Significance Of Platelet-related Parameters In Differential Diagnosis Of Immune-mediated Inflammatory Diseases And Bacterial Infectious Diseases

BackgroundSome pediatric immune-mediated inflammatory diseases（IMIDs）,such as systemic juvenile idiopathic arthritis（s JIA）and Kawasaki disease（KD）,lack the gold standard for diagnosis and need to be diagnosed according to clinical diagnosis.The clinical manifestations of these diseases are very similar to those of bacterial infectious diseases and are difficult to identify.At present,a large number of studies at home and abroad show that platelets not only have hemostatic function,but also play an important role in anti-infection and immune regulation.Therefore,the purpose of this study is to explore the differential significance of platelet-related parameters in IMIDs and bacterial infectious diseases,so as to provide evidence for early diagnosis and timely treatment of IMIDs.ObjectiveTo explore the value of platelet-related parameters in the differential diagnosis of IMIDs and bacterial infectious diseases in children by analyzing the difference of platelet-related parameters between children with s JIA and KD and children with bacterial infectious diseases.MethodNine children with s JIA and 69 children with KD diagnosed in the Department of Pediatrics of the First Affiliated Hospital of Xinxiang Medical University from July 2018to January 2022 were selected as the group of immune related diseases group,96 children diagnosed with bacterial infection during the same period were selected as the bacterial infection group,and 41 healthy children were selected as healthy control group.According to the type of bacterial infection,the bacterial infection group was divided into gram-positive bacterial infection group and gram-negative bacterial infection group.According to their age,all enrolled children were divided into 28 days to 4 years old group,4 to 6 years old group,and 6 to 16 years old group.The clinical and laboratory data of all enrolled children were collected.The differences of the above indexes in each group were statistically analyzed.Results1.A total of 9 children with s JIA and 69 children with KD were included as immune related diseases group;96 children with bacterial infection were treated as bacterial infection disease group;41 healthy children served as healthy control group.There were 81 cases in the Gram-positive bacterial infection group,including 48males and 33 females,aged 2.10（0.95,5.35）years;There were 15 cases in the Gram-negative bacterial infection group,including 9 males and 6 females,aged 2.30（0.70,5.40）years.There were no significant differences in gender and age between the two groups（?2=0.003,P=0.957;H=-0.066,P=0.948）.There were 53 cases of immune related diseases from 28 days to 4 years old,including 33 male children and 20 female children,aged 1.30（0.70,1.90）years;There were 62 cases in the bacterial infection group,including 39 male children and 23 female children,aged 1.10（0.58,2.03）years;There were 20 cases in the healthy control group,including 10 male children and 10 female children,aged 1.65（0.90,2.45）years.There was no significant difference in gender and age among the three groups（?2=1.141,P=0.565;H=2.357,P=0.308）.There were 12 cases of immune related diseases from 4 to 6 years old,including 5male children and 7 female children,aged 4.70（4.30,5.43）years;There were 15 cases in bacterial infection group,including 6 male children and 9 female children,aged 5.10（4.50,5.50）years;There were 10 cases in the healthy control group,including 6 male children and 4 female children,aged 4.40（4.08,5.13）years.There was no significant difference in gender and age among the three groups（F=1.126,P=0.700;H=2.259,P=0.323）.There were 13 cases of immune related diseases from 6 to 16 years old,including 8male children and 5 female children,aged 10.00（6.55,12.50）years;There were 19 cases in bacterial infection group,including 12 male children and 7 female children,aged 8.00（6.50,13.00）years;There were 11 cases in the healthy control group,including 7 male children and 4 female children,aged 7.30（7.00,9.00）years.There was no significant difference in gender and age among the three groups（?2=0.013,P=0.993;H=0.934,P=0.627）.2.There was no significant difference in WBC,absolute number of neutrophils,absolute number of lymphocytes,PLT,PDW,MPV,PCT,NLR,PWR,PNR and PLR between gram-positive bacterial infection group and gram-negative bacterial infection group（P>0.05）.3.Comparison between immune related disease group and bacterial infection disease group from 28 days to 4 years old:there were significant differences in MPV[（8.35±1.42）f L vs（9.07±1.51）f L],absolute number of neutrophils[（9.03（7.10,11.59）×10~9/L）vs（6.71（3.26,13.02）×10~9/L）],NLR[（2.28（1.69,4.11））vs（1.29（0.62,3.42））]between immune related disease group and bacterial infection disease group（P<0.05）.There was no significant difference in WBC,absolute number of lymphocytes,PLT,PDW,PCT,PWR,PNR and PLR between the two groups（P>0.05）.4.There was no significant difference in WBC,absolute number of neutrophils,absolute number of lymphocytes,PLT,PDW,MPV,PCT,NLR,PWR,PNR and PLR between immune related disease group and bacterial infection disease group from 4 to 6years old（P>0.05）.5.There was no significant difference in WBC,absolute number of neutrophils,absolute number of lymphocytes,PLT,PDW,MPV,PCT,NLR,PWR,PNR and PLR between immune related disease group and bacterial infection disease group from 6 to 16years old（P>0.05）.6.The data were analyzed by receiver operating characteristic curve:the AUC of MPV in the 28 days to 4 years old group was 0.636,the sensitivity was 56.6%,the specificity was 67.7%,and the optimal critical value was 8.35;The AUC of the absolute number of neutrophils was 0.621,the sensitivity was 77.4%,the specificity was 54.8%,and the optimal critical value was 6.93;The AUC of NLR was 0.628,the sensitivity was84.9%,the specificity was 51.6%,and the optimal critical value was 1.32.The differences were statistically significant（P<0.05）.Conclusions1.MPV,neutrophil absolute number and NLR have certain value in identifying IMIDs from bacterial infectious diseases in children aged 28 days to 4 years old.2.This study did not show significant significance of platelet-related parameters in the differential diagnosis of IMIDs and bacterial infections in children aged 4 to 16 years old.