文章摘要
杨惠安,俞晓玲,官升灿,等.中性粒细胞与淋巴细胞比值、血小板计数与平均血小板体积比值对重症肺炎并发脓毒症病人预后的评估价值[J].安徽医药,2024,28(7):1451-1456.
中性粒细胞与淋巴细胞比值、血小板计数与平均血小板体积比值对重症肺炎并发脓毒症病人预后的评估价值
Prognostic value of neutrophil to lymphocyte ratio, platelet to mean platelet volume ratio in severe pneumonia patients complicated with sepsis
  
DOI:10.3969/j.issn.1009-6469.2024.07.039
中文关键词: 社区获得性肺炎  脓毒症  中性粒细胞与淋巴细胞比值  血小板计数与平均血小板体积比值  预后
英文关键词: Community-acquired pneumonia  Sepsis  Neutrophil to lymphocyte ratio  Platelet to mean platelet volume ratio  Prognosis
基金项目:福建省自然科学基金面上项目( 2023J011466);福州市级科技计划项目( 2022-S-035)
作者单位E-mail
杨惠安 福建医科大学孟超肝胆医院感染科福建福州 350025  
俞晓玲 福建医科大学孟超肝胆医院药学部福建福州 350025 xiaolingyu82@163.com 
官升灿 福建医科大学孟超肝胆医院感染科福建福州 350025  
韩荔芬 福建医科大学孟超肝胆医院感染科福建福州 350025  
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中文摘要:
      目的探讨外周血中性粒细胞与淋巴细胞比值(NLR)、血小板计数(PLT)与平均血小板体积(MPV)比值对重症肺炎(SP)并发脓毒症 28 d死亡的预测价值。方法选取 2018年 3月至 2022年 3月福建医科大学孟超肝胆医院收治的 SP并发脓毒症病人为研究对象。记录病人的临床及实验室资料,计算 NLR、PLT/MPV、24 h内急性生理学和慢性健康状况评价 Ⅱ(APACHEⅡ)。根据病人 28 d预后情况分为病死组与存活组,比较两组病人的临床资料,分析 NLR、PLT/MPV与 APACHEⅡ评分的相关性,应用多因素 logistic回归分析影响 SP并发脓毒症病人预后的独立危险因素。绘制受试者操作特征曲线(ROC曲线)评价相关指标对预后的预测价值;根据最佳截断值进行亚组分析,并绘制 Kaplan-Meier生存曲线,分析 SP并发脓毒症病人 28 d累积生存率。结果共纳入 92例病人, 28 d病死 30例,存活 62例, 28 d病死率为 32.6%。病死组病人的 NLR为 17.88(13.72,27.63)显著高于存活组 NLR的 11.55(8.85,15.55);病死组病人的 PLT/MPV显著低于存活组 PLT/MPV(均 P<0.05)。与存活组比较,病死,组病人的 MPV、降钙素原(PCT)及 APACHEⅡ评分均升高,淋巴细胞计数降低,住院天数缩短(均 P<0.05)。SP并脓毒症病人 NLR、PLT/MPV均与 APACHEⅡ评分呈中度相关(r=0.52、-0.68,均 P<0.01),logistic回归分析显示 NLR、PLT/MPV、APACHEⅡ评分是影响 SP并发脓毒症病人 28 d死亡的独立危险因素。与传统指标 APACHEⅡ评分相比较, NLR、PLT/MPV对 SP并脓毒症病人 28 d死亡预后均具有很好的预测价值[曲线下面积(AUC):0.77、0.68比 0.73,Z=0.65、1.01,均 P>0.05]; NLR预测价值优于 PLT/MPV(Z=2.18,P=0.029);三项指标联合显示出更高的预测价值( AUC=0.81)。NLR最佳截断值为 11.72时,灵敏度为 86.7%,特异度为 53.2%;PLT/MPV最佳截断值为 10.36时,灵敏度为 53.3%,特异度为 79.0%。与 NLR<11.72组( 36例)比较, NLR≥11.72组(56例)病人 PCT、28 d病死率上升(均 P<0.01);与 PLT/MPV≥10.36组(64例)比较, PLT/MPV<10.36组(28例)病人 PCT、28 d病死率上升(均 P<0.01)各亚组间 28 d累积生存率差异有统计学意义(P<0.01)。结论 NLR、PLT/MPV是 SP并发脓毒症病人 28 d死亡的独立危险因素,对,28 d死亡风险均具有良好的预测价值, NLR预测价值优于 PLT/MPV,二者联合 APACHEⅡ评分预测价值更大。
英文摘要:
      Objective To explore the value of neutrophil to lymphocyte ratio (NLR), platelet(PLT)to mean platelet volume (MPV) ratio for predicting 28-day mortality in peripheral blood of severe pneumonia (SP) patients complicated with sepsis.Methods Patients with SP complicated with sepsis who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from March 2018to March 2022 were selected as the study subjects. The clinical and laboratory data of the patients were recorded, and NLR, PLT/MPV,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score within 24 hours were calculated. According to the 28-dayprognosis, the patients were assigned into death group and survival group. The clinical data of the two groups were compared, and the correlation between NLR, PLT/MPV and APACHEⅡ score was analyzed, and Multivariate Logistic regression analysis was used to analyzethe independent risk factors