外周血细胞参数对4岁以下儿童感染相关性噬血细胞综合征预后的预测价值  

Prognostic value of peripheral blood cell parameters in children under the age of 4 years with infection-asso-ciated hemophagocytic syndrome

作　　者：王欣 毛舒婷 刘玉峰[1] Wang Xin;Mao Shuting;Liu Yufeng(Department of Hematology and Oncology,Children′s Hospital,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院儿童医院血液肿瘤科,郑州450052

出　　处：《中华实用儿科临床杂志》2023年第10期768-773,共6页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨外周血细胞参数[中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、平均血小板体积/淋巴细胞比值(MPVLR)]对4岁以下儿童感染相关性噬血细胞综合征(IAHS)预后的预测价值。方法回顾性分析2015年1月至2020年10月郑州大学第一附属医院收治的70例4岁以下IAHS患儿的临床资料,包括确诊时、治疗2周、治疗4周、治疗8周外周血细胞参数的变化。采用Mann-Whitney U检验比较不同预后患儿外周血细胞参数的差异。采用受试者工作特征(ROC)曲线评估确诊时NLR、PLR和MPVLR对患儿预后的预测价值,采用约登指数确定最佳截断值。根据NLR、PLR和MPVLR的最佳截断值分别将患儿分组,生存率的估计采用Kaplan-Meier法,组间比较采用Log-rank检验。结果1.与存活组患儿相比,死亡组患儿确诊时的NLR、PLR、MPVLR偏高,差异均有统计学意义(均P<0.001)。2.ROC曲线分析结果显示,确诊时NLR、PLR、MPVLR预测IAHS患儿预后的ROC曲线下面积分别为0.805、0.815和0.772。当NLR、PLR、MPVLR分别取最佳截断值为0.73、32.86、14.19时,敏感度和特异度分别为69.57%和89.36%、86.96%和68.09%、60.87%和89.36%。3.根据最佳截断值分组,NLR>0.73组患儿总生存时间明显短于NLR≤0.73组患儿,PLR>32.86组患儿总生存时间明显短于PLR≤32.86组患儿,MPVLR>14.19组患儿总生存时间明显短于MPVLR≤14.19组患儿,差异均有统计学意义(均P<0.001)。4.治疗2周后,死亡组患儿NLR、MPVLR均大于存活组患儿,差异均有统计学意义(均P<0.05)。治疗2、4、8周后,存活组患儿NLR、PLR、MPVLR均较确诊时明显改善(均P<0.05),而死亡组患儿无明显变化(均P>0.05)。结论确诊时NLR、PLR、MPVLR对4岁以下IAHS患儿预后具有一定的预测价值,治疗早期动态关注其变化有助于判断IAHS患儿预后。Objective To explore the prognostic values of peripheral blood cell parameters:neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and mean platelet volume-to-lymphocyte ratio(MPVLR)in children under the age of 4 years with infection-associated hemophagocytic syndrome(IAHS).Methods The clinical data of 70 children under the age of 4 years with IAHS treated in the First Affiliated Hospital of Zhengzhou University from January 2015 to October 2020 were analyzed retrospectively,including the changes in peripheral blood cell parameters at the time of diagnosis,and 2,4 and 8 weeks after treatment.Mann-Whitney U test was used to compare the differences in peripheral blood cell parameters of IAHS children with different prognosis statues.The prognostic values of NLR,PLR and MPVLR were evaluated by plotting receiver operating characteristic(ROC)curves.The optimal cut-off value was determined by Youden index.Children were grouped according to the optimal cut-off values of NLR,PLR and MPVLR.The survival rate was estimated by Kaplan-Meier method,followed by Log-rank test for pairwise comparison.Results(1)Compared with the survival group,NLR,PLR and MPVLR were significantly higher at the diagnosis in the death group(all P<0.001).(2)ROC curves showed that the area under the curve(AUC)of NLR,PLR and MPVLR to predict the prognosis of children with IAHS were 0.805,0.815 and 0.772,respectively.When the optimal cut-off value of NLR,PLR and MPVLR were 0.73,32.86 and 14.19,respectively,the sensitivity and specificity were 69.57%and 89.36%,86.96%and 68.09%,and 60.87%and 89.36%,respectively.(3)According to the optimal cut-off value,the total survival time of children in NLR>0.73 group was significantly shorter than that in NLR≤0.73 group,and that of children in PLR>32.86 group was significantly shorter than that in PLR≤32.86 group;the total survival time of children in MPVLR>14.19 group was significantly shorter than that in MPVLR≤14.19 group(all P<0.001).(4)After 2 weeks of treatment,the NLR and MPVLR in the de

关 键 词：噬血细胞综合征 外周血细胞参数 儿童 预后 

分 类 号：R725.1[医药卫生—儿科]