NLR、D-二聚体、CRP、PCT对新型冠状病毒肺炎病情进展的预测价值  

The value of NLR,D-dimer,CRP and PCT in predicting the progression of COVID-19 patients

作　　者：曹志龙 韩旭东[1] 张素燕[1] 田李均[1] 徐俊贤[1] 高爱忠 朱玉成[3] 刘永福 CAO Zhilong;HAN Xudong;ZHANG Suyan;TIAN Lijun;XU Junxian;GAO Aizhong;ZHU Yucheng;LIU Yongfu(Department of Intensive Care Unit,the Third People′s Hospital of Nantong City,Jiangsu 226006;Department of Intensive Care Unit,Huai′an No4 People′sHospital;Department of Intensive Care Unit,Xuzhou Infectious Disease Hospital;Department of Intensive Care Unit,the Second Hospital of Nanjing)

机构地区：[1]南通市第三人民医院重症医学科,江苏226006 [2]淮安市第四人民医院重症医学科 [3]徐州市传染病医院重症医学科 [4]南京市第二人民医院重症医学科

出　　处：《交通医学》2020年第5期463-466,469,共5页Medical Journal of Communications

基　　金：南通市市级科技计划项目:2020新冠冠状病毒科研攻关专项项目(XG202003-3)。

摘　　要：目的:探究中性粒细胞/淋巴细胞比(NLR)、D-二聚体、C反应蛋白(CRP)、降钙素原(PCT)对新型冠状病毒肺炎病情进展的预测价值。方法:新型冠状病毒肺炎患者78例,分为轻症组48例和重症组30例。测定患者血常规、血乳酸脱氢酶(LDH)、白蛋白(Alb)、CRP、血沉(ESR)、PCT、D-二聚体及CD4^+T淋巴细胞。以SpO2作为病情进展的评定指标,将WBC、NLR、CRP、ESR、PCT、D-二聚体、CD4^+T淋巴细胞等因素进行Logistic回归,分析影响新冠肺炎病情进展的危险因素。采用ROC曲线分析NLR、PCT、CRP、D-二聚体以及联合检测对新冠肺炎病情进展的预测价值。结果:重症组WBC、NLR、CRP、ESR、PCT、D-二聚体高于轻症组,CD4^+T淋巴细胞、SpO2低于轻症组,差异均有统计学意义(P<0.05)。Logistic回归分析显示,NLR是新冠肺炎疾病进展的独立危险因素,具有统计学意义(P<0.05)。ROC曲线分析显示,NLR的曲线下面积(AUC)为0.825,取最佳截断值时预测疾病进展的特异性为93.7%,敏感度为93.3%,约登指数为0.87;PCT的AUC为0.459,取最佳截断值时特异性为12.5%,敏感度为93.3%,约登指数为0.058;CRP的AUC为0.636,取最佳截断值时特异性为97.9%,敏感度为36.7%,约登指数为0.346;D-二聚体的AUC为0.683,取最佳截断值时特异性为59.2%,敏感度为60.0%,约登指数为0.392;联合检测的AUC为0.843,取最佳截断值时特异性为97.9%,敏感度为93.3%,约登指数为0.912,NLR对病情加重的预测价值优于PCT、CRP、D-二聚体,而联合检测的预测价值更优,差异均有统计学意义(P<0.05)。结论:新冠肺炎重症患者NLR明显升高,NLR对新冠肺炎病情加重具有一定的预测价值,联合检测NLR、PCT、CRP和D-二聚体的预测价值更高。Objective:To explore the predictive value of NLR,D-dimer,CRP and PCT in the progression of COVID-19 patients.Methods:According to the standard of novel coronavirus′s diagnosis and treatment Program for severe and critical cases(trial second Edition)issued by the State,the 78 patients definitely diagnosed as COVID-19 were divided into the mild group(n=48)and the severe group(n=30).The quantitative values of WBC,NLR,PLT,LDH,Alb,CRP,ESR,PCT,D-dimer and CD4^+T lymphocytes in serum were determined by related instruments.The baseline data of the two groups were compared and analyzed;at the same time,SpO2 was used as an evaluation index to evaluate the disease progression of COVID-19 patients,and WBC,NLR,CRP,ESR,PCT,D-dimer and CD4^+T lymphocytes as mixed factors wereincluded in the multiple regression model for comparative analysis.Multivariate COX regression was used to analyze the risk factors of COVID-19′s disease progression.Finally,the predictive value of ROC curve in SPSS for the progression of COVID-19′s disease was calculated.Results:By comparing the baseline data of the two groups,it was found that the levels of WBC,NLR,CRP,ESR,PCT and D-dimer in the severe group were significantly higher than those in the mild group,while the levels of CD4^+T lymphocytes and SpO2 in the severe group were significantly lower than those in the mild group.The results showed that NLR was an independent risk factor for disease progression in COVID-19 patients,and the difference was statistically significant.The AUC of NLR is 0.825,the specificity is 93.7%,the sensitivity is 93.3%,the Yoden index is 0.87;the AUC of PCT is 0.459,the specificity is 12.5%,the sensitivity is 93.3%,the Yoden index is 0.058,the specificity is 97.9%,the sensitivity is 36.7%,and the Yoden index is 0.346,the AUC of D-dimer is 0.683,the specificity is 59.2%,the sensitivity is 60.0%,and the Yoden index is 0.392 when the best cutoff value is taken.The AUC of combined detection was 0.843,the specificity and sensitivity of the best cutoff value were 97.9%a

关 键 词：新冠肺炎 病情进展 中性粒细胞/淋巴细胞比 D-二聚体 C反应蛋白 降钙素原 预测价值 

分 类 号：R563.1[医药卫生—呼吸系统]