中性粒细胞百分比与白蛋白比值(NPAR)在儿童肺炎支原体肺炎严重程度及并发症的价值

The Value of Neutrophil Percentage to Albumin Ratio (NPAR) in Assessing Severity and Complications of Mycoplasma Pneumoniae Pneumonia in Children

摘要: 目的：探讨中性粒细胞百分比与白蛋白比值(neutrophil percentage to albumin ratio, NPAR)在儿童肺炎支原体肺炎(MPP)严重程度及并发症的关系，并评估其临床应用价值。方法：回顾性分析2023年1月至2024年6月安徽医科大学第一附属医院儿科的290例MPP患儿的临床资料，根据病情严重程度分为重症组(SMPP，82例)和非重症组(NSMPP，208例)。比较两组临床特征及实验室指标，构建SMPP的logistic回归模型分析相关危险因素，并分别建立含CRP与不含CRP的嵌套模型以评估NPAR的增量效应。以NPAR的中位数将患儿分为低NPAR组和高NPAR组，比较住院时长及并发症发生情况。结果：SMPP组的年龄、住院时长及呼吸音减低发生率均高于NSMPP组，实验室指标中，N%、CRP、NPAR、ALT、D-二聚体、LDH、PCT在重症组显著升高，而L%、白蛋白水平显著降低(均P < 0.05)。多因素Logistic回归分析显示，年龄、呼吸音减低、CRP、D-二聚体及LDH为SMPP的独立危险因素；在不纳入CRP的模型中，NPAR为SMPP的显著危险因素。ROC分析显示，模型一(CRP + NPAR + 协变量)与模型三(CRP + 协变量)AUC差异无统计学意义(DeLong检验P = 0.259)。与低NPAR组相比，高NPAR组患儿住院时间更长，胸腔积液和塑形支气管炎发生率更高(均P < 0.05)，肺栓塞发生率差异无统计学意义。结论：NPAR水平与儿童肺炎支原体肺炎的严重程度及部分并发症密切相关，其对以CRP为核心模型的增量预测价值有限，但可作为常规炎症指标的有益补充，用于评估MPP患儿病情严重程度及并发症风险。

Abstract: Objective: To explore the association between the neutrophil percentage to albumin ratio (NPAR) and the severity and complications of Mycoplasma pneumoniae pneumonia (MPP) in children, and to evaluate its clinical utility. Methods: Retrospective cohort study. The clinical data of MPP children hospitalized in the Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University from January 2023 to June 2024 were collected. According to disease severity, patients were divided into a severe group (SMPP, n = 82) and a non-severe group (NSMPP, n = 208). Clinical characteristics and laboratory parameters were compared between the two groups. Multivariate Logistic regression methods were used to identify the influencing factors of SMPP. Models including and excluding CRP were established to assess the independent effect of NPAR. Patients were further stratified into low-NPAR and high-NPAR groups according to the median NPAR, and the associations with length of hospital stay and complications were analyzed. Results: Compared with the NSMPP group, the SMPP group showed significantly older age, a longer length of hospital stay, and a higher rate of decreased breath sounds. In laboratory findings, N%, CRP, NPAR, ALT, D-dimer, LDH, and PCT were all elevated in the SMPP group, whereas L% and albumin were reduced (all P < 0.05). Multivariable logistic regression showed that age, decreased breath sounds, CRP, D-dimer, and LDH were independent risk factors for SMPP; in the model excluding CRP, NPAR was an independent risk factor for SMPP. ROC analysis indicated no significant difference in AUC between the model including NPAR (CRP + NPAR + covariates) and the model without NPAR (CRP + covariates) (DeLong test, P = 0.259). Compared with the low-NPAR group, the high-NPAR group had a longer hospital stay and higher incidences of pleural effusion and plastic bronchitis (all P < 0.05), while there was no significant difference in the incidence of pulmonary embolism between groups. Conclusions: NPAR is closely associated with disease severity and selected complications in children with MPP. Although its incremental predictive value beyond a CRP-based model appears limited, NPAR may serve as a useful adjunct to routine inflammatory markers for risk stratification of SMPP and complications.