[1]许俊,张金玉,王东丽,等.降钙素原、中性粒细胞与淋巴细胞比值与新生儿化脓性脑膜炎预后的相关性[J].新乡医学院学报,2023,40(6):548-553.[doi:10.7683/xxyxyxb.2023.06.009]
　XU Jun,ZHANG Jinyu,WANG Dongli,et al.Correlation between the procalcitonin,neutrophil to lymphocyte ratio and the prognosis of children with neonatal purulent meningitis[J].Journal of Xinxiang Medical University,2023,40(6):548-553.[doi:10.7683/xxyxyxb.2023.06.009]
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降钙素原、中性粒细胞与淋巴细胞比值与新生儿化脓性脑膜炎预后的相关性
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年6
页码:
548-553
栏目:
临床研究
出版日期:
2023-06-05

文章信息/Info

Title:
Correlation between the procalcitonin,neutrophil to lymphocyte ratio and the prognosis of children with neonatal purulent meningitis
作者:
许俊; 张金玉; 王东丽; 丁若雨; 李付奎
（南阳市第一人民医院儿科，河南　南阳　473000）
Author(s):
XU Jun; ZHANG Jinyu; WANG Dongli; DING Ruoyu; LI Fukui
（Department of Pediatrics,the First People′s Hospital of Nanyang,Nanyang 473000,Henan Province,China）
关键词:
化脓性脑膜炎; 新生儿; 预后; 降钙素原; 中性粒细胞与淋巴细胞比值
Keywords:
purulent meningitis; newborn; prognosis; procalcitonin; neutrophil to lymphocyte ratio
分类号:
R722.13
DOI:
10.7683/xxyxyxb.2023.06.009
文献标志码:
A
摘要:
目的　探讨降钙素原（PCT）、中性粒细胞与淋巴细胞比值（NLR）与新生儿化脓性脑膜炎（PM）预后的相关性。方法　选择2020年4月至2022年4月南阳市第一人民医院收治的122例PM新生儿为研究对象。PM患儿均接受抗生素、肾上腺皮质激素及对症支持治疗，最长治疗时间为21 d，依据21 d内患儿预后情况将122例PM新生儿分为病死组（n=23）与存活组（n=99）。 设计基线资料调查表，通过查阅患儿病历资料记录患儿的基线资料，包括出生日龄、性别、出生体质量、早产情况、出生方式、胎膜早破情况、羊水粪染情况。经脑脊液培养检查明确PM患儿致病菌。记录PM患儿最高体温、惊厥发生情况及治疗时间。于入院当日抽取患儿静脉血8 mL，使用全自动生物化学分析仪测定静脉血中白细胞（WBC）、血小板（PLT）、红细胞（RBC）、中性粒细胞（NEU）、淋巴细胞（LYM）水平，并计算NLR。采用酶联免疫吸附测定法检测血清C反应蛋白（CRP）、PCT水平。采用COX回归分析检验各因素对PM患儿预后的影响；绘制受试者操作特征（ROC）曲线，并计算曲线下面积（AUC），分析PCT、NLR对PM患儿预后的预测价值；采用样条函数与回归分析相结合的限制性立方样条法分析PCT、NLR与PM患儿预后的剂量反应关系。结果　病死组患儿的惊厥发生比例显著高于存活组（χ2=11.675,P<0.05）；病死组与存活组患儿的日龄、性别、出生体质量、早产情况、生产方式、胎膜早破情况、羊水粪染情况、致病菌种类、最高体温、治疗时间比较差异无统计学意义（P>0.05）。病死组患儿的WBC、NEU、CRP、PCT水平及NLR显著高于存活组，LYM水平显著低于存活组（P<0.05）；病死组与存活组患儿的PLT、RBC水平比较差异无统计学意义（P>0.05）。发生惊厥及NEU、NLR、CRP、PCT水平高是PM患儿预后的危险因素（风险比>1，P<0.05）。ROC曲线分析显示，血清PCT、NLR对PM患儿预后预测的截断值分别为3.940 ng·L-1、2.370；PCT、NLR单独及联合预测PM患儿预后的AUC>0.70，均具有一定的预测价值。PCT、NLR单独预测PM患儿预后的AUC、特异度、敏感度比较差异无统计学意义（P>0.05）；PCT、NLR联合预测PM患儿预后的AUC显著高于PCT、NLR单独预测（P<0.05）；PCT、NLR联合预测PM患儿预后的特异度显著低于NLR单独预测，敏感度显著高于NLR单独预测（P<0.05）。剂量反应曲线分析显示，PCT、NLR水平与PM患儿预后的关联强度呈“S”型非线性剂量反应关系。结论　血清PCT水平及NLR高是PM新生儿预后的独立危险因素，血清PCT水平及NLR联合检测可用于预测PM新生儿预后情况。
Abstract:
Objective　To investigate the correlation between the procalcitonin(PCT),neutrophil to lymphocyte ratio (NLR) and the prognosis of children with neonatal purulent meningitis（PM）.Methods　A total of 122 newborns with PM admitted to the First People′s Hospital of Nanyang from April 2020 to April 2022 were selected as the research subjects.All PM newborns received antibiotics,corticosteroids,and symptomatic support treatment,with a maximum treatment time of 21 days.Based on the prognosis of the newborns within 21 days,122 PM newborns were divided into the mortality group （n=23） and the survival group （n=99）.The baseline data of the children were recorded by reviewing the medical records,including birth age,gender,birth weight,premature birth,birth mode,premature rupture of membranes,and amniotic fluid fecal contamination.The pathogenic bacteria in children with PM were identified by cerebrospinal