| 李丽,何正光,赵勇,等.血清中性粒细胞 /淋巴细胞比值、可溶性髓系细胞触发受体 1、降钙素原预测老年重症肺炎死亡风险的价值[J].安徽医药,2021,25(12):2431-2435. |
| 血清中性粒细胞 /淋巴细胞比值、可溶性髓系细胞触发受体 1、降钙素原预测老年重症肺炎死亡风险的价值 |
| Value of serum neutrophil to lymphocyte ratio, soluble triggering receptor expressed on myeloid cells-1 and procalcitonin on mortality risk of elderly patients with severe pneumonia |
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| DOI：10.3969/j.issn.1009-6469.2021.12.023 |
| 中文关键词: 肺炎 中性粒细胞 /淋巴细胞比值 可溶性髓系细胞触发受体 1 降钙素原 预测价值 病死率 老年人 |
| 英文关键词: Pneumonia Neutrophil to lymphocyte ratio Soluble triggering receptor expressed on myeloid cells-1 Procalcito. nin Predictive value Mortality Aged |
| 基金项目:四川省卫生健康委科技项目( 17PJ037) |
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| 中文摘要: |
| 目的评估血清中性粒细胞 /淋巴细胞比值( neutrophil to lymphocyte ratio，NLR)、可溶性髓系细胞触发受体 1(soluble triggering receptor expressed on myeloid cells-1，sTREM-1)、降钙素原预测老年重症肺炎病人 30 d死亡风险的临床应用价值。方法回顾性分析 2016年 10月至 2019年 6月遂宁市中心医院收治的 148例老年重症肺炎的临床资料。收集病人的年龄、性别、基础疾病，以及入院 24 h内血常规、 sTREM-1、降钙素原、 C反应蛋白( C-reactive protein，CRP)、肝肾功能、 D-二聚体、血乳酸、动脉血氧分压( PaO2)资料，计算 NLR、氧合指数及急性生理学和慢性健康状况评分 Ⅱ(acute physiology and chronic health evalua. tion Ⅱ，APACHEⅡ)。根据 30 d生存情况将病人分为存活组和死亡组，并采用多因素 logistic回归分析筛选老年重症肺炎病人 30 d死亡的高危因素；绘制受试者工作特征( ROC)曲线，评估 NLR、sTREM-1、降钙素原对老年重症肺炎病人 30 d死亡风险的预测价值。结果 148例病人中存活 92例，死亡 56例。死亡组病人入院时白细胞总数、中性粒细胞( neutrophil，NEU)绝对值、淋巴细胞( lymphocyte，LYM)绝对值、 NLR、sTREM-1、降钙素原、 CRP、血乳酸、 D-二聚体及 APACHEⅡ评分与存活组比较均差异有统计学意义［白细胞:(15.01±4.59)×109/L比( 12.37±2.69)×109/L，NEU绝对值:(12.02±3.87)×109/L比( 9.46±2.52)×109/L， LYM绝对值:(1.00±0.17)×109/L比( 1.38±0.54)×109/L，NLR:(11.96±2.87)比( 7.61±2.59)sTREM-1:(64.75±5.55)ng/L比( 55.01±6.73)ng/L，降钙素原:(5.33±2.81)mg/L比( 2.39±1.10)mg/L，CRP:(101.66±48.90)mg/L66.73±43.35)mg/L，血乳酸:(3.02± 比(1.27)mmol/L比( 1.57±0.71)mmol/L，D-二聚体:(2.90±1.69)mg/L比( 1.56±0.58)mg/L，APACHEⅡ评分:(30.51±6.90)分比( 24.24±3.71)分，均 P<0.05］。而两组在年龄、性别、基础疾病、肝肾功能、氧合指数比较中差异无统计学意义(均 P>0.05)。多因素 lo. gistic回归分析显示， NLR［OR=2.129，95%CI:1.233~3.677，P=0.007］、 sTREM-1(OR=1.277，95%CI:1.086~1.502，P=0.003)、降钙素原( OR=1.769，95%CI:1.166~2.683，P=0.007)和 APACHEⅡ评分( OR=1.327，95%CI:1.119~1.575，P=0.001)为老年重症肺炎病人 30 d死亡的独立危险因素。 ROC曲线显示， NLR、sTREM-1、降钙素原对老年重症肺炎病人 30 d死亡均具有很好的预测价值，三者联合检测时曲线下面积( AUC)升高，为 0.951，灵敏度和特异度均较高，分别为 96.43%、79.35%。结论入院时 NLR、 sTREM-1、降钙素原增高可以作为老年重症肺炎病人死亡的高危因素，且对 30 d死亡风险有一定的预测价值，联合检测较单一指标预测价值更高。 |
| 英文摘要: |
| Objective To evaluate the predictive value of serum neutrophil to lymphocyte ratio(NLR), soluble triggering receptor ex. pressed on myeloid cells-1 (sTREM-1) and procalcitonin on 30-day mortality risk of elderly patients with severe pneumonia.Methods The clinical datas of 148 elderly patients with severe pneumonia admitted to Suining Central Hospital from October 2016 to June 2019were retrospectively analyzed. The clinical parameters, such as age , gender, underlying