儿童传染性单核细胞增多症与急性化脓性扁桃体炎早期鉴别指标及相关性分析

黄象维; 王红; 徐霞; 吴冬京; 杨向绸

doi:10.16766/j.cnki.issn.1674-4152.003204

儿童传染性单核细胞增多症与急性化脓性扁桃体炎早期鉴别指标及相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.003204

1.
温州医科大学附属第二医院临床检验中心，浙江温州 325000
2.
温州医科大学附属第二医院风湿免疫科
3.
温州医科大学附属第二医院血液肿瘤科

基金项目:

浙江省自然科学基金项目 LGJ21H100001

详细信息

通讯作者:
杨向绸，E-mail：yangxiangchou@163.com

中图分类号: R512.7 R766.18
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- 被引次数: 0
出版历程
- 收稿日期: 2023-02-06
- 网络出版日期: 2023-11-23

Early identification and correlation analysis of infectious mononucleosis and acute suppurative tonsillitis in children

1.
Department of Laboratory Medicine, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨儿童传染性单核细胞增多症(IM)与急性化脓性扁桃体炎(AST)的早期鉴别指标及相关性，为临床诊断提供参考依据。方法选取2021年1月—2022年6月温州医科大学附属第二医院收治的IM儿童130例(IM组)和AST儿童100例(对照组)作为研究对象。对2组患儿的临床资料及实验室相关检测指标水平进行分析比较，通过ROC曲线分析联合多个指标对IM早期诊断的价值，使用Spearman相关性分析分析各实验室指标之间的相关性。结果临床表现上，IM组体温 < 39 ℃、眼睑浮肿、颈部淋巴结肿大、扁桃体分泌物占比均明显高于对照组，差异均有统计学意义(均P < 0.05)。感染早期，IM组CRP、中性粒细胞与淋巴细胞比值(NLR)、单核细胞与淋巴细胞比值(MLR)、CD4⁺/CD8⁺值、前白蛋白(PA)、C反应蛋白与前白蛋白比值(CRP/PA)、C反应蛋白与白蛋白比值(CAR)均低于对照组，差异均有统计学意义(均P < 0.05)。IM治疗后，CRP、WBC、MLR、CRP/PA及CAR水平均下降，NLR与PA水平升高，与治疗前比较差异有统计学意义(P < 0.05)，而ALB水平治疗前后差异无统计学意义。ROC曲线显示，联合检测的AUC为0.988，均高于单独检测。NLR与CRP、CAR呈正相关关系(r=0.431、0.433，均P < 0.05)；CRP/PA与NLR呈正相关关系(r=0.443，P < 0.05)，与PA呈负相关关系(r=-0.340，P < 0.05)。结论 IM与AST的早期鉴别难度较大，易出现误诊情况，可通过CRP、NLR、MLR、CD4⁺/CD8⁺、PA、CRP/PA和CAR等实验室指标及临床表现(体温 < 39 ℃、眼睑浮肿、颈部淋巴结肿大、扁桃体分泌物)进行评估与比较，联合运用各指标对IM早期诊断与疗效评估具有较大的应用价值，可为临床提供辅助。
- 传染性单核细胞增多症 /
- 急性化脓性扁桃体炎 /
- 临床表现 /
- 相关性
Abstract: Objective To explore the early differential diagnosis and correlation between pediatric infectious mononucleosis (IM) and acute suppurative tonsillitis (AST), and to provide reference for clinical diagnosis. Methods A total of 130 children with IM (IM group) and 100 children with AST (control group) admitted between January 2021 and June 2022 were selected as study subjects. The clinical data and laboratory indicators of the two groups were analyzed and compared. The receiver operating characteristic curve (ROC curve) was used to analyze the predictive ability of multiple indicators for the early diagnosis of IM. Spearman correlation was used to analyze the correlation between laboratory indicators. Results In terms of clinical manifestations, body temperature < 39 ℃, eyelid edema, neck lymph node enlargement and tonsil secretions were significantly higher in IM group than in the control group, with statistical significance (all P < 0.05). At the early stage of infection, the levels of CRP, neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), CD4⁺/CD8⁺, prealbumin (PA), CRP/PA and C-reactive protein/albumin ratio (CAR) levels were lower in IM group than in the control group, with statistical significance (all P < 0.05). After IM treatment, the levels of CRP, WBC, MLR, CRP/PA and CAR were decreased, while the levels of NLR and PA were increased with statistical significance compared with before treatment (P < 0.05), while the level of ALB was not statistically significant. The ROC curve showed that the AUC of combined detection was 0.988, both higher than that of single detection. NLR was positively correlated with CRP and CAR (r=0.431, 0.433, all P < 0.05). CRP/PA was positively correlated with NLR (r=0.443, P < 0.05), and negatively correlated with PA (r=-0.340, P < 0.05). Conclusion Early identification of IM and AST is difficult and misdiagnosis is easy. Laboratory indicators such as CRP, NLR, MLR, CD4⁺/CD8⁺, PA, CRP/PA, CAR and clinical manifestations (body temperature < 39 ℃, eyelid edema, cervical lymph node enlargement, amygdala secretion) can be evaluated and compared. The combined application has great application value to improve the early diagnosis and efficacy evaluation of IM, and provides clinical assistance.
- Infectious mononucleosis /
- Acute suppurative tonsillitis /
- Clinical manifestations /
- Correlation

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图 1 CRP、NLR、MLR、CD4⁺/CD8⁺、PA、CRP/PA及CAR诊断IM的ROC曲线

Figure 1. ROC curves for diagnosing IM using CRP, NLR, MLR, CD4⁺/CD8⁺, PA, CRP/PA, and CAR

