Diagnostic value of the combination of serum neutrophil CD64, CRP and LDH in children with refractory Mycoplasma pneumoniae pneumonia

doi:10.11958/20252783

Abstract

Abstract:

Objective To investigate the value of the combined detection of neutrophil CD64 (nCD64), C-reactive protein (CRP) and lactate dehydrogenase (LDH) in the diagnosis of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. Methods A total of 147 children with Mycoplasma pneumoniae infection were enrolled and divided into the RMPP group (n = 70) and the general Mycoplasma pneumoniae pneumonia group (GMPP, n = 77) based on disease severity and treatment response. The age, gender, white blood cell count (WBC) within 24 hours of admission, serum procalcitonin (PCT), C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels were collected in the study participants. The expression level of nCD64 in peripheral blood was measured using flow cytometry. Multivariate Logistic regression analysis was conducted to identify the independent risk factors associated with RMPP in children. Additionally, a receiver operating characteristic (ROC) curve was constructed to assess the diagnostic performance of the combined detection of nCD64, CRP and LDH for RMPP in children. Results The RMPP group had a longer hospital stay than the GMPP group (P<0.05). Levels of nCD64, CRP and LDH were significantly higher in the RMPP group compared to those of the GMPP group (P<0.05), and there were no significant differences in WBC and PCT levels between the two groups. Multivariate Logistic regression analysis showed that elevated nCD64, CRP and LDH were risk factors for RMPP in children (P<0.05). ROC curve analysis revealed that the areas under the curve (AUC) for nCD64, CRP and LDH in diagnosing RMPP were 0.817, 0.863 and 0.805, respectively. The combined detection of three indicators for AUC was 0.948. Conclusion The levels of nCD64, CRP and LDH in blood of children with RMPP are higher than those of children with GMPP. The combined detection of the three indicators has a high diagnostic value for RMPP in children with Mycoplasma pneumoniae pneumonia.

Key words: pneumonia, mycoplasma, refractory diseases, C-reactive protein, neutrophil CD64, lactate dehydrogenase

CLC Number:

R725.6

Figures/Tables 5

References 21

[1]	ÁLVARO VARELA A I, AGUINAGA PÉREZ A, NAVASCUÉS ORTEGA A, et al. Macrolide-resistant Mycoplasma pneumoniae:Do we know the situation in Europe?[J]. Rev Esp Quimioter, 2023, 36(3):259-266. doi:10.37201/req/118.2022.
[2]	YAN C, XUE G H, ZHAO H Q, et al. Current status of Mycoplasma pneumoniae infection in China[J]. World J Pediatr, 2024, 20(1):1-4. doi:10.1007/s12519-023-00783-x.
[3]	何倩倩, 黄晗, 梁利红, 等. 难治性肺炎支原体肺炎患儿外周血Galectin-3、IL-1β、IL-9表达水平及临床意义[J]. 天津医药, 2025, 53(4):393-397.
	HE Q Q, HUANG H, LIANG L H, et al. Expression levels and clinical significance of Galectin-3,IL-1β and IL-9 in peripheral blood of children with refractory mycoplasma pneumoniae pneumonia[J]. Tianjin Med J, 2025, 53(4):393-397. doi:10.11958/20250076.
[4]	YEH C F, WU C C, LIU S H, et al. Comparison of the accuracy of neutrophil CD64,procalcitonin,and C-reactive protein for sepsis identification:a systematic review and meta-analysis[J]. Ann Intensive Care, 2019, 9(1):5. doi:10.1186/s13613-018-0479-2.
[5]	熊丹, 邓琼, 陈婷. 重症肺炎患者外周血CD64指数、NLR及CD14⁺单核细胞HLA-DR的检测意义分析[J]. 中国医学创新, 2024, 21(21):166-170.
	XIONG D, DENG Q, CHEN T. Analysis of the detection significance of peripheral blood CD64 index,NLR and CD14⁺ monocytes HLA-DR in patients with severe pneumonia[J]. Medical Innovation of China, 2024, 21(21):166-170. doi:10.3969/j.issn.1674-4985.2024.21.040.
[6]	李娟, 石青峰, 李春亮, 等. 中性粒细胞CD64指数对新生儿吸入性肺炎的诊断价值[J]. 检验医学与临床, 2024, 21(9):1214-1217.
	LI J, SHI Q F, LI C L, et al. Application value of neutrophil CD64 index in diagnosis of neonatal aspiration pneumonia[J]. Lab Med Clin, 2024, 21(9):1214-1217. doi:10.3969/j.issn.1672-9455.2024.09.006.
[7]	KOCA T, GOCEN VARDAR N, AKSOY R A, et al. Comprehensive evaluation of inflammatory biomarkers in cervical cancer treated with chemoradiotherapy[J]. Curr Oncol, 2025, 32(1):39. doi:10.3390/curroncol32010039.
[8]	ZHANG R, MU Y, ZHANG M, et al. Lactate dehydrogenase/albumin to urea ratio:A novel prognostic indicator for adverse outcomes in patients with severe fever with thrombocytopenia syndrome[J]. J Med Virol, 2025, 97(6):e70428. doi:10.1002/jmv.70428.
[9]	QIU J, GE J, CAO L. D-dimer:The risk factor of children's severe mycoplasma pneumoniae pneumonia[J]. Front Pediatr, 2022,10:828437. doi:10.3389/fped.2022.828437.
[10]	赵亚宁, 胡涛, 王一鸣, 等. HBP、SAA、nCD64在颅内感染早期诊疗中作用的研究进展[J]. 中南医学科学杂志, 2024, 52(4):685-688.
	ZHAO Y N, HU T, WANG Y M, et al. Research progress on the role of HBP,SAA,and nCD64 in the early diagnosis and treatment of intracranial infection[J]. Medical Science Journal of Central South China, 2024, 52(4):685-688. doi:10.15972/j.cnki.43-1509/r.2024.04.046.
[11]	DARYAPEYMA A, PEDERSEN G, LAXDAL E, et al. Neutrophil CD64 as a marker for postoperative infection:a pilot study[J]. Eur J Vasc Endovasc Surg, 2009, 38(1):100-103. doi:10.1016/j.ejvs.2009.03.012.
[12]	YE Z, ZOU H, LIU S, et al. Diagnostic performance of neutrophil CD64 index in patients with sepsis in the intensive care unit[J]. J Int Med Res, 2019, 47(9):4304-4311. doi:10.1177/0300060519860677.
[13]	HOFFMANN J, ETATI R, BRENDEL C, et al. The low expression of Fc-Gamma receptor III(CD16)and high expression of Fc-Gamma receptor I(CD64)on neutrophil granulocytes mark severe COVID-19 pneumonia[J]. Diagnostics(Basel), 2022, 12(8):2010. doi:10.3390/diagnostics12082010.
[14]	LI Y, ZHANG J, WANG S, et al. Diagnostic and prognostic value of peripheral neutrophil CD64 index in elderly patients with community-acquired pneumonia[J]. Crit Rev Immunol, 2024, 44(4):79-89. doi:10.1615/CritRevImmunol.2024050769.
[15]	ULLAH N, WU Y. Regulation of conformational changes in C-reactive protein alters its bioactivity[J]. Cell Biochem Biophys, 2022, 80(4):595-608. doi:10.1007/s12013-022-01089-x.
[16]	RIZO-TÉLLEZ S A, SEKHERI M, FILEP J G. C-reactive protein:a target for therapy to reduce inflammation[J]. Front Immunol, 2023,14:1237729. doi:10.3389/fimmu.2023.1237729.
[17]	LI W, DENG F. Clinical significance of measuring MP-DNA,C-reactive protein,and inflammatory cytokines in children with mycoplasma pneumoniae pneumonia[J]. Am J Transl Res, 2024, 16(2):577-583. doi:10.62347/VCVW7593.
[18]	JIANG Y, WANG W, ZHANG Z, et al. Serum amyloid a,C-reactive protein,and procalcitonin levels in children with Mycoplasma pneumoniae infection[J]. J Clin Lab Anal, 2022, 36(3):e24265. doi:10.1002/jcla.24265.
[19]	GUPTA G S. The lactate and the lactate dehydrogenase in inflammatory diseases and major risk factors in COVID-19 patients[J]. Inflammation, 2022, 45(6):2091-2123. doi:10.1007/s10753-022-01680-7.
[20]	BERTILACCHI M S, VANNUCCI G, PICCARDUCCI R, et al. Serum lactate dehydrogenase levels reflect the lung injury extension in COVID-19 patients at hospital admission[J]. Immun Inflamm Dis, 2025, 13(3):e70168. doi:10.1002/iid3.70168.
[21]	INAMURA N, MIYASHITA N, HASEGAWA S, et al. Management of refractory Mycoplasma pneumoniae pneumonia:utility of measuring serum lactate dehydrogenase level[J]. J Infect Chemother, 2014, 20(4):270-273. doi:10.1016/j.jiac.2014.01.001.

