外周血感染性指标IL-6联合NLR评估脓毒血症患者病情的临床价值  

Clinical value of IL-6 combined with NLR in evaluating patients with sepsis

作　　者：于欢[1] 张秀丽[2] YU Huan;ZHANG Xiu-li(Emergency Department,Hangzhou Normal University Affiliated Hospital,Hangzhou,Zhejiang 310015,China;不详)

机构地区：[1]杭州师范大学附属医院急诊科,浙江杭州310015 [2]杭州师范大学附属医院重症监护室,浙江杭州310015

出　　处：《中国预防医学杂志》2020年第10期1120-1124,共5页Chinese Preventive Medicine

基　　金：浙江省医学会临床科研基金资助项目(2015ZYC-A39)。

摘　　要：目的探讨外周血感染性指标白细胞介素-6(IL-6)和中性粒细胞与淋巴细胞比值(NLR)的相关性以及其联合检测对脓毒血症患者病情的严重程度和预后评估的临床价值。方法回顾性分析自2016年5月~2019年5月于杭州师范大学附属医院重症监护病房(ICU)治疗的脓毒血症患者的临床资料共96例,按28 d后的生存情况分为存活组和死亡组两个组别。计算两组病例的急性生理与慢性健康状况评分系统Ⅱ评分(APACHEⅡ)和序贯器官衰竭(SOFA)评分;入院后患者检测血常规、生化指标以及凝血功能,分析IL-6和NLR之间的相关性,评价IL-6、NLR及IL6联合NLR对脓毒血症患者预后的价值。结果 96例脓毒血症患者28 d后存活病例数为73例,死亡23例。通过比较存活组和死亡组两组之间的基线资料,发现差异无统计学意义。在APACHEⅡ评分、SOFA评分、IL-6以及NLR值表现上死亡组均明显高于存活组(均P<0.05)。IL-6与NLR呈正相关(r=0.455,P<0.01),通过比较ROC生存曲线结果发现,IL-6水平的ROC曲线下面积(AUC)为0.801,评估预后的敏感度为84.00%,特异度为71.00%;NLR的AUC为0.696,评估预后的敏感度为87.80%,特异度为54.50%。IL-6评估预后的价值和同期的APACHEⅡ评分及SOFA评分相比更具优势,IL-6联合NLR的AUC为0.805,评估预后的敏感度为70.50%,特异度为84.20%。IL-6联合NLR与其他单独指标相比评估预后的价值最好。结论 IL-6预测脓毒血症患者28d病死率的敏感度最高,但特异性和其他指标比相对较低;而IL-6联合NLR敏感度稍低,但特异性好。Objective To explore the correlation between IL-6 and the ratio of neutrophils to lymphocytes(NLR), and the clinical value of the combined detection of IL-6 and NLR in the evaluation for disease severity and prognosis of patients with sepsis. Methods Clinical data of 96 patients with sepsis treated in intensive care unit(ICU) of our hospital from May 2016 to May 2019 were retrospectively analyzed.Patients were divided into survival group and death group based on their survival status after 28 days.Scores of the acute physiology and chronic health evaluation system Ⅱ(APACHEⅡ) and sequential organ failure(SOFA) were calculated.After admission, blood test, biochemical and coagulation tests were performed and the correlation between IL-6 and NLR was analyzed.The receiver operating characteristic curve(ROC) was generated to assess the clinical value of Il-6, NLR for the prognosis of patients with sepsis. Results Out of 96 patients, 73 survived and 23 died after 28 days.The baseline data between the two groups was not statistically different.The APACHEⅡscore,SOFA score and levels of IL-6 and NLR were all significantly higher in survival group than that in death group(P<0.05).IL-6 was positively correlated with NLR(r=0.455,P<0.01).By comparing ROC survival curves,it revealed that the area under the ROC curve(AUC)was 0.801 for IL-6 and 0.696 for NLR,the sensitivity and specificity in prognosis evaluation were 84%,71%for IL-6 and 87.8%,54.5%for NLR.The power of IL-6 for evaluating disease prognosis was stronger than PACHEⅡ score and SOFA score.The AUC of combined IL-6 with NLR was 0.805,and the sensitivity and specificity were 70.5% and84.2%.Il-6 combined with NLR showed the greatest value for disease prognosis assessment. Conclusions IL-6 is the most sensitive predictor for 28 dmortality of patients with sepsis,but its specificity is relatively low,while the specificity of IL-6 combined with NLR is much better even though the sensitivity is slightly low.

关 键 词：脓毒血症 IL-6 NLR 预后 

分 类 号：R55[医药卫生—血液循环系统疾病]