基于平均血小板体积/淋巴细胞比值的多指标联合评估在发热伴血小板减少综合征患者病情进展中的应用研究

doi:10.19871/j.cnki.xfcrbzz.2025.06.013

摘要/Abstract

摘要： 目的探讨在发热伴血小板减少综合征（severe fever with thrombocytopenia syndrome,SFTS）患者病情进展中应用基于平均血小板体积/淋巴细胞比值（mean platelet volume/lymphocyte ratio,MPVLR）的多指标联合评估的效果,为SFTS患者的诊治提供科学指导。方法回顾性选取2017年1月至2024年10月南京市溧水区人民医院收治的150例SFTS患者作为SFTS组,选取同期发热伴血小板正常患者150例作为发热伴血小板正常组,不发热伴血小板减少患者150例作为不发热伴血小板减少组,同期接受体检的健康者150例作为对照组。比较4组不同病情严重程度患者的MPVLR、白细胞介素-11（interleukin-11,IL-11）水平、C反应蛋白（C reactive protein,CRP）水平、血小板体积（mean platelet volume,MPV）、淋巴细胞（lymphocyte,LYM）水平、中性粒细胞（neutrophil,NEUT）计数、白细胞（white blood cell,WBC）计数、乳酸脱氢酶（lactate dehydrogenase,LDH）水平、肌酸激酶同工酶（creatine kinase isoenzymes,CK-MB）水平、丙氨酸氨基转移酶（alanine aminotransferase,ALT）水平、天门冬氨酸氨基转移酶（aspartate amino transferase,AST）水平,并进行单因素与多因素Logistic回归分析。绘制受试者操作特征曲线（receiver operating characteristic curve,ROC曲线）,以明确多指标联合评估对SFTS病情进展的预测价值。结果 4组MPVLR、IL-11、CRP水平比较差异有统计学意义（P<0.05）。150例SFTS患者中,共有88例（58.67%）判定为轻症,62例（41.33%）判定为重症。单因素分析结果显示,重症组MPVLR、IL-11、CRP、LDH、CK-MB、ALT、AST水平较轻症组更高（P<0.05）。多因素Logistic回归分析结果显示,MPVLR（OR=2.639,P<0.05）、IL-11水平（OR=4.127,P<0.05）、CRP水平（OR=2.693,P<0.05）是SFTS病情进展的独立危险因素。绘制ROC曲线显示,MPVLR、IL-11水平、CRP水平三者联合评估预测SFTS病情进展的曲线下面积为0.856,较MPVLR（曲线下面积为0.823）、IL-11水平（曲线下面积为0.752）、CRP水平（曲线下面积为0.745）单独检测更高（P<0.05）。结论 MPVLR、IL-11水平、CRP水平在SFTS患者体内表达较高,特别是重症SFTS患者,MPVLR、IL-11水平、CRP水平三者联合检测在评估SFTS病情进展中具有较高的临床价值,可作为该疾病诊治方案制定的重要依据。

关键词: 发热伴血小板减少综合征, 病情进展, 平均血小板体积/淋巴细胞比值, 白细胞介素-11, C反应蛋白

Abstract: Objective To explore the effect of using a multi-index combined evaluation based on mean platelet volume/lymphocyte ratio (MPVLR) in the progression of fever with thrombocytopenia syndrome (SFTS) patients, provide scientific guidance for the diagnosis and treatment of SFTS patients. Method A retrospective of a total of 150 patients with SFTS from January 2017 to October 2024 admitted to Nanjing Lishui District People's Hospital were selected as the SFTS group. 150 patients with fever accompanied by normal platelets during the same period were selected as the fever accompanied by normal platelets group, 150 patients without fever accompanied by thrombocytopenia were selected as the non fever accompanied by thrombocytopenia group, and 150 healthy individuals who underwent physical examination during the same period were selected as the control group. The levels of MPVLR, interleukin-11 (IL-11), C reactive protein (CRP), mean platelet volume (MPV), lymphocyte (LYM), neutrophil (NEUT), white blood cell (WBC), lactate dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB), alanine aminotransferase (ALT), and aspartate amino transferase (AST) of patients with different degrees of illness in the four groups were compared, and univariate and multivariate Logistic regression analyses were conducted. Receiver operating characteristic (ROC) curves were plotted to clarify the predictive value of multi-index joint evaluation for the progression of SFTS. Result There were statistically significant differences in the levels of MPVLR, IL-11, and CRP among the four groups (P<0.05). Among 150 SFTS patients, a total of 88 cases (58.67%) were classified as mild symptoms, and 62 cases (41.33%) were classified as severe symptoms. The results of one-way factor analysis showed that MPVLR, IL-11, CRP, LDH, CK-MB, ALT and AST levels in severe group were higher than those in mild group (P<0.05). The results of multiple Logistic regression analysis showed that MPVLR (OR=2.639, P<0.05), IL-11 (OR=4.127, P<0.05), and CRP (OR=2.693, P<0.05) were independent factors affecting the progression of SFTS. The ROC curve showed that the area under the curve of MPVLR, IL-11 and CRP combined to predict the progression of SFTS was 0.856, which was higher than that of MPVLR (area under the curve was 0.823), IL-11 (area under the curve was 0.752) and CRP (area under the curve was 0.745) alone (P<0.05). Conclusion The expression levels of MPVLR, IL-11, and CRP are relatively high in SFTS patients, especially in severe SFTS patients. The combined evaluation of multiple indicators has high clinical value in predicting the progression of SFTS and can serve as an important basis for disease diagnosis and treatment planning.