组别	年龄/岁			住院时间/d	体质量/kg
GMPP组	6.71±2.60			5.84±1.45	26.00（20.30，34.00）
RMPP组	6.31±2.65			7.11±2.07	24.50（19.63，30.50）
t或Z	0.925			4.271^＊＊	1.271
组别		n	男性			身高/cm
GMPP组		77	42（54.5）			127.35±19.46
RMPP组		70	32（45.7）			123.76±19.39
χ²或t			1.144			1.120

组别	年龄/岁			住院时间/d	体质量/kg
GMPP组	6.71±2.60			5.84±1.45	26.00（20.30，34.00）
RMPP组	6.31±2.65			7.11±2.07	24.50（19.63，30.50）
t或Z	0.925			4.271^＊＊	1.271
组别		n	男性			身高/cm
GMPP组		77	42（54.5）			127.35±19.46
RMPP组		70	32（45.7）			123.76±19.39
χ²或t			1.144			1.120

组别	CRP/（mg/L）			LDH/（U/L）		PCT/（ng/L）
GMPP	6.24±4.20			230.32±33.94		0.13±0.07
RMPP	15.39±8.35			305.90±113.43		0.16±0.06
t	8.264^＊＊			5.360^＊＊		1.818
组别		n	nCD64		WBC/（×10⁹）
GMPP		77	0.74±0.53		8.42±3.13
RMPP		70	1.62±0.88		9.10±3.32
t			7.261^＊＊		1.286

组别	CRP/（mg/L）			LDH/（U/L）		PCT/（ng/L）
GMPP	6.24±4.20			230.32±33.94		0.13±0.07
RMPP	15.39±8.35			305.90±113.43		0.16±0.06
t	8.264^＊＊			5.360^＊＊		1.818
组别		n	nCD64		WBC/（×10⁹）
GMPP		77	0.74±0.53		8.42±3.13
RMPP		70	1.62±0.88		9.10±3.32
t			7.261^＊＊		1.286

变量	β	SE	Wald χ²	P	OR	OR 95%CI
nCD64	1.346	0.403	11.173	0.001	3.843	1.745~8.462
LDH	0.031	0.008	13.212	<0.001	1.031	1.014~1.048
CRP	0.313	0.067	21.710	<0.001	1.368	1.199~1.560
常数项	-12.523	2.505	24.988	<0.001	0.000