【摘要】 目的 探讨淋巴细胞与单核细胞比值（LMR）、降钙素原（PCT）与儿童重症肺炎（SP）严重程度的关系及其预后评估价值。方法 选取2021年1月-2023年9月泰安市妇幼保健院儿内科住院并确诊的SP患儿223例作为研究对象。根据肺炎严重指数评分（PSI）将患儿分为低危组78例、中危组93例、高危组52例；按照患儿预后情况分为预后良好组152例、预后不良组71例。检测血常规及PCT水平，计算中性粒细胞/淋巴细胞比值（NLR）、LMR、血小板/淋巴细胞比值（PLR）、系统免疫炎症指数（SII）。采用Spearman相关性分析LMR、PCT与PSI评分的相关性；采用Logistic回归分析SP预后不良的独立危险因素；采用受试者工作特征（ROC）曲线评估LMR、PCT对SP预后的预测价值。结果 不同病情严重程度SP患儿的LMR呈现高危组<中危组<低危组，PCT水平呈现低危组<中危组<高危组，差异均有统计学意义（P<0.05）。与低危组比较，高危组NLR、PLR、SII、hs-CRP均升高，中危组NLR、SII均升高（P<0.05）。Spearman相关分析显示，LMR与PSI呈负相关（r=-0.398,P<0.05）,PCT与PSI呈正相关（r=0.348,P<0.05）。与预后良好组比较，预后不良组血PCT、NLR、PLR、SII、hs-CRP水平均升高，LMR水平降低（P<0.05）。Logistic单因素回归分析显示，高PCT、PLR、SII及低LMR与SP患儿不良预后独立相关。多因素回归分析显示，校正年龄、性别影响后，PCT的升高、LMR的降低仍可作为影响SP患儿预后不良的独立危险因素。ROC曲线分析显示，LMR、PCT联合检测对SP患儿预后诊断的灵敏度、特异度、AUC均优于单项检测。结论 LMR、PCT与SP患儿病情严重程度及预后密切相关，是SP预后不良的独立危险因素，联合检测对SP预后不良的预测价值更高。更多还原

【Abstract】 Objective To investigate the relationship between lymphocyte-to-monocyte ratio(LMR), procalcitonin(PCT) and the severity of severe pneumonia(SP) in children and its prognostic value. Methods A total of 223 children with SP who were hospitalized and diagnosed in the Department of Pediatrics at Tai′ an Maternity and Child Health Hospital from January 2021 to September 2023 were selected as the study objects.According to the pneumonia severity index score(PSI), the patients were divided into low-risk group(78 patients), medium-risk group(93 patients),and high-risk group(52 patients); according to the prognosis, the patients were divided into good prognosis group(152 patients) and poor prognosis group(71 patients). Blood routine and PCT levels were measured, and neutrophil/lymphocyte ratio(NLR), LMR, platelet/lymphocyte ratio(PLR), and systemic immune inflammation index(SII) were calculated. Spearman correlation analysis was used to analyze the correlation between LMR, PCT and PSI score. Logistic regression was used to analyze the independent risk factors for poor prognosis of SP. The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of LMR and PCT for the prognosis of SP. Results The LMR of SP patients with different severity levels was as follows: high-risk group<medium-risk group<low-risk group, and PCT level was as follows: low-risk group<medium-risk group<highrisk group, with statistically significant differences(P<0.05). Compared with the low-risk group, the NLR, PLR, SII, and hs-CRP in the high-risk group were increased, the NLR and SII in the medium-risk group were increased(P <0.05). Spearman correlation analysis showed that LMR was negatively correlated with PSI(r=-0.398, P<0.05), PCT was positively correlated with PSI(r=0.348, P<0.05). Compared with the good prognosis group,the PCT, NLR, PLR, SII, and hs-CRP levels in the poor prognosis group were increased, while the LMR level was decreased( P <0.05). Logistic univariate regression analysis showed that high PCT, PLR, SII and low LMR were independently associated with poor prognosis in children with SP.Multivariate regression analysis showed that after adjusting for age and gender, the increase of PCT and the decrease of LMR could still be used as independent risk factors for poor prognosis in children with SP. ROC curve analysis showed that the sensitivity, specificity and AUC of combined detection of LMR and PCT in the prognosis diagnosis of SP children were better than those of single detection. Conclusion LMR and PCT are closely related to the severity and prognosis of children with SP, and are independent risk factors for poor prognosis of SP. The combined detection has a higher predictive value for poor prognosis of SP.更多还原