背景:哮喘是一种慢性炎症性疾病,其特征是急性哮喘发作(AAE)。除了慢性气道炎症,这对受影响的患者和他们的父母都有巨大的影响。这项研究的主要目的是探索可用的白细胞衍生的炎症标志物在诊断AAE和识别需要进入儿科重症监护病房(PICU)的严重恶化风险的儿童中的实用性。
方法:本研究为回顾性队列研究。回顾了128名被诊断为哮喘恶化的儿童和131名2至12岁的稳定哮喘儿童的医疗记录。
结果:共有259名参与者入组。AAE患儿的白细胞计数显着升高(WBC:10.0±4.2×103/μLvs.7.1±2.2×103/μL,p<0.001),绝对中性粒细胞计数(ANC:7398.5±4600细胞/μLvs.2634.8±1448个细胞/μL,p<0.001),和中性粒细胞与淋巴细胞的比率(NLR:7.0±6.8与0.9±0.7,p<0.001),但绝对淋巴细胞计数显着降低(ALC:1794.1±1536×103/μLvs.3552.9±1509×103/μL,p<0.001)。有趣的是,血液嗜酸性粒细胞计数显示出相反的趋势:与经历恶化的儿童相比,稳定的哮喘儿童的嗜酸性粒细胞明显更多(370.1±342.7细胞/mm3vs.0.9±1.9细胞/mm3,p<0.001)。确定了指示AAE的两个标准:NLR值大于1.2,具有良好的辨别能力(曲线下面积[AUC]0.90;95%置信区间[CI]0.85-0.94;灵敏度82.5%;特异性79.5%),ANC值超过3866,具有中等辨别能力(AUC0.86;95%CI0.81-0.91;敏感性75.0%;特异性82.3%)。此外,这些标记的比较分析(NLR,ANC,PLR,WBC,AEC,AAE患者和ALC)在需要PICU入院的患者和不需要PICU的患者之间没有显着差异。
结论:这项研究贡献了两个主要发现。首先是NLR,ANC,WBC,与稳定哮喘患者相比,AAE患者的PLR明显更高。第二个是与AAE相比,哮喘稳定儿童的AEC和ALC水平更高。此外,这项研究表明,所研究的标记(NLR,ANC,PLR,WBC,AEC,和ALC)没有区分需要PICU入院的AAE患者和普通病房的患者,这表明需要替代预测因素。
BACKGROUND: Asthma is a chronic inflammatory condition characterized by episodes of acute asthma exacerbations (AAEs), in addition to chronic airway inflammation, which has a huge impact on both the affected patients and their parents. The main objective of this study was to explore the utility of available white-blood-cell-derived inflammatory markers in diagnosing AAEs and identifying children at risk for severe exacerbations requiring admission to the pediatric intensive care unit (PICU).
METHODS: This study was a retrospective cohort study. The medical records of 128 children diagnosed with asthma exacerbation and 131 children with stable asthma between the ages of 2 and 12 years were reviewed.
RESULTS: A total of 259 participants were enrolled. Children with AAE demonstrated significantly higher white blood cell counts (WBC: 10.0 ± 4.2 × 103/μL vs. 7.1 ± 2.2 × 103/μL, p < 0.001), absolute neutrophil counts (ANC: 7398.5 ± 4600 cells/μL vs. 2634.8 ± 1448 cells/μL, p < 0.001), and neutrophil-to-lymphocyte ratios (NLR: 7.0 ± 6.8 vs. 0.9 ± 0.7, p < 0.001) but significantly lower absolute lymphocyte counts (ALC: 1794.1 ± 1536 × 103/μL vs. 3552.9 ± 1509 × 103/μL, p < 0.001). Interestingly, blood
eosinophil count displayed an opposite trend: children with stable asthma had significantly more eosinophils compared to those experiencing an exacerbation (370.1 ± 342.7 cells/mm3 vs. 0.9 ± 1.9 cells/mm3, p < 0.001). Two criteria that are indicative of AAE were identified: NLR values greater than 1.2, with good discriminative ability (area under the curve [AUC] 0.90; 95% confidence interval [CI] 0.85-0.94; sensitivity 82.5%; specificity 79.5%), and ANC values exceeding 3866, with moderate discriminative ability (AUC 0.86; 95% CI 0.81-0.91; sensitivity 75.0%; specificity 82.3%). Moreover, a comparative analysis of these markers (NLR, ANC, PLR, WBC, AEC, and ALC) in patients with AAE did not demonstrate significant differences between those requiring PICU admission and those who did not require it.
CONCLUSIONS: This study contributes two major findings. The first is that NLR, ANC, WBC, and PLR are significantly higher in AAE patients compared to those with stable asthma. The second is that children with stable asthma have higher AEC and ALC levels compared to those with AAE. Furthermore, this study has revealed that the studied markers (NLR, ANC, PLR, WBC, AEC, and ALC) did not differentiate between AAE patients requiring PICU admission and those managed in the general ward, suggesting a need for alternative predictive factors.