influencing the prognosis of SP patients complicated with sepsis. Receiver operating characteristic (ROC)curve was drawn to evaluate the predictive value of relevant indicators for prognosis; subgroup analysis was performed according to thebest cut-off value, and Kaplan-Meier survival curve was drawn to analyze the 28-day cumulative survival rate of patients with SP complicated with sepsis.Results A total of 92 patients were included. Among them, 30 patients died on the 28th day, and 62 survived. The 28·day mortality rate was 32.6%. The NLR of patients in the death group was 17.88 (13.72, 27.63), which was significantly higher than thatof the survival group 11.55 (8.85, 15.55); and the PLT/MPV of patients in the death group was significantly lower than that of the survivalgroup, and the above indexes were compared between the two groups, and the differences were statistically significant (all P< 0.05). Compared with the survival group, the levels of MPV, procalcitonin (PCT) and APACHEⅡ scores of the patients in the death group were significantly increased, the levels of lymphocyte counts were significantly decreased, and the length of hospital stay was significantly shortened (all P<0.05). The levels of NLR, PLT/MPV in patients with SP complicated with sepsis were moderately correlated with APACHEⅡ score (r=0.52, -0.68, all P<0.01). Logistic regression analysis showed that NLR, PLT/MPV and APACHEⅡ score were independent risk factors affecting the 28-day death of SP patients complicated with sepsis. ROC curve analysis showed that NLR and PLT/MPV had good predictive value for 28-day mortality in SP patients complicated sepsis compared with the traditional index APACHEⅡ score [area underthe curve (AUC): 0.77, 0.68 vs. 0.73, Z=0.65, 1.01, all P<0.05]; the predictive value of NLR was better than that of PLT/MPV (Z=2.18, P= 0.029); the three indicators combined showed higher predictive value (AUC=0.81). When the best cut-off value of NLR was 11.72, the sensitivity was 86.7% and the specificity was 53.2%; when the best cut-off value of PLT/MPV was 10.36, the sensitivity was 53.3% and thespecificity was 79.0%. Subgroup analysis showed that compared with the NLR<11.72 group (36 cases), the PCT and 28-day mortality of patients in the NLR≥11.72 group (56 cases) increased significantly (both P<0.01); compared with the PLT/MPV≥10.36 group (64 cases), the PCT and 28-day mortality of patients in the PLT/MPV<10.36 group (28 cases) increased significantly (all P<0.01), and the 28-day cumulative survival rates were different among subgroups (P<0.01).Conclusions NLR and PLT/MPV are independent risk factors for 28day death in SP patients complicated with sepsis, and both have good predictive value for 28-day mortality risk. The predictive value ofNLR is better than that of PLT/MPV, and the two indicators combined with APACHEⅡ score have greater predictive value.
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