血常规及肝肾功能检测在新型冠状病毒肺炎病情预判中的应用  

The clinical application of blood routine and liver and kidney function test in COVID-19 disease prediction

作　　者：梁运来 马雅婷 黄康康 罗惠丹 王爱民[2] 熊曾[3] 罗毅 易斌[1] Liang Yun lai;Ma Yating;Huang Kangkang;Luo Hu id an;Wang Aimin;Xiong Zeng;Luo Yi;Yi Bin(Clinical Laboratory,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Emergency Department,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Radiology,Xiangya Hospital,Central South University,Changsha 410008,China;Xiangya Medical College,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅医院检验科,长沙410008 [2]中南大学湘雅医院急诊科,长沙410008 [3]中南大学湘雅医院放射科,长沙410008 [4]中南大学湘雅医学院检验系,长沙410013

出　　处：《中华预防医学杂志》2021年第1期89-95,共7页Chinese Journal of Preventive Medicine

摘　　要：目的探讨血常规和肝肾功能等常规指标对新型冠状病毒肺炎(COVID-19)患者的辅助诊断和病情预测的临床价值。方法回顾性研究,收集2020年1月28日至2月14日中南大学湘雅医院的COVID-19患者30例、其他病毒性肺炎29例、甲型/乙型流感患者35例及往期健康体检者25名,采用SNK-q等方法分析4组人群及COVID-19各亚组间血常规、肝肾功能及其他炎性指标的差异。结果中性粒细胞计数在COVID-19组、甲乙流组和其他类型病毒性肺炎组中逐步递增,且COVID-19组与其他病毒性肺炎组间差异具有统计学意义(H=-19.064,P<0.05);而淋巴细胞计数则在对照组、甲乙流组、其他病毒性肺炎组及COVID-19组中逐步递减,此外DB、UA及GLU在各组间也存在一定差异;亚组分析显示COVID-19患者肺部累及范围+~++者与肺部累及范围+++~++++者组间N(F=9.581,t=-0.152,P<0.05)、N%(F=5.723,t=-0.600,P<0.05)、NLR(F=4.773,t=-1.161,P<0.05)、PCT(F=17.464,t=-1.477,P<0.05)及CRP(F=7.656,t=-1.973,P<0.05)差异具有统计学意义,COVID-19临床分型中轻型、普通型患者与重型、危重型患者组间NLR(F=63.931,t=-2.815,P<0.01)、AST(F=15.704,t=-1.930,P<0.01)、ALT(F=35.551,t=-2.199,P<0.01)、LDH(F=7.715,t=-2.703,P<0.05)及GLU(F=6.306,t=-5.116,P<0.05)差异具有统计学意义;相关分析显示临床分型与影像学分期均与NLR(r=0.406,P=0.026;r=0.397,P=0.030)、ALT(r=0.403,P=0.049;r=0.418,P=0.047)、LDH(r=0.543,P<0.01;r=0.643,P<0.01)及GLU(r=0.750,P<0.01;r=0.471,P=0.042)显著相关;从所有纳入指标中共提取出5个主成分,综合信息提取率为82.86%,其中载荷量较大者有Ur、PCT和CRP(PC1);ALT、AST和GLU(PC2);N%、L%、L和NLR(PC3),表明急性感染指标、肝功能和血常规对疾病监测具有一定的提示作用。ROC曲线分析结果表明,N+TB+Urea的联合检测为区分COVID-19与其他病毒性肺炎的最佳方案;N+L+UA的联合检测则为区分COVID-19与甲乙流患者的最佳方案;在评估病情方面,NLR+LDH+GLU+ALT�Objective To explore the clinical application value of routine indicators such as blood routine and liver and kidney function in auxiliary diagnosis and prognosis of COVID-19 patients.Methods SNK-q and other methods were used to retrospectively analyzed the differences of blood routine test,liver and kidney function and other inflammatory indexes of 30 patients with covid-19,29 patients with other viral pneumonia,35 patients with influenza A/B and 25 healthy persons from January 28 to February 14,2020 in Xiangya Hospital of Central South University.Results The neutrophils count increased gradually in COVID-19 group,influenza A/B group and other types of viral pneumonia group,and the difference between COVID-19 group and other viral pneumonia groups was statistically significant(H=-19.064,P<0.05);The lymphocyte count decreased gradually in the control group,influenza A/B group,other viral pneumonia group and COVID-19 group.In addition,DB,UA and GLU were also different among groups.Subgroup analysis showed that there were statistically significant differences in N(F=9.581,t=-0.152,P<0.05),N%(F=5.723,t=-0.600,P<0.05),NLR(F=4.773,t=-1.161,P<0.05),PCT(F=17.464,t=-1.477,P<0.05)and CRP(F=7.656,t=-1.973,P<0.05)between patients with lung involvement+-++and patients with lung involvement+++-++++.There were statistically significant differences in NLR(F=63.931,t=-2.815,P<0.01),AST(F=15.704,t=-1.930,P<0.01),ALT(F=35.551,t=-2.199,P<0.01),LDH(F=7.715,t=-2.703,P<0.05)and GLU(F=6.306,t=-5.116,P<0.05)between the light+common subgroup and the heavy+critical subgroup of COVID-19 clinical classification.Correlation analysis showed that clinical stage and imaging credit period were significantly correlated with NLR(r=0.406,P=0.026;r=0.397,P=0.030),ALT(r=0.403,P=0.049;r=0.418,P=0.047),LDH(r=0.543,P<0.01;r=0.643,P<0.01)and GLU(r=0.750,P<0.01;r=0.471,P=0.042).A total of 5 principal components were extracted from all the included indicators,and the comprehensive information extraction rate was 82.86%.Indicators of a large load included U

关 键 词：血细胞计数 肝功能检测 肾功能检测 冠状病毒感染 预测 

分 类 号：R563.1[医药卫生—呼吸系统]