Key words: Severe fever with thrombocytopenia syndrome, Disease progression, Mean platelet volume/lymphocyte ratio, Interleukin-11, C reactive protein

中图分类号:

R552
R441.3

翁吕雷, 龙东娣, 武银铃, 缪家立. 基于平均血小板体积/淋巴细胞比值的多指标联合评估在发热伴血小板减少综合征患者病情进展中的应用研究[J]. 新发传染病电子杂志, 2025, 10(6): 81-86.

Weng Lyulei, Long Dongdi, Wu Yinling, Miao Jiali. Application of multi-index joint evaluation in the disease progression of severe fever with thrombocytopenia syndrome: a study based on the mean platelet volume/lymphocyte ratio[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(6): 81-86.

参考文献

[1] 黄晓霞,杜珊珊,李阿茜,等.2018-2021年中国发热伴血小板减少综合征流行特征分析[J].中华流行病学杂志,2024,45(1):112-116.
[2] HIDAKA K, MITOMA S, NORIMINE J, et al.Seroprevalence for severe fever with thrombocytopenia syndrome virus among the residents of Miyazaki, Japan: An epidemiological study[J]. J Infect Chemother, 2023, 30(6):481-487.
[3] SONG L, ZOU W, WANG G, et al.Cytokines and lymphocyte subsets are associated with disease severity of severe fever with thrombocytopenia syndrome[J]. Virol J, 2024, 21(1):126.
[4] SUL H, YUN NR, KIM DM, et al.Development of a Scoring System to Differentiate Severe Fever with Thrombocytopenia Syndrome from Scrub Typhus[J]. Viruses, 2022, 14(5):1093.
[5] 李斌, 王锦春, 王志斌, 等. 平均血小板体积/淋巴细胞比值与老年非瓣膜性心房颤动患者左心房血栓形成的关系[J]. 国际检验医学杂志, 2024, 45(6):681-685.
[6] 中华人民共和国卫生部. 发热伴血小板减少综合征防治指南(2010版)[J].中华临床感染病杂志, 2011, 4(4):193-194.
[7] 中华医学会感染病学分会. 发热伴血小板减少综合征诊疗共识[J].中华传染病杂志, 2022, 40(12):711-721.
[8] 许坦, 周楠, 胡琴琴, 等. 碱性磷酸酶和白介素-8对重型发热伴血小板减少综合征患者早期预测价值研究[J/CD].新发传染病电子杂志, 2025, 10(1):50-55.
[9] 许晴晴, 吴修龙, 尹华发. 重症发热伴血小板减少综合征的影响因素分析[J].南昌大学学报(医学版), 2025, 65(4):56-61.
[10] 霍雪平, 刘贞君, 谢琴秀. 重症发热伴血小板减少综合征预警指标分析[J/CD].新发传染病电子杂志, 2023, 8(5):41-45.
[11] 汪玲妹, 王成浩, 姚杰, 等. 血清铁蛋白评估发热伴血小板减少综合征患者预后的预测价值[J].中国血液流变学杂志, 2024, 34(4):635-639.
[12] 王娟, 范雪娟. mAST/ALT对严重发热伴血小板减少综合征患者预后的预测价值[J].中国现代医药杂志, 2024, 26(4):22-26.
[13] 张诗雨, 迪丽胡玛尔•扎衣尔, 田进, 等. 血清白细胞介素-6和白细胞介素-10对发热伴血小板减少综合征患者死亡的预测价值[J].中华传染病杂志, 2024, 42(7):424-428.
[14] 李焱, 贾振薇, 刘亚宁. 人白介素11在弥漫性大B细胞淋巴瘤中的表达及其与患者化疗后血小板减少的相关性[J].中国肿瘤生物治疗杂志, 2017, 24(11):1287-1292.
[15] 陈冲, 张照如. C反应蛋白与白蛋白比值对发热伴血小板减少综合征患者的预后意义[J].临床医学进展, 2023, 13(7):11484-11491.
[16] KAWAGUCHI T, UMEKITA K, YAMANAKA A, et al.Impact of C-Reactive Protein Levels on Differentiating of Severe Fever With Thrombocytopenia Syndrome From Japanese Spotted Fever[J]. Open Forum Infect Dis, 2020, 7(11):473.
[17] 江娜, 张睿锐, 李楠, 等. 平均血小板体积/淋巴细胞比值联合NEWS评分对脓毒症预后评估的价值[J].检验医学与临床, 2023, 20(10):1379-1382, 1387.
[18] 鲁翠红, 耿贝贤, 赖建明, 等. 发热伴血小板减少综合征病人实验室检查指标与临床结局的相关性[J].青岛大学学报(医学版), 2024, 60(1):133-136.
[19] LIU Z, ZHANG R, ZHOU W, et al.High levels of C-reactive protein-to-albumin ratio (CAR) are associated with a poor prognosis in patients with severe fever with thrombocytopenia syndrome in early stage[J]. J Med Virol, 2022, 94(11):5375-5384.
[20] NGUYEN A, REPESSE Y, EBBO M, et al.IVIg increases interleukin-11 levels, which in turn contribute to increased platelets, VWF and FVIII in mice and humans[J]. Clin Exp Immunol, 2021, 204(2):258-266.