| 杨海龙,王冬利,刘燕平,等.中性粒细胞与淋巴细胞比值联合红细胞分布宽度在急诊老年脓毒症病人中的应用价值[J].安徽医药,2024,28(4):676-680. |
| 中性粒细胞与淋巴细胞比值联合红细胞分布宽度在急诊老年脓毒症病人中的应用价值 |
| Application value of neutrophil to lymphocyte ratio combined with red blood cell distribution width in emergency elderly sepsis patients |
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| DOI：10.3969/j.issn.1009-6469.2024.04.008 |
| 中文关键词: 脓毒症 红细胞分布宽度 中性粒细胞与淋巴细胞比值 降钙素原 急性生理与慢性健康状况评估 老年人 |
| 英文关键词: Sepsis Red blood cell distribution width (RDW) Neutrophil to lymphocyte ratio (NLR) Procalcitonin (PCT) Acute physiology and chronic health evaluation (APACHE Ⅱ) Aged |
| 基金项目:国家重点研发计划课题( 2020YFC2005402) |
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| 中文摘要: |
| 目的探讨中性粒细胞与淋巴细胞比值( NLR)结合红细胞分布宽度( RDW)对急诊老年脓毒症病人疾病严重程度和预后的评估意义。方法收集 2019年 1月到 2022年 2月在首都医科大学宣武医院急诊科就诊及住院治疗的老年脓毒症病人 169例。病人入急诊后给予生化全项、血气分析、全血细胞计数、降钙素原( PCT)、胸部计算机体层摄影( CT)、病原学检查等。依据以上检查结果进行急性生理与慢性健康状况评估( APACHEⅡ)。根据病人入急诊时合并脓毒性休克情况分为脓毒症组 114例和脓毒性休克组 55例。随访 28 d，依据病人死亡情况分成生存组 125例和死亡组 44例。分别比较脓毒性休克组和脓毒症组、生存组和死亡组病人 NLR、白细胞计数( WBC)、 PCT、RDW和 APACHEⅡ评分的区别，进行 NLR、RDW与 PCT及 APACHE Ⅱ评分的相关性分析；分析 RDW、NLR及 2个指标相互结合评估老年脓毒症病人死亡风险的受试者工作特征曲线下面积(AUC)和 PCT曲线下面积的区别。结果脓毒症休克组病人 PCT、NLR、RDW和 APACHEⅡ评分分别为( 1.86±1.04)μg/L、9.63±3.92、(14.95±3.49)%和( 16.75±3.53)分，均明显高于脓毒症组的(1.38±1.06)μg/L、7.87±3.94、(12.74±3.83)%、(14.61±2.87)分( P<0.01)； WBC在脓毒症死亡组与生存组比较差异无统计学意义( P=0.361)死亡组 APACHE Ⅱ评分、 NLR、PCT和 RDW分别为( 18.52±2.41)分、(10.64±3.74)、(2.55±1.14)μg/L和( 15.98±3.69)%，均大于生存组的( 14.17±2.71)分、 7.67±3.82、(1.19±0.81)μg/L、(12.57±3.43)%(P<0.01)，RDW和 NLR均与 APACHE Ⅱ评分和 PCT具有相关性(均 P<0.01)； PCT的 AUC 95%CI为0.86(0.80，0.92)， APACHE Ⅱ评分的 AUC 95%CI为 0.88(0.83，0.93)， RDW的 AUC 95%CI为 0.75(0.66，0.83)， NLR的 AUC 95%CI为 0.73(0.64，0.81)RDW和 NLR的 AUC均小于 PCT(P=0.048，0.024)但 RDW与 NLR联合的 AUC为 0.80，与 PCT比较差异无统计学意义( P=0.363。结论 NLR及 RDW两个指标都能够在急诊脓毒症病人的病情和预后评估中有较好的应 |
| 英文摘要: |
| Objective To study the value of neutrophil to lymphocyte rate (NLR) combined with red blood cell distribution width(RDW) in evaluating the condition and prognosis of elderly sepsis patients in emergency.Methods One hundred and sixty-nine elder? ly sepsis patients in the Department of Emergency, Xuanwu Hospital of Capital Medical University from January 2019 to February2022 were accumulated. After entering the emergency department, biochemical examination, blood gas analysis, blood routine examina?tion, procalcitonin (PCT), chest computer tomography (CT), etiological examination and other examinations were given, the acute physi?ology and chronic health evaluation (APACHE Ⅱ) scores were scored according to the inspection results. According to the patient'sconcurrent septic shock at the time of admission to the emergency department, there were 114 cases of sepsis and 55 cases of septicshock. After 28 days of follow-up, the patients were separated into a survival group of 125 cases and a death group of 44 cases. The dif?ferences of PCT, white blood cell count (WBC), NLR, APACHE Ⅱ scores and RDW were compared between sepsis group and septicshock group, the differences of those were also compared between the death group and the survival group. The correlation betweenNLR, RDW and APACHE Ⅱ scores, PCT were analyzed. The difference of area under receiver operating characteristic curve (AUC) ofRDW, NLR, their combination and PCT in predicting death were compared in elderly sepsis patients.Results The PCT, NLR, RDW,and APACHE Ⅱ scores of patients in the septic shock group were respectively (1.86±1.04) μg/L, 9.63±3.92, (14.95±3.49)% and(16.75±3.53) points, these indicators were significantly higher than the sepsis group [PCT (1.38±1.06) μg/L, NLR (7.87±3.94), RDW(12.74±3.83)% and APACHE Ⅱ scores (14.61±2.87) points ] (P<0.01). The difference of WBC was not obvious between the survival group and the death group (P=0.361). The APACHE Ⅱ score, NLR, PCT and RDW of the death group were (18.52±2.41) points, 10.64±3.74, (2.55 ±1.14) μg/L and (15.98±3.69)% respectively, these indicators were all higher than the survival group [APACHE Ⅱ score(14.17±2.71) points, NLR (7.67±3.82), PCT (1.19±0.81) μg/L and RDW (12.57±3.43)%] (P<0.01). The RDW and NLR were correlated with APACHE Ⅱ scores and PCT (all P<0.01). The AUC 95%CI of PCT in predicting death was 0.86 (0.80, 0.92), the AUC of APACHEⅡ scores was 0.88 (0.83, 0.93), the AUC of RDW was 0.75 (0.66, 0.83), and the AUC of NLR was 0.73 (0.64, 0.81). The AUC of RDWand NLR was smaller than that of PCT (P=0.048, 0.024), but the AUC of RDW combined with NLR was 0.80, which had no significant difference compared with PCT (P=0.363).Conclusion Both NLR and RDW indicators have good application value in the evaluation ofthe condition and prognosis of elderly sepsis patients, the combined evaluation value of the two indicators is similar to that of PCT. |
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