文章摘要

甲型H1N1流感患儿血常规、血清淀粉样蛋白A及C反应蛋白水平

作者: 1姜 舒亚, 1杨 霞, 1曾 昭成, 1陈 小桥
1 中国人民解放军第一0一医院儿内科,江苏 无锡 214000
通讯: 杨 霞 Email: 871700504@qq.com
DOI: 10.3978/j.issn.2095-6959.2019.01.011
基金: 无锡市卫生与计划生育委员会项目(0201770)。

摘要

目的:分析甲型H1N1流感(简称“甲流”)患儿血常规、血清淀粉样蛋白A(serum amyloid A, SAA)及C反应蛋白(C reactive protein,CRP)水平,为初步诊断儿童甲流提供帮助。方法:选择138例甲流患儿(A组)、126例普通流感患儿(B组)和120名健康对照儿童(C组),统计分析白细胞(white blood cells,WBC)计数、血小板(platelet,PLT)计数、平均血小板体积(mean platelet volume,MPV)、中性粒细胞百分比、淋巴细胞百分比、单核细胞百分比以及全血SAA和CRP 水平。三组间计量资料比较采用F 检验, 两两组间计量资料比较采用LSD检验。结果: 3 组WBC计数差异无统计学意义(F=2.698,P>0.05);A组PLT计数较B组和C组显著降低(F=6.598, P<0.05);A组MPV水平与B,C两组相比,差异有统计学意义(F=5.989,P<0.05)。采用LSD检验进行两两组间比较:A组PLT计数显著低于B组(q=6.26,P<0.05),但与C组相比差异无统计学意义(q=3.02,P>0.05);A组MPV水平显著低于C组(q=6.23,P<0.05),B组MPV水平也显著低于C组(q=6.84,P<0.05),但A组与B组MPV水平无显著差异(q=1.06,P>0.05)。三组中性粒细胞含量、单核细胞含量、淋巴细胞含量差异均有统计学意义(F值分别为5.364,5.261,6.169,均P<0.05)。A组淋巴细胞和中性粒细胞含量与C组比较差异无统计学意义(q值分别为2.36、1.94, 均P>0.05),但A组单核细胞百分比明显高于B组和C组,差异有统计学意义(q值分别为6.29, 6.10,均P<0.05)。A组SAA水平与B组和C组比较,差异有统计学意义(F=8.198,P<0.05)。A组与B组SAA水平差异有统计学意义(q=6.97,P<0.05);A,B两组SAA 水平均显著高于C组,差异有统计学意义(q值分别为6.99、6.07,均P<0.05)。A组CRP 水平与B组和C组比较,差异有统计学意义(F=7.654,P<0.05)。A组与B组间CRP 水平差异无统计学意义(q=1.94,P>0.05);但A, B两组CRP水平均显著高于C组,差异有统计学意义(q值分别为6.48,6.61,均P<0.05)。通过ROC分析得知,SAA诊断甲流的ROC曲线下面积(AUC)为0.823(95%CI 0.701~0.944),最佳诊断临界值为121.34 mg/L;CRP诊断甲流的AUC为0.904(95%CI 0.814~0.994),最佳诊断临界值为 11.06 mg/L。结论:甲流患儿血常规中单核细胞比例、SAA和CRP水平增高,而PLT总数低于普通流感患儿,这可为初步鉴别普通流感和甲流提供参考。
关键词: 甲型H1N1流感;儿童;血常规指标;血清淀粉样蛋白A;C反应蛋白

Plasma routine and serum amyloid A and C-reactive protein levels in influenza A (H1N1) children

Authors: 1JIANG Shuya, 1YANG Xia, 1ZENG Zhaocheng, 1CHEN Xiaoqiao
1 Department of Pediatrics, No. 1 Hospital of the People’s Liberation Army, Wuxi Jiangsu 214000, China

CorrespondingAuthor:YANG Xia Email: 871700504@qq.com

Foundation: This work was supported by Wuxi City Health and Family Planning Commission Project, China (0201770).

Abstract

Objective: To analyze the characteristics of blood routine test, serum amyloid A and C-reactive protein (CRP) levels in children with influenza A (H1N1) so as to provide help for the preliminary diagnosis of influenza A in children. Methods: A total of 138 children with influenza (group A), 126 children with flu (group B) and 120 healthy controls (group C) were selected. WBC, PLT, MPV, percentage of neutrophils, percentage of lymphocytes, percentage of monocytes and total number of leukocytes were analyzed statistically. Blood SAA and CRP levels. The F data were compared between the three groups. LSD test was used to compare the data between the 2 groups. Results: There was no significant difference in WBC count among the 3 groups (F=2.698, P>0.05); PLT count in group A was significantly lower than that in group B and C (F=6.598, P<0.05); MPV level in group A was significantly lower than that in group B and C (F=5.989, P<0.05). The results showed that the total number of PLT in group A was significantly lower than that in group B (q=6.26, P<0.05), but there was no significant difference between group A and group C (q=3.02, P>0.05); the MPV level in group A was significantly lower than that in group C (q=6.23, P<0.05), and the MPV level in group B was significantly lower than that in group C (q=6.84, P<0.05). However, there was no significant difference in MPV level between group A and group B (q=1.06, P>0.05). There were significant differences in neutrophil content, monocyte content and lymphocyte content among the three groups (F values were 5.364, 5.261 and 6.169 respectively, P<0.05). There was no significant difference in lymphocyte and neutrophil contents between group A and group C (q values were 2.36, 1.94, P>0.05), but the percentage of monocytes in group A was significantly higher than that in group B and C (q values were 6.29, 6.10, P<0.05). The level of SAA in group A was significantly different from that in group B and group C (F=8.198, P<0.05). There was significant difference in SAA level between group A and group B (q=6.97, P<0.05). The levels of SAA in group A and group B were significantly higher than those in group C (q=6.99, 6.07, P<0.05). The level of CRP in group A was significantly different from that in group B and group C (F=7.654, P<0.05). There was no significant difference in CRP level between group A and group B (q=1.94, P>0.05), but the levels of CRP in group A and group B were significantly higher than those in group C (q=6.48, 6.61, P<0.05). ROC analysis showed that the area under ROC curve (AUC) of SAA was 0.823 (95% CI 0.701–0.944), and the optimal diagnostic threshold was 121.34 mg/L; the AUC of CRP was 0.904 (95% CI 0.814–0.994), and the optimal diagnostic threshold was 11.06 mg/L. Conclusion: The proportion of monocytes, the levels of SAA and CRP in the blood routine of children with influenza A were increased, while the total number of PLT was lower than that of children with influenza A.
Keywords: H1N1 influenza; children; routine blood test; serum amyloid A; C-reactive protein