fluid culture examination.The highest body temperature,incidence of convulsions,and treatment time of PM children were recorded.On the day of admission,8 mL of venous blood was taken from the children,and the white blood cell (WBC),platelet (PLT),red blood cell (RBC),neutrophil (NEU) and lymphocyte (LYM) levels in venous blood were measured with the automatic biochemical analyzer;and the NLR was calculated.The serum C-reactive protein (CRP) and PCT levels of children were detected by enzyme-linked immunosorbent assay.The impact of various factors on the prognosis of children with PM was analyzed by COX regression analysis.The predictive value of PCT and NLR for the prognosis of children with PM was analyzed by the receiver operating characteristic (ROC) curve and the area under curve (AUC).The dose-response relationship between PCT,NLR and prognosis in children with PM was analyzed by the restricted cubic spline method combined with spline function and regression analysis.Results　The incidence of seizures in the mortality group was significantly higher than that in the survival group (χ2=11.675,P<0.05);there was no significant difference in the age,gender,birth weight,premature birth,mode of production,premature rupture of membranes,amniotic fluid fecal contamination,type of pathogenic bacteria,highest body temperature and treatment time of children between the mortality group and survival group (P>0.05).The levels of WBC,NEU,CRP,PCT and NLR in the mortality group were significantly higher than those in the survival group,while the level of LYM was significantly lower than that in the survival group (P<0.05);there was no significant difference in the PLT and RBC levels of children between the mortality group and the survival group (P>0.05).Seizures,high levels of NEU,NLR,CRP and PCT were risk factors for the prognosis of children with PM (risk ratio>1,P<0.05).ROC curve analysis showed that the cutoff values of serum PCT and NLR for predicting the prognosis of children with PM were 3.940 ng·L-1 and 2.370,respectively;the AUC of PCT and NLR alone and in combination for predicting the prognosis of children with PM was greater than 0.70,which had certain predictive value.There was no significant difference in AUC,specificity,and sensitivity between PCT and NLR alone in predicting the prognosis of children with PM (P>0.05);the AUC of combining PCT and NLR in predicting the prognosis of children with PM was significantly higher than that of PCT and NLR alone (P<0.05);the specificity of combining PCT and NLR in predicting the prognosis of children with PM was significantly lower than that of NLR alone,and the sensitivity was significantly higher than that of NLR alone (P<0.05).The dose-response curve analysis showed that the correlation strength between PCT and NLR levels and the prognosis of children with PM showed an "S" type nonlinear dose-response relationship.Conclusion　High serum PCT level and NLR are independent risk factors for the prognosis of PM newborns,and combined detection of serum PCT level and NLR can be used to predict the prognosis of PM newborns.

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更新日期/Last Update: 2023-06-05