摘要
目的探究传染性单核细胞增多症(Infectious mononucleosis,IM)患儿应用糖皮质激素的预测指标。方法回顾性分析2012年1月至2017年12月在浙江大学医学院附属儿童医院住院治疗的554例IM患儿的临床资料,根据患儿病程7 d时临床表现是否改善将其分为病情缓解组(n=436)和病情持续组(n=118),对两组患儿的临床特征、基线实验室检查结果进行单因素分析,应用随机森林模型筛选出重要变量,再纳入二分类Logistic回归模型,分析影响IM患儿病情持续的危险因素。采用受试者工作特征曲线(ROC)评估各指标预测IM患儿病情持续的价值,并用MedCalc 19统计软件对各指标的曲线下面积(AUC)进行比较。随后在2018年141例IM住院患儿中,对符合预测指标者予糖皮质激素,并比较使用前后患儿的临床和实验室指标的变化。采用SPSS 20.0软件对数据进行分析。结果Logistic回归分析结果显示,发热时间(OR=1.493,95%CI 1.372~1.626,P<0.01)、受累系统(OR=2.023,95%CI 1.453~2.817,P<0.01)及铁蛋白水平(OR=1.002,95%CI 1.000~1.004,P<0.05)为IM患儿病情持续的独立危险因素。发热时间的AUC为0.854,临界值为10 d,敏感度为75.4%,特异度为86.9%。受累系统和铁蛋白水平的AUC分别为0.640和0.607。与受累系统、铁蛋白水平相比,发热时间在预测IM患儿病情持续中的价值更高(P<0.01)。2018年的141例IM患儿中,23例发热>10 d,应用糖皮质激素治疗。87.0%(20/23)患儿当日体温高峰开始下降,91.3%(21/23)患儿3 d内下降至正常。所有患儿均在干预后2 d内体温高峰下降,5 d内体温正常。应用糖皮质激素后,患儿的白细胞计数、淋巴细胞计数、异常淋巴细胞计数、血清铁蛋白、血清EB病毒DNA载量及白细胞介素6水平均下降(P<0.05或<0.01)。患儿随访22~34个月未发现EB病毒再活动。结论病情持续的IM患儿常表现为发热时间长、受累系统多及铁蛋白水平增高,需联合糖皮质激素抗炎来控制病情。
Objective To explore the predictors of glucocorticoid application in children with infectious mononucleosis(IM).Methods The clinical data of 554 children with IM admitted in Children’s Hospital,Zhejiang University School of Medicine from January 2012 to December 2017 were retrospectively analyzed.The patients were divided into improved cases(n=436)and deteriorated cases(n=118),according the clinical conditions at day 7 after admission.The clinical characteristics and baseline laboratory examination results of the two groups were analyzed by univariate analysis.The important variables were screened by random forest model,and then included into the binary logistic regression model to analyze the risk factors for deteriorated IM.Receiver operating characteristic(ROC)curve was used to evaluate the value of each factor in predicting deteriorated IM.The area under curve(AUC)of each factor was compared by MedCalc 19 statistical software.Then,141 patients admitted in 2018 who met the predictors were given glucocorticoid,and the changes of clinical and laboratory indicators were compared.SPSS 20.0 software was used to analyze the data.Results Binary logistic regression analysis showed that febrile time(OR=1.493,95%CI 1.372-1.626,P<0.01),involved systems(OR=2.023,95%CI 1.453-2.817,P<0.01)and ferritin level(OR=1.002,95%CI 1.000-1.004,P<0.05)were the independent risk factors of deterioration of IM patients.The AUC of febrile time was 0.854,when the cut-off value was 10 d,the sensitivity and specificity for prediction were 75.4%and 86.9%,respectively.AUC of involved systems and ferritin level were 0.640 and 0.607,respectively.Compared with the involved systems and ferritin level,febrile time had a higher value in predicting deteriorated cases(P<0.01).Among 141 IM patients admitted in 2018,23 cases had fever for more than 10 days,and glucocorticoids were administrated;in whom 20 cases(87.0%)had temperature dropped on the same day,and 21 cases(91.3%)had temperature returned to normal within 3 days.The body temperature dropped within 2 days after glucocorticoid,and was back to normal within 5 days in all children.The white blood cell count,lymphocyte count,lymphocyte count,serum ferritin,serum EBV DNA load and interleukin 6 level were also significantly decreased(P<0.05 or<0.01).No EBV reactivation was found during the follow-up period of 22 to 34 months.Conclusions IM children with persistent illness often present with a persistent fever,more involved systems,and increased ferritin levels.It is necessary to give the patients therapy with glucocorticoid to control their illness.
作者
杨颖
李伟
高峰
Yang Ying;Li Wei;Gao Feng(Department of Neurology,The Children’s Hospital,Zhejiang University School of Medicine,National Clinical Research for Child Health,Hangzhou 310052,China;Clinical Laboratory,The Children’s Hospital,Zhejiang University School of Medicine,National Clinical Research for Child Health,Hangzhou 310052,China)
出处
《中华临床感染病杂志》
CAS
CSCD
2020年第6期412-418,共7页
Chinese Journal of Clinical Infectious Diseases
基金
浙江省重点研发科技计划项目(2020C030038)。
