新型冠状病毒肺炎患者外周血细胞动态变化特征及预测价值  

Dynamic characteristics and predictive value of peripheral blood cells in patients with coronavirus disease 2019

作　　者：秦志均 刘磊 孙群[1] 刘家盛[3] 罗建飞[3] 刘丹[4] QIN Zhijun;LIU Lei;SUN Qun;LIU Jiasheng;LUO Jianfei;LIU Dan(Department of Intensive Care Unit,Sichuan Provincial Orthopedic Hospital,Chengdu,Sichuan 610041,P.R.China;Department of Infection Management,Sichuan Provincial Orthopedic Hospital,Chengdu,Sichuan 610041,P.R.China;Department of Gastrointestinal Surgery,Renmin Hospital of Wuhan University,Wuhan,Hubei 430060,P.R.China;Department of Respiratory and Critical Care Medicine,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川省骨科医院重症医学科,四川成都610041 [2]四川省骨科医院感染管理科,四川成都610041 [3]武汉大学人民医院胃肠外科,湖北武汉430060 [4]四川大学华西医院呼吸与危重症医学科,四川成都610041

出　　处：《中国呼吸与危重监护杂志》2020年第5期457-462,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：科技部–国家重点研发计划项目(2017YFC0910004)。

摘　　要：目的分析不同类型新型冠状病毒肺炎(简称新冠肺炎)患者的外周血细胞动态变化特征,探讨外周血细胞及其动态变化对新冠肺炎患者临床结局的预测价值。方法选择2020年2月2日至2020年3月15日在武汉大学人民医院东院第五、六病区住院,并已出院/死亡的新冠肺炎患者48例,根据病情危重程度及临床结局分为普通型组(A组,17例),重症存活组(B组,21例),重症死亡组(C组,10例)。描述分析各亚组的外周血细胞指标值,分析入院前后及三组间统计学差异;比较各组患者的中性粒细胞、淋巴细胞变化动态;通过受试者工作特征(ROC)曲线分析中性粒细胞、淋巴细胞、中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)对于临床结局的预测效能。结果外周血细胞计数:B组出院时淋巴细胞计数较入院时显著增高(P=0.002),中性粒细胞、NLR和PLR较入院时显著降低(P值分别为0.012、0.001、0.007);A、B、C三组入院时淋巴细胞计数由高到低排列,三组间差异均有统计学意义(P值分别A-B=0.020,A-C<0.001,B-C=0.006),NLR由低到高排列,三组间差异均有统计学意义(P值分别A-B=0.001,A-C<0.001,B-C=0.026);出院/死亡前淋巴细胞计数和NLR在A、B两组间差异无统计学差异(P>0.05),在C组与A、B两组间差异均有统计学意义(均P<0.001)。中性粒细胞、淋巴细胞变化动态:A组和B组出现"中性淋巴靠拢"的比例分别为64.7%和76.2%,显著高于C组(10.0%);C组出现"中性淋巴分离"的比例为70.0%,显著高于A组(0)和B组(4.76%)。ROC分析结果显示,NLR预测患者重症化(不含死亡)的曲线下面积为0.843,≥3.55时的敏感度和特异度分别为0.810和0.882;淋巴细胞计数预测重症患者出现死亡的曲线下面积为0.845,≤0.5×10^9/L时的敏感性和特异性分别为0.700和0.905。结论外周血细胞组分动态变化是新冠肺炎的临床特征之一,"中性淋巴靠拢"和"中性淋巴分离"分别预示较好和�Objective To analyze dynamic characteristics of peripheral blood cells in patients with different types of coronavirus disease 2019(COVID-19),so as to investigate the predictive value of peripheral blood cells and their dynamic changes for clinical outcome of patients with COVID-19.Methods Forty-eight patients with COVID-19 were collected and analyzed from East Hospital of Renmin Hospital of Wuhan University from February 2 to March 15,2020.These patients were divided into general group(group A,17 cases),severe survival group(group B,21 cases),and severe death group(group C,10 cases).Blood routine examination was done and analyzed before and after admission and among the three groups.The changes of neutrophils and lymphocytes were compared.The predictive power of neutrophils,lymphocytes,neutrophil-to-lymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR)for clinical outcomes was analyzed through the receiver operating characteristic(ROC)curve.Results In group B,the lymphocyte count at discharge was significantly higher than at admission(P=0.002),and the neutrophil count,NLR and PLR were significantly lower than at admission(P values were 0.012,0.001 and 0.007,respectively).The lymphocyte counts in the A,B,and C groups were ranked from high to low upon admission,and the differences among the three groups were statistically significant(P values were 0.020,<0.001 and 0.006 for the contrasts between groups A and B,groups A and C,groups B and C,respectively),the NLR were ranked from low to high,and the differences among the three groups were statistically significant(P values were 0.001,<0.001 and 0.026 for the contrasts between groups A and B,groups A and C,groups B and C,respectively).Before discharge or death,there was no significant difference in lymphocyte counts and NLR between A and B groups(P>0.05),and there were statistically significant differences between group C and groups A and B(all P values were<0.001).The proportions of"Neutrophils Lymphocytes Convergence"in groups A and B were 64.7%and 76.2%,resp

关 键 词：新型冠状病毒肺炎 中性粒细胞 淋巴细胞 临床结局 

分 类 号：R563.1[医药卫生—呼吸系统]