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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (06) : 559 -564. doi: 10.3877/cma.j.issn.1674-1358.2018.06.008

所属专题： 文献；

论著

中性粒细胞/淋巴细胞比值与手足口病患儿重症化的相关性
李亚萍1, 翟嵩1,†(), 李梅1, 王媛1, 邓慧玲2, 张欣1, 党双锁1   
  1. 1. 710004　西安市，西安交通大学第二附属医院感染科
    2. 710004　西安市，西安交通大学第二附属医院感染科；710043　西安市，西安市儿童医院
  • 收稿日期:2018-05-02 出版日期:2018-12-15
  • 通信作者: 翟嵩
  • 基金资助:
    国家自然科学基金青年项目(No. 81701632); 陕西省重点项目-社会发展领域(No. 2017ZDXM-SF-07)

Neutrophil-lymphocyte ratio as a prognostic factor in severe hand, foot and mouth disease

Yaping Li1, Song Zhai1,†(), Mei Li1, Yuan Wang1, Huiling Deng2, Xin Zhang1, Shuangsuo Dang1   

  1. 1. Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China
    2. Department of Infectious Disease, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China; Department of Infectious Diseases, Xi’an Children’s Hospital, Xi’an 710043, China
  • Received:2018-05-02 Published:2018-12-15
  • Corresponding author: Song Zhai
  • About author:
    Corresponding author: Zhai Song, Email:
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引用本文：

李亚萍, 翟嵩, 李梅, 王媛, 邓慧玲, 张欣, 党双锁. 中性粒细胞/淋巴细胞比值与手足口病患儿重症化的相关性[J]. 中华实验和临床感染病杂志(电子版), 2018, 12(06): 559-564.

Yaping Li, Song Zhai, Mei Li, Yuan Wang, Huiling Deng, Xin Zhang, Shuangsuo Dang. Neutrophil-lymphocyte ratio as a prognostic factor in severe hand, foot and mouth disease[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(06): 559-564.

目的

探讨中性粒细胞/淋巴细胞比值（NLR）预测手足口病（HFMD）患儿重症化的临床价值。

方法

回顾性分析2008年5月至2017年12月西安交通大学第二附属医院和西安市儿童医院收治的1 593例手足口病患儿，根据病情程度分为普通病例组（929例）和重症病例（664例）。利用受试者工作特征曲线（ROC工作曲线）计算中性粒细胞/淋巴细胞比值（NLR）预测HFMD重症化的最佳临界值，根据NLR将1 593例患儿分为高NLR组和低NLR组；多因素二分类Logistic回归分析各相关因素与手足口病患儿重症化的相关性。

结果

重症手足口病组与普通病例组患儿的发热、高热、神经系统症状、循环系统症状、白细胞（WBC）、NLR、降钙素原（PCT）、血糖、肠道病毒71型IgM抗体（EV71-IgM）阳性、合并Epstein-Barr病毒（EBV）感染等差异均有统计学意义（P均< 0.05）。利用受试者工作特征曲线（ROC工作曲线）确定NLR比值预测重症化的最佳临界值为1.59；多因素Logistic回归分析显示，高热（> 39 ℃）、EV71-IgM阳性、合并EBV感染、血糖> 8.3 mmol/L、PCT > 0.1 ng/ml和NLR > 1.59均为HFMD重症化的危险因素[比值比（OR）值分别为1.557、5.124、3.533、7.323、1.727和2.031，P均< 0.01]。

结论

NLR> 1.59与HFMD重症化密切相关，具有重要的预测价值。NLR为指导HFMD初诊患儿临床决策和治疗方案的临床指标之一。

关键词: 手足口病, 中性粒细胞/淋巴细胞比值, 重症化, 危险因素
Objective

To investigate the clinical implication of the neutrophil to lymphocyte ratio (NLR) in predicting the severity of hand, foot and mouth disease (HFMD).

Methods

From May 2008 to December 2017, a total of 1 593 children with HFMD were collected from The Second Affiliated Hospital of Xi’an Jiaotong Univesity and Xi’an Children’s Hospital. According to the degree of illness, they were divided into mild HFMD group (929 cases) and severe HFMD group (664 cases). The best critical value of neutrophil/lymphocyte ratio (NLR) for predicting the severity of HFMD was calculated by receiver operating characteristic curve (ROC curve). According to NLR, 1 593 children were divided into high NLR group and low NLR group. Multivariate two-classification Logistic regression analysis was used to analyze the correlation between the factors and the severity of children with HFMD.