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表 1 2组患儿一般资料与临床表现比较

Table 1. Comparison of general information and clinical manifestations between two groups of pediatric patients

项目	IM组(n=130)	对照组(n=100)	统计量	P值
性别[例(%)]			3.735^a	0.053
男	60(46.15)	59(59.00)
女	70(53.85)	41(41.00)
年龄[例(%)]			1.121^a	0.290
≤6岁	102(78.46)	84(84.00)
>6岁	28(21.54)	16(16.00)
体重(x±s, kg)	20.18±10.02	9.20±8.77	0.714^b	0.243
发热[例(%)]			5.860^a	0.015
< 39 ℃	58(44.62)	29(29.00)
≥39 ℃	72(55.38)	71(71.00)
眼睑浮肿[例(%)]			134.699^a	< 0.001
有	101(77.69)	1(1.00)
无	29(22.31)	99(99.00)
颈部淋巴结肿大[例(%)]			147.922^a	< 0.001
有	127(97.69)	20(20.00)
无	3(2.31)	80(80.00)
扁桃体肿大程度[例(%)]			2.090^a	0.148
≤Ⅱ度	115(88.46)	94(94.00)
>Ⅱ度	15(11.54)	6(6.00)
扁桃体分泌物[例(%)]			6.457^a	0.011
有	89(68.46)	52(52.00)
无	41(31.54)	48(48.00)
注：^a为χ²值，^b为t值。

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表 2 2组患儿血常规与生化指标比较

Table 2. Comparison of blood routine and biochemical parameters between two groups of pediatric patients

组别	例数	CRP [M(P₂₅, P₇₅), mg/L]	WBC (x±s, ×10⁹/L)	NLR [M(P₂₅, P₇₅)]	MLR (x±s)	CD4⁺/CD8⁺ (x±s)	PA (x±s, mg/L)	ALB (x±s, g/L)	CRP/PA [M(P₂₅, P₇₅)]	CAR [M(P₂₅, P₇₅)]
IM组	130	5.70(3.20, 11.33)	16.88±7.06	0.42(0.29, 0.59)	0.15±0.09	0.27±0.26	107.52±28.56	41.08±3.06	0.06(0.03, 0.12)	0.14(0.08, 0.27)
对照组	100	17.90(9.25, 45.95)	14.65±8.18	2.94(1.53, 6.41)	0.46±0.41	1.50±0.64	124.35±45.00	44.30±3.23	0.19(0.08, 0.42)	0.43(0.21, 1.04)
统计量		3.661^a	2.214^b	6.309^a	-7.351^b	-18.046^b	-3.267^b	-7.724^b	3.169^a	3.470^a
P值		< 0.001	0.061	< 0.001	< 0.001	< 0.001	< 0.001	0.999	< 0.001	< 0.001
注：^a为Z值，^b为t值。

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表 3 IM组患儿治疗前后血常规与生化指标比较

Table 3. Comparison of complete blood count and biochemical parameters before and after treatment in the IM group of pediatric patients

组别	例数	CRP [M(P₂₅, P₇₅), mg/L]	WBC (x±s, ×10⁹/L)	NLR (x±s)	MLR [M(P₂₅, P₇₅)]	PA (x±s, mg/L)	ALB (x±s, g/L)	CRP/PA [M(P₂₅, P₇₅)]	CAR [M(P₂₅, P₇₅)]
治疗前	130	5.70(3.20, 11.33)	16.88±7.06	0.48±0.30	0.14(0.08, 0.19)	107.52±28.56	41.08±3.06	0.06(0.03, 0.12)	0.14(0.08, 0.27)
治疗后	130	1.03(0.25, 3.03)	8.90±3.36	0.69±0.65	0.11(0.08, 0.15)	187.76±53.96	43.33±3.25	0.01(0.00, 0.02)	0.02(0.01, 0.07)
统计量		4.465^a	11.634^b	-3.416^b	1.923^a	-14.985^b	-5.738^b	4.651^a	4.465^a
P值		< 0.001	< 0.001	< 0.001	0.001	< 0.001	0.462	< 0.001	< 0.001
注：^a为Z值，^b为t值。

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表 4 CRP、NLR、MLR、CD4⁺/CD8⁺、PA、CRP/PA及CAR诊断IM的ROC曲线分析结果

Table 4. ROC curve analysis for CRP, NLR, MLR, CD4⁺/CD8⁺, PA, CRP/PA, and CAR as diagnostic markers for IM

项目	AUC	阈值	约登指数	灵敏度(%)	特异度(%)
CRP	0.754	43.10	0.487	77.7	71.0
NLR	0.973	1.07	0.839	96.9	87.0
MLR	0.877	0.25	0.646	94.6	70.0
CD4⁺/CD8⁺	0.967	0.63	0.929	96.9	96.0
PA	0.612	123.00	0.274	75.4	52.0
CRP/PA	0.726	0.17	0.422	86.2	56.0
CAR	0.740	0.29	0.462	76.2	70.0
联合检测	0.988		0.957	97.7	98.0

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表 5 IM患儿NLR、MLR、CD4⁺/CD8⁺、PA与CRP、CRP/PA、CAR的相关性

Table 5. Correlation of NLR, MLR, CD4⁺/CD8⁺, PA with CRP, CRP/PA, and CAR in pediatric patients with IM

项目	CRP		CRP/PA		CAR
项目	r值	P值	r值	P值	r值	P值
NLR	0.431	< 0.001	0.443	< 0.001	0.433	< 0.001
MLR	0.108	0.221	0.058	0.509	0.105	0.236
CD4⁺/CD8⁺	0.073	0.410	0.039	0.659	0.061	0.490
PA	-0.084	0.344	-0.340	< 0.001	-0.115	0.193

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