目的: 探讨炎症负担指数（inflammation burden index,IBI）与儿童重症腺病毒感染后闭塞性细支气管炎（bronchiolitis obliterans,BO）的关系。方法: 将2023年4月至2025年3月本院收治的215例单纯重症腺病毒感染患儿作为非BO组,将同期收治的82例重症腺病毒感染后BO患儿作为BO组。检测患儿C-反应蛋白（C-reactive protein,CRP）水平、中性粒细胞（neutrophil,NE）计数、淋巴细胞（lymphocyte,LYM）计数,并计算IBI（IBI=CRP×NE/LYM）。采用受试者工作特性（receiver operating characteristic,ROC）曲线评估CRP、NE、LYM、IBI对重症腺病毒感染患儿BO的预测价值;采用多因素Logistic回归分析探讨重症腺病毒感染患儿BO的影响因素。结果: BO组CRP、NE、IBI高于非BO组,LYM低于非BO组。CRP、NE、LYM、IBI预测重症腺病毒感染患儿BO的曲线下面积（95% CI）分别为0.852（0.849~0.905）、0.761（0.718~0.814）、0.742（0.689~0.795）、0.903（0.850~0.956）,截断值分别为18.40 mg/L、2.78×109/L、1.70×109/L、31.58,特异度分别为67.11%、58.27%、56.35%、87.36%,灵敏度分别为91.25%、92.41%、92.41%、84.19%。BO组年龄小于非BO组,发热持续时间≥5 d、低氧血症、机械通气、肺外并发症所占比例均大于非BO组。多因素分析显示,发热持续时间长（OR=2.081,95%CI：1.483~2.921）、有机械通气（OR=2.342,95%CI：1.598~3.432）、高水平CRP（OR=3.524,95%CI：1.692~3.765）、IBI高（OR=3.025,95%CI：1.943~4.711）是重症腺病毒感染患儿BO的危险因素。结论: IBI高可能与重症腺病毒感染患儿BO发病有关,临床可及性强,可望作为预测重症腺病毒感染后并发BO的重要标记物。
Abstract
Objective To explore the relationship between inflammation burden index (IBI) and bronchiolitis obliterans (BO) after severe adenovirus infection in children. Methods A total of 215 children with severe adenovirus infection without BO from April 2023 to March 2025 were selected as the non-BO group, and 82 children with severe adenovirus infection and BO during the same period were selected as the BO group. C-reactive protein (CRP), neutrophil count (NE), and lymphocyte count (LYM) were detected, and IBI was calculated (IBI=CRP×NE/LYM). The predictive value of CRP, NE, LYM, and IBI for BO in children with severe adenovirus infection was evaluated by the receiver operating characteristic (ROC) curve. The influencing factors of BO in children with severe adenovirus infection were explored by multivariate Logistic regression. Results CRP, NE, and IBI were higher in the BO group than in the non-BO group, while LYM was lower (P<0.05). The area under the curve (AUC) (95%CI) of CRP, NE, LYM, and IBI for predicting BO in children with severe adenovirus infection were 0.852(0.849-0.905), 0.761(0.718-0.814), 0.742(0.689-0.795), and 0.903(0.850-0.956), respectively. The cut-off values were 18.40 mg/L, 2.78×109/L, 1.70×109/L, and 31.58, respectively. The specificity was 67.11%, 58.27%, 56.35%, and 87.36%, respectively, and the sensitivity was 91.25%, 92.41%, 92.41%, and 84.19%, respectively. The age of the BO group was younger than that of the non-BO group, and the proportion of children with fever duration ≥5 days, hypoxemia, mechanical ventilation, and extrapulmonary complications was higher in the BO group than in the non-BO group. Multivariate analysis showed that long fever duration (OR=2.081, 95%CI: 1.483-2.921), mechanical ventilation (OR=2.342, 95%CI: 1.598-3.432), high CRP level (OR=3.524, 95%CI: 1.692-3.765), and high IBI (OR=3.025, 95%CI: 1.943-4.711) were risk factors for BO in children with severe adenovirus infection. Conclusion IBI is highly likely to be associated with the onset of BO in children with severe adenovirus infection, and has strong clinical accessibility. It is expected to serve as an important biomarker for predicting the occurrence of BO after severe adenovirus infection.
关键词
炎症负担指数 /
腺病毒感染 /
儿童 /
闭塞性细支气管炎
Key words
inflammation burden index /
adenovirus infection /
children /
obliterans bronchiolitis
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基金
湖南省卫生健康委科研计划项目“儿童感染后闭塞性细支气管炎的高危因素及治疗”（C2016021）
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