摘要
目的 比较噬血细胞性淋巴组织细胞增生症(HLH)与脓毒症的临床特征,寻找帮助鉴别诊断的实验室指标。方法 回顾性分析2013年1月—2020年12月无基础疾病HLH以及发热伴外周血二系细胞减少或脾脏肿大的脓毒症患儿的临床资料。结果 共106例患儿纳入研究。HLH组患儿72例,男46例、女26例,中位年龄26.5(14.3~56.8)个月;脓毒症组患儿34例,男18例、女16例,中位年龄14.0(3.8~89.0)个月。脓毒症组总住院时间和PICU入住时间均长于HLH组,差异有统计学意义(P<0.05)。与脓毒症组相比,HLH组的白细胞计数(WBC)-Min、中性粒细胞绝对值(ANC)-Min、血红蛋白(HB)-Min、血小板计数-Min、肌酐(CREA)-Max、纤维蛋白原(FIB)-Min、C反应蛋白-Max、降钙素原(PCT)-Max较低,三酰甘油-Max、血清铁蛋白(SF)-Max较高,HB减少持续时间较短,ANC减少持续时间较长,组间差异均有统计学意义(均P<0.05)。多因素logistic回归分析发现WBC-Min、FIB-Min、CREA-Max和PCT-Max水平的下降有助于诊断HLH(P<0.05)。ROC曲线分析显示,SF-Max协助判断HLH的AUC为0.72(95%CI:0.62~0.80)。经logistic回归方程拟合,获得WBC-Min、FIB-Min、CREA-Max和PCT-Max的联合预测因子,其协助判断HLH的AUC为0.95(95%CI:0.89~0.99);联合预测因子的AUC显著大于SF-Max,差异有统计学意义(P<0.01)。结论 WBC-Min、FIB-Min、CREA-Max、PCT-Max四项指标拟合可能有助于更好鉴别HLH和脓毒症。
Objective To compare the clinical features of hemophagocytic lymphohistiocytosis(HLH)and sepsis,and to find laboratory markers to help differential diagnosis.Methods The clinical data of HLH children without underlying disease or sepsis children with fever and decreased peripheral blood two cell lines or splenomegaly from January 2013 to December 2020 was retrospectively analyzed.Results A total of 106 patients were enrolled in this study.There were 72 children(46 boys and 26 girls)in the HLH group,and the median age was 26.5(14.3-56.8)months.There were 34 children(18 boys and 16 girls)in the sepsis group,and the median age was 14.0(3.8-89.0)months.The total length of hospital stay and PICU stay in the sepsis group were longer than those in the HLH group,and the differences were statistically significant(P<0.05).Compared with the sepsis group,the white blood cell count(WBC)-Min,absolute neutrophil count(ANC)-Min,hemoglobin(HB)-Min,platelet count(PLT)-Min,creatinine(CREA)-Max,fibrinogen(FIB)-Min,C-reactive protein(CRP)-Max,and procalcitonin(PCT)-Max were lower,and triglyceride-Max and serum ferritin(SF)-Max were higher in the HLH group.The duration of HB reduction was shorter in the HLH group,while the duration of ANC reduction was longer,and the differences between the two groups were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that the decreased levels of WBC-Min,FIB-Min,CREA-Max and PCT-Max were helpful for the diagnosis of HLH(P<0.05).The AUC of SF-Max to aid in the diagnosis of HLH was 0.72(95%CI:0.62-0.80),according to ROC curve analysis.The combined predictors of WBC-Min,FIB-Min,CREAMax and PCT-Max were obtained by logistic regression equation fitting,and the AUC of which in the diagnosis of HLH was 0.95(95%CI:0.89-0.99).The AUC of the combined predictors was significantly larger than that of SF-Max,and the difference was statistically significant(P<0.01).Conclusions The fitting of WBC-Min,FIB-Min,CREA-Max and PCT-Max may help to better distinguish HLH from sepsis.
作者
钟小梅
任宏
张建
李璧如
钱娟
宁铂涛
高怡瑾
王莹
ZHONG Xiaomei;REN Hong;ZHANG Jian;LI Biru;QIAN Juan;NING Botao;GAO Yijin;WANG Ying(Department of Pediatric Intensive Care Unit,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Department of Hematology&Oncology,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2024年第6期547-552,共6页
Journal of Clinical Pediatrics
