细菌性急性上呼吸道感染患儿血常规、炎症因子水平变化及其相关性.pdf

Hainan Med J,Aug.2023,Vol.34,No.15海南医学2023年8月第34卷第15期细菌性急性上呼吸道感染患儿血常规、炎症因子水平变化及其相关性张勇1，刘海萍2，任伟娟11.陕西省核工业二一五医院检验科，陕西咸阳712000；2.西安大兴医院检验科，陕西西安710016【摘要】目的探讨细菌性急性上呼吸道感染患儿血常规、炎症因子水平的变化及其相关性。方法选择2019年2年至2020年3月陕西省核工业二一五医院儿科收治的100例细菌性急性上呼吸道感染患儿作为观察组，并选择100例体检健康的儿童作为对照组。比较两组儿童的血常规中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、白细胞(WBC)、平均血小板体(MPV)、红细胞分布宽度(RDW)和炎症因子白细胞介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-(TNF-)水平，并采用Pearson相关分析法分析血常规NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-的相关性。结果观察组患儿的血常规NLR、LMR、WBC、MPV、RDW和IL-6、CRP、TNF-水平分别为5.680.20、22.495.01、(15.283.63)109L、(8.181.26)fL、(22.114.30)%、(410.1240.04)pg/L、(19.574.10)mg/L、(396.2235.48)ng/mL，明显高于对照组的2.020.24、12.152.30、(8.051.29)109L、(4.870.75)fL、(11.302.74)%、(221.2023.38)pg/L、(12.302.51)mg/L、(300.5120.60)ng/mL，差异均有统计学意义(P0.05)；经Pearson 相关分析结果显示，NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-均呈正相关(r值=0.418、0.704、0.501、0.590、0.620、0.426、0.627、0.574、0.672、0.881、0.856、0.535、0.610、0.712、0.419，P0.05)。结论细菌性急性上呼吸道感染患儿的血常规NLR、LMR、WBC、MPV、RDW明显高表达，且与IL-6、CRP、TNF-水平密切相关，可为临床的诊疗提供参考。【关键词】细菌性急性上呼吸道感染；中性粒细胞/淋巴细胞比值；淋巴细胞与单核细胞比值；白细胞；平均血小板体；红细胞分布宽度；炎症因子【中图分类号】R725.6【文献标识码】A【文章编号】10036350（2023）15220303Changes of blood routine and inflammatory factors in children with acute bacterial upper respiratory tractinfection and their correlation.ZHANG Yong1,LIU Hai-ping2,REN Wei-juan1.1.Department of Clinical Laboratory,Shaanxi Nuclear Industry 215 Hospital,Xianyang 712000,Shaanxi,CHINA;2.Department of Clinical Laboratory,XianDaxing Hospital,Xian 710016,Shaanxi,CHINA【Abstract】ObjectiveTo investigate the changes of blood routine and inflammatory factors in children withacute bacterial upper respiratory tract infection and their correlation.MethodsA total of 100 children with acute bacteri-al upper respiratory tract infection admitted to the Department of Pediatrics,Shaanxi Nuclear Industry 215 Hospital fromFebruary 2019 to March 2020 were selected as the observation group,and 100 healthy children were selected as the con-trol group.The blood routine neutrophil/lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR),white blood cell(WBC),mean platelet body(MPV),red blood cell distribution width(RDW),inflammatory factors interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-(TNF-)levels were compared between the two groups,and Pearsoncorrelation analysis was used to analyze the correlation between serum levels of NLR,LMR,WBC,MPV,RDW and serumlevels of IL-6,CRP,TNF-.ResultsThe blood routine NLR,LMR,WBC,MPV,RDW,IL-6,CRP,and TNF-levelsof children in the observation group were 5.680.20,22.495.01,(15.283.63)109L,(8.181.26)fL,(22.114.30)%,(410.1240.04)pg/L,(19.574.10)mg/L,(396.2235.48)ng/mL,which were significantly higher 2.020.24,12.152.30,(8.051.29)109L,(4.870.75)fL,(11.302.74)%,(221.2023.38)pg/L,(12.302.51)mg/L,(300.5120.60)ng/mL in thecontrol group(P0.05).Pearson correlation analysis showed that the levels of NLR,LMR,WBC,MPV,and RDW werepositively correlated with serum IL-6,CRP,and TNF-(r=0.418,0.704,0.501,0.590,0.620,0.426,0.627,0.574,0.672,0.881,0.856,0.535,0.610,0.712,0.419,P0.05)，具有可比性，见表1。1.2观察指标与检测方法(1)血常规测定：清晨采集两组儿童空腹静脉血5 mL，常规离心处理后，提取血清液至冷冻箱中储存备检。采用乙二胺四乙酸二钾血常规专用抗凝管，通过Sysmex(生产厂家：希森美康有限公司；型号：XN-2000)全自动血细胞分析仪检测 NLR、LMR、WBC、MPV、RDWD 水平指标。