中性粒细胞与淋巴细胞比值对慢加急性肝衰竭患者短期预后的评估价值  

Value of neutrophil-lymphocyte ratio in evaluating the short-time prognosis of patients with acute-on-chronic liver failure

作　　者：吴杜娟 金蕾[1] 郜玉峰[1] 叶珺[1] 夏国美[1] 李芳[1] 邹桂舟[1] WU Dujuan;JIN Lei;GAO Yufeng(Department of Hepatology,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院肝病科,合肥230601

出　　处：《临床肝胆病杂志》2018年第9期1945-1949,共5页Journal of Clinical Hepatology

基　　金：安徽省自然科学基金资助项目(1608085MH164)

摘　　要：目的研究中性粒细胞与淋巴细胞比值(NLR)对HBV相关慢加急性肝衰竭(ACLF)患者28 d预后的影响。方法回顾性分析2015年1月-2016年12月在安徽医科大学第二附属医院住院的HBV-ACLF患者100例,根据患者第28 d表现出的疾病转归状况进行分组,分别归为死亡组(n=42)或者生存组(n=58),收集两组性别、年龄、实验室指标、MELD评分以及临床并发症情况,并对上述指标进行单因素分析,计量资料组间比较采用t检验或者Mann-Whithey U检验;计数资料组间比较采用χ2检验。多因素分析采用二元logistic回归分析。MELD评分与NLR的关系采用Pearson相关性分析,并通过受试者工作特征曲线(ROC曲线)分析不同预测指标对HBV-ACLF预后的临床价值。结果对100例HBV-ACLF患者分析显示,死亡组的年龄、Alb、ALT、肌酐、WBC、中性粒细胞计数、淋巴细胞计数、单核细胞计数、国际标准化比值、TBil、NLR、MELD评分与生存组比较,差异均有统计学意义(P值均<0.05)。生存组肝性脑病、出血、腹水、感染的发生率均低于死亡组,但组间差异均无统计学意义(P值均>0.05)。采用二元logistic分析发现NLR、MELD评分为HBV-ACLF患者28 d死亡的独立预测因素(P值分别为<0.001、0.022),且NLR与MELD评分呈正相关(r=0.264,P=0.008)。NLR和MELD评分ROC曲线下面积分别为0.889和0.728,二者差异具有统计学意义(P=0.026 7)。结论 NLR是影响HBV-ACLF患者短期预后的独立预测因素。bObjective To investigate the effect of neutrophil-lymphocyte ratio（NLR） on the 28-day prognosis of patients with HBV-associated acute-on-chronic liver failure（HBV-ACLF）. Methods A total of 100 patients with HBV-ACLF who were admitted to The Second Affiliated Hospital of Anhui Medical University from January 2015 to December 2016 were enrolled,and according to their prognosis on day 28,they were divided into death group and survival group. The data on sex,age,laboratory markers,Model for End-Stage Liver Disease（MELD） score,and clinical complications were collected for univariate analysis. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups. The Chi-square test was used for comparison of categorical data between two groups. Binary logistic regression was used for multivariate analysis. Pearson correlation analysis was used to investigate the correlation between MELD score and NLR. The receiver operating characteristic（ROC） curve was used to analyze the value of indices in predicting the prognosis of HBV-ACLF. Results The analysis of 100 patients with HBV-ACLF showed that there were significant differences between the survival group and the death group in age,albumin,alanine transaminase,serum creatinine,white blood cell count,neutrophil count,lymphocyte count,monocyte count,international normalized ratio,total bilirubin,NLR,and MELD score（all P〈0. 05）. The survival group had lower incidence rates of hepatic encephalopathy,hemorrhage,ascites,and infection than the death group,but there were no significant differences between the two groups（all P〉0. 05）. The binary logistic regression analysis showed that NLR and MELD score were independent predictive factors for 28-day mortality in HBV-ACLF patients（P〈0. 001 and P = 0. 022）,and NLR was positively correlated with MELD score（r = 0. 264,P = 0. 008）. The ROC curve analysis showed that NLR had a significantly larger area under the ROC curve than MELD score（0. 889 vs 0.728,P =0.026 7）.

关 键 词：肝功能衰竭 淋巴细胞 中性白细胞 预后 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]