外周血 NLR、PLR、SII在婴幼儿川崎病中的临床意义

Clinical values of NLR, PLR and SII in peripheral blood for diagnosis of Kawasaki disease in infants

摘要

目的 探讨外周血中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、系统性免疫性炎症指数(SII)在婴幼儿川崎病(KD)及不完全性川崎病(IKD)中诊断的临床意义。方法 回顾性收集2015年4月至2021年10月于惠州市中心人民医院儿科诊断为川崎病的198例婴幼儿作为KD组,进一步分为完全性川崎病(CKD)组155例和IKD组43例;另选取198例健康婴幼儿作为健康对照组.统计组间冠状动脉损害发生率,比较组间临床特征、实验室检查指标及外周血NLR、PLR、SII水平的差异,使用受试者工作特征(ROC)曲线、Youden指数检验各指标对KD的诊断效能。结果 婴幼儿KD患儿中,IKD组发热热程中位天数10.51天较CKD组热程8.99天长,IKD组1~18月龄共有32例(74.4%)、冠脉损害共有9例(20.9%),其占比均较CKD组高,差异均具有统计学意义(χ²/Z值分别为-3.12、12.04和5.36,P<0.05);KD组外周血血常规白细胞(WBC)、淋巴细胞绝对值(ALC)、中性粒细胞绝对值(ANC)、血小板(PLT)、NLR、PLR、SII指标的水平均较健康对照组高,差异有统计学意义(Z值分别为128.6、228.3、56.1、51.4、236.7、146.8、250.0,P<0.05).IKD组的ALC和PLT水平高于CKD组,而ANC和NLR水平则低于CKD组,差异具有统计学意义(Z值分别为-49.19、-56.13、51.04、59.80,P<0.05);ROC曲线分析显示,WBC、PLR、SII对川崎病的诊断效能如下:WBC曲线下面积(AUC)为0.829,灵敏度73.2%,特异度81.8%,Youden指数0.551;PLR的AUC为0.852,灵敏度73.7%,特异度86.9%,Youden指数0.606;SII的AUC为0.959,灵敏度89.4%,特异度94.5%,Youden指数0.849。结论 不完全性川崎病患儿多见于小月龄幼儿,发热病程更长,且更易发生冠脉损害.不完全性川崎病组ANC和NLR水平低于完全性川崎病组,而ALC和PLT水平明显升高.早期监测WBC、PLR、SII水平的变化,尤其是SII水平升高,结合部分川崎病特征性体征,可有助于不完全性川崎病的早期诊断.

Abstract

Objective To investigate clinical values of peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune inflammatory index (SII) for diagnosis of infantile Kawasaki disease (KD) and incomplete Kawasaki disease (IKD). Methods The clinical data of 198 infants who were diagnosed as KD in Department of Pediatrics, Huizhou Municipal Central People's Hospital from April 2015 to October 2021 were retrospectively collected and analyzed as KD group. 198 infants with KD were divided into complete KD (CKD) group (155 cases) and IKD group (43 cases). Other 198 healthy infants were selected as healthy control group. The incidences of coronary artery damage in the three groups were recorded, and the differences in clinical features, laboratory tests and NLR, PLR and SII levels in peripheral blood were compared among the three groups. Receiver operating characteristic (ROC) curve and Youden index were used to evaluate diagnostic efficacy of the indexes for KD. Results Among infants with KD, the mean fever course in IKD group was 10.51 (8, 12) days, which was longer than 8.99 (7, 10) days in the CKD group. In the IKD group, there were 32 infants with IKD (32/43, 74.4%) aged 1-18 months and 9 cases (9/43, 20.9%) of coronary artery damage, both of which accounted for higher proportions than those in the CKD group, and the differences were statistically significant (χ²/Z=-3.12, 12.04 and 5.36 respectively, P<0.05). In blood routine examination, the plasma levels of white blood count (WBC), absolute lymphocyte count (ALC), absolute neutrophil count (ANC), platelet count (PLT), NLR, PLR and SII indexes of the infants in the KD group were higher than those in the healthy control group, and the differences were statistically significant (Z=128.6, 228.3, 56.1, 51.4, 236.7, 146.8 and 250.0 respectively, P<0.05). The plasma levels of ALC and PLT in the IKD group were higher than those in the CKD group, while the levels of ANC and NLR were lower than those in the CKD group, and the differences were statistically significant (Z=-49.19, -56.13, 51.04 and 59.80 respectively, all P<0.05). ROC curve analysis shown that the efficacy of WBC, PLR and SII for diagnosing KD were as follow: the area under the curve (AUC), the sensitivity, the specificity and the Youden index of WBC were 0.829, 73.2%, 81.8% and 0.551 respectively, and those of PLR were 0.852, 73.7%, 86.9% and 0.606 respectively, and those of SII were 0.959, 89.4%, 94.5% and 0.849 respectively. Conclusions IKD is more commonly seen in young month-aged infants who have long fever course, and these infants are more prone to coronary artery damage. Compared with CKD, peripheral blood routine indexes of those IKD infants presented lowered ANC and NLR levels, and significantly elevated ALC and PLT levels. Early monitoring changes in peripheral blood routine indexes, such as the levels of WBC, PLR and SII, especially the elevated SII level, and combining some characteristic signs of KD, all these measures are conducive to early diagnosis of IKD.

关键词

婴幼儿 / 川崎病 / 不完全性川崎病 / 中性粒细胞与淋巴细胞比值 / 血小板淋巴细胞比值 / 系统性免疫性炎症指数

Key words

infant / Kawasaki disease / incomplete Kawasaki disease / neutrophil-to-lymphocyte ratio / neutrophil-to-lymphocyte ratio / systemic immune inflammatory index

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基金资助

广州市市校(院)联合资助项目(SL2023A03J00610)