25（OH）D3、EOS％联合CT Bhalla评分评估支气管肺炎病情严重程度及预后的价值

Value of serum 25-hydroxyvitamin D3, EOS%, and CT Bhalla score in assessing disease severity and prognosis of bronchopneumonia

摘要:

目的 探讨血清25羟维生素D₃［25（OH）D₃］、嗜酸性粒细胞百分比（EOS%）及CT Bhalla评分评估支气管肺炎病情严重程度及预后的效果。方法 选取2024年11月—2025年3月阜阳市人民医院收治的支气管肺炎患者93例，根据病情严重程度分为轻症组（59例）和重症组（34例），另取59例同期该院健康体检人群作为对照组。检测各组血清25（OH）D₃、EOS%水平，并行胸部CT Bhalla评分。比较各组间25（OH）D₃、EOS%及Bhalla评分的差异，以及不同严重程度患者的预后情况。通过多元线性回归分析影响患者疾病严重程度的独立影响因素，采用受试者工作特征（ROC）曲线评估联合指标的预测效能。结果 重症组吸烟史率、既往慢性病史率、胸闷率和NEUT%均高于轻症组（P <0.05），发热率低于轻症组（P <0.05）。重症组和轻症组25（OH）D₃和EOS%水平均低于对照组（P <0.05），重症组患者25（OH）D₃和EOS%水平均低于轻症组（P <0.05）。重症组CT Bhalla评分高于轻症组。重症组住院总时间长于轻症组（P <0.05），住院费用高于轻症组（P <0.05）。进行多因素一般回归Logistic回归分析结果显示，低25（OH）D₃水平［O^R=0.586（95%CI：0.431，0.797）］、低EOS%［O^R=0.391（95%CI：0.167，0.915）］和高CT Bhalla评分［O^R=1.251（95%CI：1.017，1.539）］是支气管肺炎患者疾病加重的危险因素（P <0.05）。血清25（OH）D₃、EOS%与CT Bhalla评分联合预测支气管肺炎患者病情加重的曲线下面积为0.906（95% CI：0.846，0.966），敏感性为97.1%（95% CI：0.847，0.999），特异性为78.0%（95% CI：0.653，0.877）。结论 血清25（OH）D₃、EOS%与CT Bhalla评分可作为评估支气管肺炎病情严重程度的有效指标，且重症患者的医疗费用更高，联合检测有助于临床病情评估及医疗资源管理。

Abstract:

Objective To investigate the value of serum 25-hydroxyvitamin D₃ [25(OH)D₃], eosinophil percentage (EOS%), and CT Bhalla score in assessing the disease severity and prognosis in bronchopneumonia.Methods A total of 93 bronchopneumonia patients admitted to Fuyang People’s Hospital from November 2024 to March 2025 were enrolled and stratified into the mild (n = 59) and severe (n = 34) groups based on disease severity, with 59 cases of healthy individuals undergoing health check-ups in the hospital during the same period as controls. Serum levels of 25(OH)D₃ and EOS% were measured, and chest CT scans were performed for Bhalla scoring in each group. Differences in 25(OH)D₃ levels, EOS%, and Bhalla scores, along with prognosis in patients of varying severity, were compared among the three groups. Multivariable linear regression was performed to identify independent factors influencing disease severity, and receiver operating characteristic curve analysis was used to evaluate the predictive performance of combined indicators.Results The severe group showed higher rates of smoking, pre-existing chronic diseases, and chest tightness, as well as higher NEUT%, compared to the mild group (P < 0.05). The rate of fever was lower in the severe group than in the mild group (P < 0.05). Both severe and mild groups had lower levels of 25(OH)D₃ and EOS% than the control group (P < 0.05), and the severe group exhibited significantly lower 25(OH)D₃ and EOS% levels than the mild group (P < 0.05). The CT Bhalla score was higher in the severe group than in the mild group (P < 0.05). Total length of hospital stay was longer and medical costs were higher in the severe group (P < 0.05). Multivariable logistic regression analysis revealed that low levels of 25(OH)D₃ [O^R = 0.586 (95% CI: 0.431, 0.797) ], low EOS% [O^R = 0.391 (95% CI: 0.167, 0.915) ], and high CT Bhalla scores [O^R = 1.251 (95% CI: 1.017, 1.539) ] were identified as risk factors for disease exacerbation. The combination of serum 25(OH)D₃, EOS%, and CT Bhalla scores yielded the largest area under the curve (AUC) of 0.906 (95% CI: 0.846, 0.966), with a sensitivity of 97.1% (95% CI: 85.1%, 99.9%), a specificity of 78.0% (95% CI: 65.3%, 87.7%) and a Youden index of 0.750.Conclusion Serum 25(OH)D₃, EOS%, and CT Bhalla scores serve as effective indicators for assessing bronchopneumonia severity, with severe cases associated with higher medical costs. Combined detection of these indicators aids clinical evaluation and healthcare resource management.