2025 年第 1 期 第 0 卷

下呼吸道感染儿童外周血免疫细胞动态变化与31天内非计划再入院的相关性研究

Study on the correlation between the dynamic changes of peripheral blood immune cells and unplanned readmission within 31 d in children with lower respiratory tract infection

作者：张世挺  高艳如

英文作者：Zhang Shiting Gao Yanru

单位：南京医科大学第四附属医院儿科，南京210000

英文单位：Department of Pediatrics the Fourth Affiliated Hospital of Nanjing Medical University Nanjing 210000 China

关键词：下呼吸道感染；  外周血免疫细胞；  31d内非计划再入院

英文关键词：Lowerrespiratorytractinfection;  Peripheralbloodimmunecells;  Unplannedreadmissionwithin31d

• 摘要：

• 目的  探究下呼吸道感染儿童外周血免疫细胞动态变化与31 d内非计划再入院的相关性。方法  回顾性选择2021年12月至2023年12月在南京医科大学第四附属医院住院治疗的1 081例下呼吸道感染患儿进行研究，根据治疗后31 d内非计划再入院情况，分为未再入院组（976例）和再入院组（105例）。比较2组患儿的临床资料；重复测量方差分析2组患儿免疫细胞水平；LOWESS分析免疫细胞水平与25%潮气量时的呼气流速（TEF25）的曲线关系；多因素Logistic回归方法分析31 d内非计划再入院的危险因素，并对模型进行评价；限制性立方样条法分析免疫细胞水平与31 d内非计划再入院风险的关系。结果  相比于未再入院组，再入院组的TEF25水平明显更低［（61±9）ml/s比（70±9）ml/s］，被动吸烟、户外活动时间＜2 h/d、年抗菌药物使用≥3次比例、C反应蛋白（CRP）水平明显更高（均P＜0.05）。2组免疫细胞水平在时间效应、组间效应、交互效应方面的差异均有统计学意义（均P＜0.05）。LOWESS分析结果显示，免疫细胞水平与TEF25之间具有一定的非线性关系。多因素Logistic回归分析结果显示，被动吸烟、户外活动时间＜2 h/d、年抗菌药物使用≥3次、TEF25、CRP水平、治疗前CD+3、CD+4、CD+8、CD+4/CD+8T细胞比值水平是下呼吸道感染患儿31 d内非计划再入院的独立危险因素（均P＜0.05）。建模数据中的数据点对模型参数估计不存在强影响性；各变量间无多重共线性；模型的区分能力、预测能力及有效性较高。限制性立方样条法分析结果显示，下呼吸道感染患儿31 d内非计划再入院风险与治疗前CD+3、CD+4、CD+4/CD+8T细胞比值水平存在负向线性关系，与CD+8T细胞水平存在正向线性关系。结论  外周血免疫细胞动态变化与下呼吸道感染患儿31 d内非计划再入院具有明显相关性，临床上可通过监测外周血免疫细胞水平的变化，及时采取预防措施，以降低非计划再入院的发生率。

• Objective  To explore the correlation between the dynamic changes of peripheral blood immune cells and unplanned readmission within 31 d in children with lower respiratory tract infection. Methods   A total of 1 081 children with lower respiratory tract infection who were hospitalized in the Fourth Affiliated Hospital of Nanjing Medical University from December 2021 to December 2023 were retrospectively selected for the study. According to the unplanned readmission within 31 d after treatment, they were divided into non-readmission group (976 cases) and readmission group (105 cases). The clinical data of the two groups were compared. Repeated measurement analysis of variance was used to analyze the levels of immune cells in the two groups. LOWESS was used to analyze the curve relationship between the level of immune cells and expiratory flow when 25% tidal volume (TEF25). Multivariate Logistic regression was used to analyze the risk factors of unplanned readmission within 31 d, and the model was evaluated.Restricted cubic spline method was used to analyze the relationship between immune cell levels and the risk of unplanned readmission within 31 d. Results   Compared to the non-readmission group, the TEF25 levels were significantly lower in the readmission group ［(61±9)ml/s vs (70±9)ml/s］, and the passive smoking, outdoor activity time <2 h/d, annual use of antibiotics ≥ 3 times/year, and C-reactive protein (CRP) levels were significantly higher (all P＜0.05). There were significant differences in the levels of immune cells between the two groups in terms of time effect, between-group effect and interaction effect (all P＜0.05). LOWESS analysis showed that there was a non-sexualrelationship between the level of immune cells and TEF25. Multivariate Logistic regression analysis showed that passive smoking, outdoor activity time <2 h/d, annual use of antibiotics ≥3 times/year, TEF25, CRP levels, levels of CD+3, CD+4, CD+8, CD+4/CD+8 T cells ratio before treatment were independent risk factors for unplanned readmission within 31 d of lower respiratory tract infection in children (all P＜0.05). The data points in the modeling data did not have a strong influence on the model parameter estimation. There was no multicollinearity among variables. The model has high discrimination ability, prediction ability and validity.The results of restricted cubic spline analysis showed that there was a negative linear relationship between the risk of unplanned readmission within 31 d and the levels of CD+3, CD+4, and CD+4/CD+8 T cells ratio before treatment, and a positive linear relationship between the risk of unplanned readmission and CD+8 T cells level in children with lower respiratory tract infection. Conclusion   There is a significant correlation between the dynamic changes of peripheral blood immune cells and the unplanned readmission of children with lower respiratory tract infection within 31 d. Clinically, monitoring the changes in peripheral blood immune cell levels can help take preventive measures in time to reduce the incidence of unplanned readmission.