单核细胞计数与高密度脂蛋白比值预测急性肺栓塞病情严重程度与院内病死率的研究  

Application of monocyte count and HDL ratio in the severity of acute pulmonary embolism and in-hospital mortality

作　　者：陈佳龙 林晶[1] 吴淡森[2] 石松菁[1] Chen Jia-long;Lin Jing;Wu Dan-sen;Shi Song-jing(Critical Care Department,Fujian Prorincial Hospital,Fujian Medical University,Fuzhou 350000,China)

机构地区：[1]福建医科大学省立临床医学院重症二科,福建福州350000 [2]福建省立医院重症二科,福建福州350000

出　　处：《中国急救医学》2020年第7期637-643,共7页Chinese Journal of Critical Care Medicine

摘　　要：目的探究新型炎症指标单核细胞计数(monocyte)与高密度脂蛋白(high density lipoprotein,HDL)比值(monocyte/HDL ratio,MHR)与急性肺栓塞(acute pulmonary embolism,APE)病情严重程度及院内病死率的关系.方法采用回顾性队列研究方法,选择2012年5月至2019年3月福建省立医院收治的286例APE患者,收集入组患者年龄、基础疾病等基本信息,进行血白细胞计数(WBC)、单核细胞计数、HDL、肌钙蛋白(cTn)及D-二聚体等实验室检查,计算MHR,分析不同病情严重程度院内生存和死亡患者的MHR水平.结果根据院内生存情况分为生存组(n=271)及死亡组(n=15),两组患者年龄、高血压、糖尿病及脑梗死等基础疾病比较差异无统计学意义(P>0.05),血WBC、单核细胞计数、白蛋白、HDL及MHR等差异有统计学意义(P<0.05).利用上述指标绘制受试者工作特征曲线(ROC曲线)对院内病死率进行预测,曲线下面积(AUG)最大分别为血WBC 0.798,MHR 0.675.根据MHR截断值0.37分为MHR>0.37组及MHR≤0.37组,发现MHR>0.37组患者D-二聚体、cTn水平明显高于MHR≤0.37组,分别为[4.08(1.91,7.54)vs.2.59(0.72,5.41)]、[0.02(0.00,0.09)vs.0.02(0.00,0.02)],差异有统计学意义(P<0.05).根据《2019年欧洲心脏病协会与呼吸协会共同制定的急性肺栓塞诊断与管理指南》[1]中危险分层将APE患者分为高危、中高危、中低危及低危.中低危、中高危及高危组患者MHR水平明显高于低危组患者,差异均有统计学意义(P值分别为0.003、0.022、0.004).应用二元Logistic回归分析发现,MHR、血WBC、D-二聚体与肌酐(Cr)升高及HDL降低均为APE患者院内死亡的独立危险因素.结论MHR、血WBC、D-二聚体与血Cr升高及HDL降低均是APE院内死亡的独立危险因素;中危及高危APE患者MHR水平高于低危患者,MHR可以预测APE患者病情严重程度.Objective To explore relationship between monocyte count/high density lipoprotein(HDL)ratio(monocyte/HDL ratio,MHR)and the severity of acute pulmonary embolism(APE)and in-hospital mortality.Methods A retrospective cohort study was conducted including 286 cases of pulmonary embolism admitted to the Fujian Provincial Hospital from May 2012 to March 2019.Basic information such as age,underlying diseases,white blood cell count,monocyte count,HDL,troponin,D-dimer and other laboratory tests were collected and MHR was calculated.The MHR levels between different severity of ilness and the survivals in the hospital were analyzed.Results The patients were divided into survival group(n=271)and death group(n=15)according to the living conditions in the hospital.There was no significant difference in the basic conditions of age,hypertension,diabetes and cerebral infarction between the two groups(P>0.05).There were statistical differences in white blood cell count,monocyte count,albumin,HDL,and MHR(P<0.05).The above indicators for the prediction of in-hospital mortality were evaluated by receiver operating characteristie curve(ROC).The largest area under the curve was white blood cell count and MHR,which were 0.798 and 0.675,respectively.According to MHR cutoff value of 0.37,the patients were divided into MHR>0.37 group and MHR≤0.37 group,D-dimer and troponin levels were significantly higher in MHR>0.37 group than in MHR≤0.37 group[4.08(1.91,7.54)vs.2.59(0.72,5.41),0.02(0.00,0.09)vs.0.02(0.00,0.02)]respectively,the difference was statistically significant(P<0.05).According to the 2019 European Association of Cardiac and Respiratory Association guidelines for the diagnosis and management of acute pulmonary embolism,risk stratification was divided into high-risk,intermediate-high risk,intermediate-low risk and low risk PE patients.The MHR levels of patients in the intermediate-high risk,intermediate-low risk,and high risk groups were significantly higher than those in the low risk group,and the diferenccs were statistically

关 键 词：炎症 单核细胞计数 高密度脂蛋白(HDL) 急性肺栓塞(APE) 院内病死率 病 情严重程度 

分 类 号：R563.5[医药卫生—呼吸系统]