、AST、TB与DB表达水平差异无统计学意义(P>0.05)。与高NLR组比较,低NLR组ALT≥80U/L的患儿比例,ALT、AST、LDH和HBDH表达水平均明显升高,差异有统计学意义(P<0.05),TB、DB和清蛋白水平差异无统计学意义(P>0.05);IM患儿NLR与ALT、AST、LDH和HBDH表达水平均呈负相关(r=-0.586、-0.506、-0.577、-0.665,均P<0.05)。结论 IM患儿NLR越低,EBV-DNA载量越高,肝脏损伤越重。Objective To explore the predictive value of neutrophil-to-lymphocyte ratio(NLR)in peripheral blood for the the liver injury induced by infectious mononucleosis(IM)in IM children.Methods A total of70 children with IM were included in the study.Fasting venous blood was taken to detect the complete blood cell count from children with IM on the day of admission.NLR was calculated according to the complete blood cell count.All children with IM were divided into high NLR(NLR≥0.42,36 patients)group and low NLR(NLR<0.42,34 patients)group according to the median of NLR.The serum was isolated to measure serum EB virus(EBV)-DNA load,alanine aminotransferase(ALT),aspartic aminotransferase(AST),lactate dehydrogenase(LDH),hydroxybutyrate dehydrogenase(HBDH),total bilirubin(TB),direct bilirubin(DB)and albumin levels.Results The detection rates of EBV-DNA were 1.62%,3.49%,3.99%from 2016 to 2018 in our hospital,which showed increasing trend,and which was the highest with the detection rate of 2.18%in children aged 6 to 15 years in 2018.Compared with the low load group,NLR in the medium load group and the high load group were lower,the level of LDH and HBDH in the medium load group and the high load group were high,the differences were statistically significant(P<0.05).The level of albumin in high load group was significantly lower than that of low load group(P<0.05).In addition,there was no difference on the level of ALT,AST,TB and DB(P>0.05).Compared with the high NLR group,the proportion of children with ALT≥80 U/L,and the level of ALT,AST,LDH and HBDH in the low NLR group significantly increased,the differences were statistically significant(all P<0.05).There was no significant difference on the level of TB,DB and albumin(P>0.05).Spearman correlation analysis showed that there were negative correlations between NLR and the level of ALT,AST,LDH and HBDH(r=-0.586,-0.506,-0.577,-0.665 respectively,all P<0.05).Conclusion In children with IM,the lower level of NLR in peripheral blood,the higher EBVDNA peak load,the more seriou

关 键 词：儿童 传染性单核细胞增多症 EB病毒 中性粒细胞与淋巴细胞比值 肝脏损伤 

分 类 号：R725.1[医药卫生—儿科]