(2)炎症因子：提取待检血清，对两组儿童的白细胞介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-(TNF-)均采用酶联免疫吸附法(ELISA)进行测定。(3)相关性分析：分析血常规NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-的相关性1.3统计学方法应用SPSS25.0统计软件进行数据分析。计量资料以均数标准差(x-s)表示，组间比较采用t检验，计数资料比较采用2检验。采用Pearson相关分析法分析血常规NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-的相关性。以P0.05为差异具有统计学意义。2结果2.1两组儿童的血常规NLR、LMR、WBC、MPV、RDW 水平比较观察组患儿的血常规 NLR、LMR、WBC、MPV、RDW水平明显高于对照组，差异均有统计学意义(P0.05)，见表2。2.2两组儿童的炎症因子水平比较观察组患儿的血清IL-6、CRP、TNF-的水平明显高于对照组，差异均有统计学意义(P0.05)，见表3。2.3血常规NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-的相关性经Pearson 相关分析结果显示，NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-均呈正相关(P0.05)，见表4。3讨论细菌性上呼吸道感染多为急性感染最常见的疾病，包括普通感冒，急性咽炎，急性喉炎，急性扁桃体炎等，可以引起畏寒发热、咳嗽、咳痰、鼻塞、流涕、咽痛等症状6-7。导致小儿出现上呼吸道感染的原因主要是由于小儿机体免疫力较弱，呼吸道防御功能较低，容易受到外界病菌的影响，从而导致患儿出现一系列临床症状。在病毒、细菌的影响下，患儿可出现持续性的发热表现，影响生活质量8-9。血常规对血液中所含的细胞，即血细胞，包括白细胞、红细胞和血小板进行计数和分析，因此又叫血细胞分析、血细胞计数。临床对血常规的数据分析主要包括红细胞计数分析、白细胞计数分析和血小板计数分析。人体血液中的白细胞可以抵抗细菌、病毒、寄生虫等能导致人发炎的病原体10。当患者感染症状明显加重后，机体的氧化应激水平会明显上升，氧自由基释放的数量增加，进而诱发红细胞脂质的过氧化表1 两组儿童的一般资料比较x-s，例(%)Table 1Comparison ofgeneral data betweenthe two groups x-s,n(%)组别观察组对照组2/t值P值例数100100男52(52.00)49(49.00)女48(48.00)51(51.00)0.1800.671病程(d)3.080.72-年龄(岁)3.030.513.050.480.2860.776体质量(kg)16.511.3716.481.400.1530.878性别表3两组儿童的炎症因子水平比较(x-s)Table 3Comparison on the levels of inflammatory factors betweenthe two groups(x-s)组别观察组对照组t值P值例数100100IL-6(pg/L)410.1240.04221.2023.3840.7450.001CRP(mg/L)19.574.1012.302.5115.1230.001TNF-(ng/mL)396.2235.48300.5120.6023.3290.001表4血常规NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-的相关性Table 4Correlation between serum levels of NLR,LMR,WBC,MPV,RDW and serum levels of IL-6,CRP,TNF-指标NLRLMRWBCMPVRDWr值0.4180.5900.6270.8810.610P值0.050.050.050.050.05r值0.7040.6200.5740.8560.712P值0.050.050.050.050.05r值0.5010.4260.6720.5350.419P值0.050.050.050.050.05IL-6CRPTNF-表2两组儿童的血常规NLR、LMR、WBC、MPV、RDW水平比较(x-s)Table 2Comparison of blood routine NLR,LMR,WBC,MPV,RDWlevels between the two groups(x-s)组别观察组对照组t值P值例数100100NLR5.680.202.020.24117.1540.001LMR22.495.0112.152.3018.7570.001WBC(109L)15.283.638.051.2918.7680.001MPV(fL)8.181.264.870.7522.5730.001RDW(%)22.114.3011.302.7421.2010.0012204Hainan Med J,Aug.2023,Vol.34,No.15海南医学2023年8月第34卷第15期损伤，从而导致红细胞形态大小发生改变，RDW明显升高11。当上呼吸道遭受到细菌感染后，机体受到病原菌侵袭，可导致局部的炎症反应加重，通过炎症指标的变化，可了解患儿机体的炎症状态。CRP是临床常用的炎症评估指标，当机体组织损伤或受到感染后，其浓度可迅速升高，并激活吞噬细胞的吞噬作用，导致炎症反应加重。IL-6对机体炎症状态也具有明显的调节作用，主要是在TNF-的刺激作用下，由单核-巨噬细胞所生成，IL-6、TNF-也均是机体重要的促炎因子，和较多炎症性疾病的发生密切相关12。本研究通过观察显示，观察组患儿的血常规NLR、LMR、WBC、MPV、RDW、IL-6、CRP、TNF-水平均明显高于对照组，差异有统计学意义(P0.05)。通过分析，由于当患儿上呼吸道受到感染后，病原菌侵入体内，通过生长、繁殖等作用，产生大量毒素，刺激机体炎症因子分泌，并激活巨噬细胞，从而导致IL-6、CRP、TNF-含量升高。随着炎症的加剧，可损伤到血管功能、促使血流量增加，继而对血常规指标产生影响，同时发热患儿血流速度加快，也能增加NLR、LMR、WBC、MPV、RDW水平的表达13-14。同时，本研究结果也显示，NLR、LMR、WBC、MPV、RDW水平与血清IL-6、CRP、TNF-均呈正相关。经分析，由于上呼吸道感染持续发热患儿炎症因子IL-6、CRP、TNF-的水平变化都是被白细胞(嗜碱性粒细胞、中性粒细胞、单核/巨噬细胞)、血小板、肥大细胞、血管内皮细胞等，导致呼吸道粘膜屏障破坏、细菌移位和相应发生的炎症导致免疫功能障碍、呼吸道粘膜损伤，血常规NLR、LMR、WBC、MPV、RDW水平因此升高15。本研究未能分析患儿免疫功能、血气指标等的变化，后续也有待开展更优质的试验。综上所述，细菌性急性上呼吸道感染患儿的血常规NLR、LMR、WBC、MPV、RDW水平有明显高表达，且与IL-6、CRP、TNF-的表达密切相关，可为临床的诊疗提供参考。参考文献1Murgia V,Manti S,Licari A,et al.Upper respiratory tract infec-tion-associated acute cough and the urge to cough:new insights 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