diseases, blood routine, sTREM-1, procalcito. nin, C-reactive protein (CRP), liver and kidney function, D-dimer, blood lactic acidand arterial partial pressure of oxygen (PaO2) at 24hours after admission were collected. NLR, oxygenation indexand acute physiology and chronic health evaluation Ⅱ (APACHEⅡ)score were calculated. According to 30-day outcomes, the patients were assigned into survival group and death group. Multivariate logis.tic regression analysis was used to screen the high risk factors of 30-day mortality in elderly patients with severe pneumonia. The receiv.er operating characteristic (ROC) curve were drawn and the predictive value of NLR, sTREM-1, procalcitonin for 30-day mortality risk in elderly patients with severe pneumonia were evaluated.Results 148 patients were enrolled in the analysis, 92 survived in 30 days and 56 died. Compared with survival group, the white blood cell (WBC) count, neutrophile (NEU), lymphocyte (LYM), NLR, sTREM-1, procalcitonin, CRP, blood lactic acid, D-dimer and APACHEⅡ score in the death group showed significant differences [WBC: (15.01± 4.59)×109/L vs. (12.37±2.69)×109/L, NEU: (12.02±3.87)×109/L vs. (9.46±2.52)×109/L, LYM: (1.00±0.17)×109/L vs. (1.38±0.54)×109/L, NLR: (11.96±2.87) vs. (7.61±2.59), sTREM-1: (64.75±5.55) ng/L vs. (55.01±6.73) ng/L, procalcitonin: (5.33±2.81) mg/L vs. (2.39±1.10) mg/L, CRP: (101.66±48.90) mg/L vs. (66.73±43.35) mg/L, blood lactic acid: (3.02±1.27) mmol/L vs. (1.57±0.71) mmol/L, D-dimer: (2.90±1.69) mg/L vs. (1.56±0.58) mg/L, APACHEⅡ score: (30.51±6.90) vs. (24.24±3.71, all P<0.05]. There was no significant differ.ence between the two groups in age, gender, underlying disease, liver and kidney function, oxygenation index (all P>0.05). Multivariate logistic regression analysis showed that NLR (OR=2.129, 95%CI: 1.233-3.677, P=0.007), sTREM-1(OR=1.277, 95%CI: 1.086-1.502, P=0.003), procalcitonin (OR=1.769, 95%CI: 1.166-2.683, P=0.007) and APACHEⅡ score (OR=1.327, 95%CI: 1.119-1.575, P=0.001) were the independent risk factors of 30-day mortality in the elderly patients with severe pneumonia. ROC curve analysis showed that NLR, sTREM-1 and procalcitonin have good predictive value for 30-day mortality in the patients with severe pneumonia. The area un.der the curve (AUC) of combined detection of three indicators was increased, which was 0.951, the sensitivity and the specificity wereincreased, which were 96.43% and 79.35%, respectively.Conclusion The increased NLR, sTREM-1 and procalcitonin at admission are high risk factors of 30-day mortality in elderly patients with severe pneumonia, which are useful for predicting prognosis of elderlypatients with severe pneumonia, the combined detection has higher predictive value than single detection. |
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