Results

Fever, hyperpyrexia, nervous system symptom, circulatory system symptom, leukocyte (WBC), NLR, procalcitonin (PCT), blood sugar, enterovirus 71 IgM antibody (EV71-IgM) positive and infection with Epstein-Barr virus (EBV) were all with significant differences in severe HFMD group compared with those of mild HFMD group (all P < 0.05). The optimal critical value of NLR ratio to predict severity was 1.59 detected by ROC curve. Multivariate Logistic regression analysis showed that high fever (> 39 ℃), positive EV71-IgM, complicated with EBV infection, blood glucose > 8.3 mmol/L, PCT > 0.1 ng/ml and NLR > 1.59 were all risk factors for severe HFMD. The ratio of odds ratio (OR) were 1.557, 5.124, 3.533, 7.323, 1.727 and 2.031, respectively (all P < 0.01).

Conclusions

NLR > 1.59 is closely related to the severity of HFMD, which has important predictive value. NLR is one of the clinical indexes to guide the clinical decision and treatment of children with HFMD.

Key words: Hand, foot and mouth disease, Neutrophil-to-lymphocyte ratio, Severity, Risk factor
表1 HFMD患儿普通病例和重症病例的临床特点
临床特征 普通病例（929例） 重症病例（664例） 统计量 P值
男/女（例） 568/361 418/246 χ2 = 0.538 0.463
年龄≤ 3岁[例（%）] 726（78.1） 526（79.2） χ2 = 0.263 0.608
皮疹[例（%）] 929（100.0） 664（100.0） — —
发热[例（%）] 836（89.9） 663（99.8） χ2 = 59.812 < 0.001
热程> 3 d [例（%）] 328（38.1） 520（78.4） χ2 = 246.915 < 0.001
高热> 39 ℃ [例（%）] 325（38.9） 363（63.5） χ2 = 51.289 < 0.001
嗜睡[例（%）] 29（3.2） 385（67.4） χ2 = 714.127 < 0.001
易惊[例（%）] 404（44.7） 549（96.1） χ2 = 404.521 < 0.001
肢体抖动[例（%）] 62（6.9） 475（83.2） χ2 = 879.832 < 0.001
抽搐[例（%）] 15（1.7） 117（20.5） χ2 = 152.111 < 0.001
呕吐[例（%）] 257（19.6） 506（63.4） χ2 = 330.970 < 0.001
病理反射[例（%）] 0（0.0） 656（98.8） — —
呼吸困难[例（%）] 0（0.0） 120（18.0） — —
循环障碍[例（%）] 0（0.0） 137（20.6） — —
WBC > 15 × 109/L [例（%）] 146（15.7） 194（29.2） χ2 = 42.044 < 0.001
NLR [M（R）] 1.43（0.11～15.52） 2.04（0.20～19.35） Z = 4.581 < 0.001
NLR（±s） 1.91 ± 1.68 2.90 ± 2.55 t =－9.288 < 0.001
NLR> 1.59 [例（%）] 392（42.2） 424（63.9） χ2 = = 72.709 < 0.001
降钙素原> 0.1 μg/ml [例（%）] 267（28.7） 292（44.0） χ2 = 39.461 < 0.001
空腹血糖> 8.3 mmol/L [例（%）] 21（2.3%） 164（24.7） χ2 = 189.935 < 0.001
EV71-IgM阳性[例（%）] 253（27.2） 450（67.8） χ2 = 258.088 < 0.001
合并EBV IgG阳性[例（%）] 190（20.5） 396（59.6） χ2 = 255.708 < 0.001
a死亡[例（%）] 0（0.0） 97（14.6） — —
图1 1 593例HFMD患儿粒细胞淋巴细胞比值预测重症化的受试者工作曲线
表2 NLR与手足口病重症化的多因素分析
相关因素 未调整[OR（95%CI）] 调整[OR（95%CI）] P值
性别 0.938（0.735～1.197） 0.966（0.745～1.252） 0.791
年龄< 3岁 0.926（0.754～1.137） 0.803（0.591～1.091） 0.161
高热> 39 ℃ 2.124（1.726～2.614） 1.557（1.206～2.011） 0.001
EV71 IgM阳性 5.619（4.520～6.984） 5.124（3.954～6.639） < 0.001
合并EBV感染 5.747（4.601～7.178） 3.533（2.726～4.580） < 0.001
WBC > 15 × 109/L 2.214（1.736～2.823） 1.262（0.916～1.738） 0.155
血糖> 8.3 mmol/L 14.182（8.889～22.628） 7.323（4.297～12.478） < 0.001
降钙素原> 0.1 ng/ml 1.946（1.579～2.399） 1.727（1.321～2.258） < 0.001
NLR > 1.59 2.420（1.972～2.971） 2.031（1.564～2.637） < 0.001
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