单核细胞与成人支原体肺炎病程的关系及其在预测病程中的应用  

The intrinsic connection and predictive value of monocytes for disease courses in adult mycoplasma pneumonia

作　　者：何婧瑜[1] 王晶[1] He Jingyu;Wang Jing(Department of Emergency,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Diseases,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院急诊科国家老年疾病临床医学研究中心(宣武医院),北京100053

出　　处：《首都医科大学学报》2021年第1期111-116,共6页Journal of Capital Medical University

基　　金：国家重点研发计划(2018YFC1312000)。

摘　　要：目的探讨单核细胞与成人支原体肺炎病程的关系及其在预测病程中的临床应用。方法收集2016年1月至2018年12月首都医科大学宣武医院急诊科收治的95例支原体肺炎患者资料,将病程>14 d的患者定义为长程病程组(n=71),病程<14 d的为短程病程组(n=24)。探讨患者入院24 h内血常规单核细胞绝对值(monocytes,MO)及百分比(M0%)与疾病病程的相关性。结果长程病程组患者入院MO、MO%、C-反应蛋白(C-reactive protein,CRP)、降钙素原、红细胞计数、血小板体积分布宽度(platelet volume distribution width,PDW)、血小板平均体积及心率均低于短病程组,入院氧分压高于短病程组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示MO%为长病程的独立预测因素(P=0.003)。受试者工作特征曲线筛选预测截点为7.4147%,预测的灵敏度为63.38%,特异度为79.17%,Kappa值为0.330,临床预测价值较差。将MO%、CRP、PDW并联预测,灵敏度为78.87%,特异度70.83%,Kappa值为0.448,预测结果与实际具有中高度一致性。结论MO%与支原体肺炎患者病程有关,MO%越低,病程越长。MO%联合CRP及PDW对病程具有一定的预测价值。Objective To explore the intrinsic connection and the clinical value of monocytes for disease courses in adult mycoplasma pneumonia.Methods A retrospective analysis of 95 patients with mycoplasma pneumonia from January 2016 to December 2018 was conducted in Department of Emergency,Xuanwu Hospital,Capital Medical University.Patients were divided into long-course group(n=71)and short-course group(n=24)based on whether disease courses were longer than 14 days.The absolute value of monocytes(MO)and the percentage of monocytes(MO%)in blood routine were collected within 24 hours of admission.Furthermore,their correlations with disease courses were discussed.Results Baseline analysis displays that the MO,MO%,C-reactive protein(CRP),procalcitonin,red blood cell,platelet volume distribution width(PDW),average platelet volume and heart rates were lower,and the oxygen partial pressure was higher in the long-course group(P<0.05).Logistic regression showed that MO%was an independent predictor of disease duration over 14 days(P=0.003).Receiver operating characteristic(ROC)curve analysis showed that MO%had moderate predictive value for disease courses.Area under ROC curve,MO%:0.708±0.062(P=0.002),cut-off value:7.4147%,sensitivity(Se)63.38%,specificity(Sp)79.17%,positive predictive value(PV+)90.0%,negative predictive value,(PV-)42.22%.The area under the combined predictive ROC curve of MO%with CRP and PDW:0.793±0.053(P=0.000),cut-off value:7.4414,Se 78.87%,Sp 70.83%,PV+88.89%,PV-53.13%.Conclusions MO%has clinical application value in disease-course prediction and evaluation of mycoplasma pneumonia in adults:especially combined with CRP and PDW.The smaller the MO%value,the longer the course of disease.

关 键 词：支原体肺炎 单核细胞 病程 成人 

分 类 号：R563[医药卫生—呼吸系统]