论文部分内容阅读
目的本文通过探讨麻疹合并肺炎患儿的临床特点,分析提示重症患儿的相关指标,运用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价其诊断重症麻疹合并肺炎的价值,从而提高认识,指导治疗。方法回顾性分析河北省儿童医院呼吸一科住院治疗的62例麻疹合并肺炎患儿的临床资料,根据病情将患儿分为重症组(n=15)与对照组(n=47)。入院24 h内空腹抽取静脉血采用仪器法检测外周血WBC、NE%、PLT,免疫比浊法检测CRP及Ig M、Ig A、Ig G,酶法检测LDH,溴甲酚绿法检测白蛋白。运用单因素统计分析方法,比较2组患儿的临床特点及实验室指标,对差异有统计学意义的指标绘制ROC曲线。结果 2组患儿麻疹疫苗接种史、WBC、NE%、PLT、Ig M、Ig A、Ig G、白蛋白差异无统计学意义(P>0.05)。重症组入院前病程[10.0(5.0,15.0)d]长于对照组[6.0(3.0,10.0)d],热程[11.0(8.0,16.0)d]长于对照组[7.0(3.0,9.0)d](P<0.05)。重症组CRP[17.0(4.0,50.0)mg/L]高于对照组[6.0(1.0,13.0)mg/L],其LDH[433.0(373.0,601.0)U/L]高于对照组[352.0(277.0,427.0)U/L](均P<0.05)。经ROC曲线评价,入院前病程、热程、CRP、LDH的ROC曲线下面积(the areas under the ROC curve,AUC)分别为0.689、0.784、0.723、0.731,临界值分别为9 d、7.5 d、25.5 mg/L、366.0 U/L,其诊断重症麻疹合并肺炎患儿的敏感度分别为60.0%、93.3%、73.3%、86.7%,特异度分别为74.5%、57.4%、68.1%、59.6%,95%CI分别为0.547~0.830、0.657~0.911、0.566~0.881、0.587~0.876。结论入院前病程、热程、CRP、LDH是重症麻疹合并肺炎的相关指标。入院前病程、热程长及CRP、LDH高的患儿易表现为重症麻疹合并肺炎。入院前病程对重症麻疹合并肺炎具有较低诊断价值,而热程、CRP、LDH具有中等诊断价值。
Objective To investigate the clinical features of children with measles complicated with pneumonia and to analyze the relevant indicators of children with severe measles and evaluate the value of the receiver operating characteristic curve (ROC) in diagnosis of severe measles complicated with pneumonia so as to raise awareness , Guide treatment. Methods The clinical data of 62 cases of children with measles and pneumonia admitted to Department of Respiratory Medicine of Children’s Hospital of Hebei Province were retrospectively analyzed. The children were divided into severe group (n = 15) and control group (n = 47) according to the condition. Venous blood samples were collected within 24 h after admission. WBC, NE% and PLT in peripheral blood were detected by instrumental method. CRP and Ig M, Ig A and Ig G were detected by immunoturbidimetry. LDH and bromocresol green assay were used to detect albumin . The single factor statistical analysis method was used to compare the clinical features and laboratory indexes of two groups of children and to draw the ROC curve for the indexes with statistically significant difference. Results There was no significant difference in the history of measles vaccination, WBC, NE%, PLT, IgM, IgA, Ig G and albumin between the two groups (P> 0.05). The duration of pre-admission [10.0 (5.0,15.0) d] in the critically ill group was longer than that in the control group [6.0 (3.0,10.0) d] and was longer than that in the control group [7.0.0 3.0 and 9.0 d] (P <0.05). The severe group had higher CRP [17.0 (4.0,50.0) mg / L] than control group [6.0 (1.0,13.0) mg / L] and LDH [433.0 (373.0,601.0] U / L] 277.0, 427.0) U / L] (all P <0.05). The ROC curve showed that the areas under the ROC curve (AUC) were 0.689,0.784,0.723,0.731 and the critical values were 9 d, 7.5 d, 25.5 mg / L and 366.0 U / L respectively. The sensitivity of the method for diagnosing severe measles complicated with pneumonia were 60.0%, 93.3%, 73.3% and 86.7%, respectively. The specificities were 74.5%, 57.4%, 68.1% and 59.6% , 95% CI were 0.547 ~ 0.830,0.657 ~ 0.911,0.566 ~ 0.881,0.587 ~ 0.876. Conclusion Pre-admission course of disease, fever, CRP and LDH are the related indicators of severe measles complicated with pneumonia. Pre-admission course of disease, long length of fever and CRP, LDH high in children prone to severe measles with pneumonia. The course of pre-admission has a low diagnostic value for severe measles complicated with pneumonia, and the heat stroke, CRP, LDH have moderate diagnostic value.