NLR、MLR、PLR对儿童急性下肢骨关节感染和一过性滑膜炎的鉴别诊断价值  

Differential diagnostic value of neutrophil to lymphocyte ratio,monocyte to lymphocyte ratio and platelet to lymphocyte ratio in acute pediatric osteoarticular infections of the lower limbs and transient synovitis

作　　者：赵超晨 孙钰涵 刘尧[1] 王晓东[1] Zhao Chaochen;Sun Yuhan;Liu Yao;Wang Xiaodong(Department of Orthopedics,Children's Hospital of Soochow University,Suzhou 215025,China;Department of Orthopedics,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Pediatric Surgery,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]苏州大学附属儿童医院骨科,苏州215025 [2]上海交通大学医学院附属儿童医院,上海市儿童医院骨科,上海200062 [3]上海交通大学医学院附属儿童医院,上海市儿童医院儿外科,上海200062

出　　处：《中华小儿外科杂志》2025年第2期163-168,共6页Chinese Journal of Pediatric Surgery

基　　金：江苏省卫健委重点项目(K2019005)。

摘　　要：目的探讨中性粒细胞计数与淋巴细胞计数比值(neutrophil to lymphocyte ratio,NLR)、单核细胞计数与淋巴细胞计数比值(monocyte to lymphocyte ratio,MLR)、血小板计数与淋巴细胞计数比值(platelet to lymphocyte ratio,PLR)对3岁以上儿童急性下肢骨关节感染(acute pediatric osteoarticular infections of the lower limbs,AOI)和一过性滑膜炎(transient synovitis,TS)的鉴别诊断价值。方法回顾性分析2017年1月至2021年12月苏州大学附属儿童医院骨科因下肢跛行伴疼痛入院80例患儿的临床资料,其中男50例,女30例,年龄范围为>3岁至<14岁。根据诊断结果分为AOI组(31例)和TS组(49例)。比较两组患儿的实验室检查指标包括血沉(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、白细胞计数、NLR、MLR、PLR等。采用二元logistic回归分析鉴别AOI和TS的相关诊断指标,通过模型方程进行转换构建联合因子,绘制受试者操作特征曲线(receiver operating characteristic,ROC),应用SPSS 26.0统计软件进行数据处理,约登指数确定最佳截断值、灵敏度和特异性度,评价其鉴别诊断价值。结果两组患儿的年龄和性别差异没有统计学意义(P>0.05)。与TS组相比,AOI组NLR(4.59比1.76,P<0.001)、MLR(0.49比0.21,P<0.001)、PLR(144.71比105.00,P=0.001)、CRP(77.65比2.13,P<0.001)和ESR(46 mm/L比8 mm/L,P<0.001)均较高,差异具有统计学意义。二元logistic回归显示ESR、NLR、MLR是鉴别AOI和TS的独立诊断指标。ESR、NLR、MLR以及三个指标联合(即联合因子)的曲线下面积(area under curve,AUC)分别为0.915、0.820、0.806、0.942(均P<0.05),联合因子的最佳截断值为210.44,灵敏度为90.3%,特异度为87.8%,阳性预测值为82.4%,阴性预测值为93.5%,准确度为88.4%。结论NLR、MLR和PLR升高对区分早期AOI和TS有较好的鉴别价值,当ESR、NLR、MLR构建的联合因子>210.44时应及时进行核磁共振检查和血培养检测以明确AOI的诊断。ObjectiveTo investigate the differential diagnostic value of neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR),platelet to lymphocyte ratio(PLR)in acute pediatric osteoarticular infections(AOI)and transient synovitis(TS)in children over 3 years of age.MethodsA retrospective analysis was conducted on the clinical data of 80 children(50 boys,30 girls)aged 3-14 years who were admitted for lower limb limp and pain to the Department of Orthopedics,Children's Hospital Affiliated to Soochow University from January 2017 to December 2021.Based on their final diagnosis,patients were divided into the AOI group(31 cases)and the TS group(49 cases).Laboratory indices,including erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),white blood cell count(WBC),neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),and platelet-to-lymphocyte ratio(PLR),were compared between the two groups.Binary logistic regression analysis was used to identify diagnostic indicators differentiating AOI from TS.The regression model equation was then transformed to construct a combined factor.A receiver operating characteristic(ROC)curve was drawn,and SPSS 26.0 statistical software was applied for data processing.The Youden index was used to determine the optimal cut-off value,sensitivity,and specificity,thereby evaluating the differential diagnostic value of these indicators.ResultsThere were no significant differences in age and gender between the AOI and TS groups(P>0.05).Compared with the TS group,patients in the AOI group had significantly higher NLR(4.59 vs.1.76,P<0.001),MLR(0.49 vs.0.21,P<0.001),PLR(144.71 vs.105.00,P=0.001),CRP(77.65 vs.2.13,P<0.001),and ESR(46 mm/L vs.8 mm/L,P<0.001).The binary logistic regression showed that ESR,NLR and MLR were independent diagnostic indicators to differentiate AOI from TS.The area under the curve(AUC)of ESR,NLR,MLR and their combination was 0.915,0.820,0.806 and 0.942,respectively(all P<0.05).The optimal cut-off value for the combination detection was 210.44,with

关 键 词：关节炎 感染性 滑膜炎 中性粒细胞计数 淋巴细胞计数 单核细胞计数 血小板计数 

分 类 号：R73[医药卫生—肿瘤]