【摘要】 目的 探讨白细胞计数（WBC）、C反应蛋白（CRP）及淋巴细胞与单核细胞比值（LMR）预测细菌性下呼吸道感染的临床价值。方法 选取2018年1月至2023年10月泰安市妇幼保健院儿内科住院并确诊为下呼吸道感染的7 767例患儿为研究对象，依据细菌培养结果将其分为细菌感染组（n=3 161）、非细菌感染组（n=4 606）；同期选取4 718名健康体检者作为对照组。分别检测三组的血常规参数及CRP水平，计算中性粒细胞与淋巴细胞比值（NLR）、LMR、血小板与淋巴细胞比值（PLR）、系统免疫炎症指数（SII）。采用Logistic回归分析及受试者工作特征（ROC）曲线分析WBC、CRP、LMR对细菌性下呼吸道感染的预测诊断价值。结果 细菌感染组的WBC、CRP水平及NLR、PLR、SII均显著高于对照组和非细菌感染组，LMR显著低于对照组和非细菌感染组，差异具有统计学意义（P<0.05）；非细菌感染组的WBC、LMR显著低于对照组，CRP水平及NLR、PLR、SII均显著高于对照组，差异具有统计学意义（P<0.05）。Logistic回归分析结果显示，高WBC、CRP及低LMR是细菌性下呼吸道感染的独立危险因素（P<0.05）。ROC曲线分析结果显示，单项检测中，CRP的特异度最高，为75.10%;WBC、CRP、LMR联合检测鉴别诊断细菌及非细菌性下呼吸道感染的曲线下面积（AUC）、灵敏度优于单项检测。结论 高WBC、CRP及低LMR是细菌性下呼吸道感染的独立危险因素；WBC、CRP、LMR联合检测对细菌及非细菌性下呼吸道感染的鉴别诊断价值优于单项检测。更多还原

【Abstract】 Objective To explore the clinical value of white blood cell count(WBC), C-reactive protein(CRP),and lymphocyte to monocyte ratio(LMR) in predicting bacterial lower respiratory tract infection. Methods A total of 7 767 children who were hospitalized in the pediatrics internal medicine department of Tai’an Maternity and Child Health Hospital from January 2018 to October 2023 and diagnosed with lower respiratory tract infection were selected as the research objects. According to the results of bacterial culture, the children were divided into bacterial infection group(n=3 161) and non-bacterial infection group(n=4 606); at the same time, 4 718 healthy subjects were selected as control group. The blood routine parameters and CRP level of the three groups were detected, and the neutrophil to lymphocyte ratio(NLR), LMR, platelet to lymphocyte ratio(PLR), and systemic immune inflammatory index(SII) were calculated. Logistic regression analysis and receiver operating characteristic(ROC) curve were used to analyze the predictive diagnostic value of WBC, CRP and LMR for bacterial lower respiratory tract infection. Results The WBC, CRP level,NLR, PLR and SII in the bacterial infection group were significantly higher than those in the control group and the non-bacterial infection group, LMR was significantly lower than that in the control group and the non-bacterial infection group, and the differences were statistically significant(P<0.05); the WBC and LMR in the non-bacterial infection group were significantly lower than those in the control group, the CRP level,NLR, PLR and SII were significantly higher than those in the control group, and the differences were statistically significant(P<0.05). Logistic regression analysis results showed that high WBC, CRP and low LMR were independent risk factors for bacterial lower respiratory tract infection(P<0.05). ROC curve analysis results showed that the specificity(75.10%) of CRP was the highest in single detection; the area under curve(AUC)and sensitivity of combined detection of WBC, CRP and LMR in differential diagnosis of bacterial and nonbacterial lower respiratory tract infection were better than those of single detection. Conclusion High WBC,CRP and low LMR are independent risk factors for bacterial lower respiratory tract infection; the value of combined detection of WBC, CRP and LMR in differential diagnosis of bacterial and non-bacterial lower respiratory tract infections is better than that of single detection.更多还原