NLR和RDW在评估成人社区获得性肺炎严重程度及预后中的临床价值  

Clinical value of NLR and RDW in assessing the severity and prognosis of community-acquired pneumonia in adults

作　　者：杨珂 于树云[1] YANG Ke;YU Shu-yun(Department of Respiratory Medicine,The Second Hospital,Tianjin Medical University,Tianjin300211,China)

机构地区：[1]天津医科大学第二医院呼吸科,天津300211

出　　处：《天津医科大学学报》2021年第1期22-27,共6页Journal of Tianjin Medical University

基　　金：天津市卫生局科技基金(2012KZ080)。

摘　　要：目的:观察中性粒细胞与淋巴细胞比值(NLR)和红细胞分布宽度(RDW)在不同严重程度的社区获得性肺炎(CAP)中的水平,旨在研究NLR、RDW在评估成人CAP严重程度及预后中的临床价值。方法:收集2017年1月—2019年6月天津医科大学第二医院呼吸科病房和重症监护病房(ICU)诊断为CAP的患者294例,根据CURB-65评分进行分组,分为低危组(0~1分,117例)、中危组(2分,75例)、高危组(3~5分,102例),比较患者的临床基线资料及相关实验室检查指标,使用Spearman相关分析,分析CURB-65评分与实验室指标的相关性,以及NLR、RDW与白细胞(WBC)、中性粒细胞(NEU)、C反应蛋白(CRP)的相关性。收集并记录患者入院后30 d内转归,再分为生存组和死亡组,比较两组患者的临床基线资料及相关实验室指标水平,绘制受试者工作特征(ROC)曲线,分析NLR、RDW在预测CAP患者死亡中的临床价值。结果:(1)3组相比较,患者病情越重,NLR、RDW的水平越高(均P<0.05),RDW水平位于正常参考范围内。(2)CURB-65评分与NLR、RDW均呈正相关(r=0.419、0.280,均P<0.01)。NLR与WBC、NEU、CRP均呈正相关(r=0.621、0.376、0.522,均P<0.01)。RDW与NEU呈正相关(r=0.120,P<0.05),RDW与WBC、CRP之间均无相关性(均P>0.05)。(3)根据入院后30 d内转归分为生存组(238例)与死亡组(56例)。生存组患者NLR、RDW低于死亡组患者(均P<0.01)。(4)NLR、RDW预测CAP患者30 d死亡的ROC曲线下面积分别为0.768、0.693。结论:NLR在评估成人CAP严重程度及预后方面具有一定的临床价值,病情越重、预后越差的患者,NLR值越大。RDW与成人CAP病情严重程度及预后无明显相关性。Objective:To observe the levels of neutrophil-lymphocyte ratio(NLR)and red blood cell distribution width(RDW)in community-acquired pneumonia(CAP)with different degrees of severity,in order to study the value of NLR and RDW in assessing the severity and prognosis of CAP in adults.Methods:Collect 294 patients diagnosed with community-acquired pneumonia in the respiratory ward and intensive care unit(ICU)of the Second Hospital of Tianjin Medical University from January 2017 to June 2019.According to CURB-65,they were divided into low-risk group(0-1scores,117 cases),middle-risk group(2scores,75 cases)and high-risk group(3-5scores,102 cases).The clinical baseline data and related laboratory indicators were compared.Spearman correlation analysis was performed to investigate the correlation of CURB-65 score with laboratory indicators,as well as the correlation of NLR,RDW with white blood cell(WBC),neutrophil(NEU)and C-reactive protein(CRP).The patients′outcome within 30 days of admission was collected and recorded,and divided into survival group and death group.The clinical basic data and laboratory indicators between the two groups were compared.The work of receiver operating characteristic(ROC)curve was drawed to analyze the clinical value of NLR and RDW in predicting the death of patients within 30 days.Results:(1)In the three groups,the sicker the patient,the higher the levels of NLR and RDW(all P<0.05),and RDW was within the normal reference range.(2)CURB-65 score was positively correlated with NLR and RDW(r=0.419,0.280,all P<0.01).NLR was positively correlated with WBC,NEU and CRP(r=0.621,0.376,0.522,all P<0.01).There was a positive correlation between RDW and NEU(r=0.120,P<0.05),but there was no correlation between RDW and WBC,CRP(all P>0.05).(3)The patients were divided into survival group(n=238)and death group(n=56)according the patients′outcome within 30 days of admission.In survival group,NLR and RDW were lower than those in death group(all P<0.01).(4)The areas under the ROC curve predicted by NLR and RDW

关 键 词：社区获得性肺炎 中性粒细胞 淋巴细胞 中性粒细胞与淋巴细胞比值 红细胞分布宽度 

分 类 号：R563.1[医药卫生—呼吸系统]