外周血中性粒细胞计数与淋巴细胞和血小板计数比值对脓毒症患者28d死亡的预测价值  

Value of neutrophil to lymphocytes and platelets ratio for predicting 28-day mortality in sepsis patients

作　　者：刘大东[1] 虞宗颖 张德厚[1] 张建国[1] 张亚峰 王旭[4] Liu Dadong;Yu Zongying;Zhang Dehou;Zhang Jianguo;Zhang Yafeng;Wang Xu(Department of Intensive Care Unit,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,Jiangsu,China;Department of Electrocardiograph,the 4th Affiliated Hospital of Jiangsu University,Zhenjiang 212001,Jiangsu,China;Department of Infection Management,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,Jiangsu,China;Department of Oncology,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,Jiangsu,China)

机构地区：[1]江苏大学附属医院重症医学科,江苏镇江212001 [2]镇江市第四人民医院心电图室,江苏镇江212001 [3]江苏大学附属医院感染管理科,江苏镇江212001 [4]江苏大学附属医院放疗科,江苏镇江212001

出　　处：《中华危重病急救医学》2021年第1期33-37,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81701945)。

摘　　要：目的评价外周血中性粒细胞计数与淋巴细胞和血小板计数比值(N/LPR)对脓毒症患者28 d死亡的预测价值。方法回顾性分析2017年6月至2020年6月江苏大学附属医院重症医学科收治的154例脓毒症患者的临床资料。以患者入住重症监护病房(ICU)首次诊断为脓毒症的时间为研究起点,以患者死亡或28 d为研究终点,并记录患者28 d预后。收集所有患者诊断为脓毒症后3 d内外周血中性粒细胞计数(NEU)、淋巴细胞计数(LYM)和血小板计数(PLT),分别计算N/LPR和NEU与LYM比值(NLR)。比较两组患者N/LPR和NLR的差异;绘制受试者工作特征曲线(ROC曲线),评价N/LPR和NLR对脓毒症患者28 d死亡的预测价值;根据ROC曲线分析得出的最佳截断值对脓毒症患者的28 d病死率进行亚组分析,并绘制Kaplan-Meier生存曲线,分析脓毒症患者28 d累积生存情况。结果154例脓毒症患者中,排除年龄<18岁、妊娠期、存在血液系统疾病、近1周内服用过阿司匹林或其他抗血小板药物、近1周内服用过升白细胞药物、ICU住院时间<3 d及资料不完整患者,最终共50例患者纳入分析,其中28 d存活30例,死亡20例。死亡组患者N/LPR和NLR均显著高于存活组(N/LPR:23.85±11.99比12.41±5.25,NLR:17.83±8.69比10.75±3.63),差异均具有统计学意义(均P<0.01)。ROC曲线分析显示,N/LPR预测脓毒症患者28 d死亡的ROC曲线下面积(AUC)为0.827,高于NLR(AUC=0.762);以15.48作为N/LPR预测脓毒症患者28 d死亡的最佳截断值,敏感度为75.0%,特异度为80.0%;以10.65作为NLR预测脓毒症患者28 d死亡的最佳截断值,敏感度为75.0%,特异度为56.7%。亚组分析显示,N/LPR≥15.48组脓毒症患者(21例)28 d病死率显著高于N/LPR<15.48组(29例;71.4%比17.2%,χ^(2)=14.901,P<0.01);NLR≥10.65组脓毒症患者(28例)28 d病死率亦显著高于NLR<10.65组(22例;53.6%比22.7%,χ^(2)=4.884,P<0.05),与Kaplan-Meier生存曲线分析结果吻合。结论外周血N/LPR对脓毒症患者2Objective To evaluate the value of neutrophil to lymphocyte and platelet ratio(N/LPR)for predicting 28-day mortality in sepsis patients.Methods A retrospective analysis was conducted.The clinical data of 154 sepsis patients admitted to intensive care unit(ICU)of the Affiliated Hospital of Jiangsu University from June 2017 to June 2020 were enrolled.The time of first diagnosis of sepsis in ICU was taken as the research starting point,and the death or 28 days as the end point.The 28-day outcomes of patients were recorded.The counts of peripheral blood neutrophil(NEU),lymphocyte(LYM)and platelet(PLT)were collected from all the enrolled patients within 3 days after diagnosis of sepsis.The ratios of N/LPR and NEU/LYM(NLR)were calculated respectively.The differences of N/LPR and NLR between survival group and death group were compared.Receiver operating characteristic(ROC)curve analysis was used to analyze the value of N/LPR and NLR on predicting the 28-day mortality of sepsis patients.According to the best cut-off value of ROC curve analysis,the 28-day mortality of patients with sepsis was analyzed by subgroup analysis,and the 28-day cumulative survival of patients with sepsis was analyzed by Kaplan-Meier survival curve.Results Of the 154 sepsis patients,the patients with age<18 years,pregnancy,blood disease,taking aspirin or other antiplatelet drugs within 1 week,taking leucocyte drugs within 1 week,length of ICU stay<3 days and incomplete data were excluded.Finally,50 patients were enrolled.Among them,30 patients survived on the 28th day and 20 died.Compared with the survival group,the levels of N/LPR and NLR in the death group were significantly increased(N/LPR:23.85±11.99 vs.12.41±5.25,NLR:17.83±8.69 vs.10.75±3.63),with statistical differences(both P<0.01).ROC curve analysis indicated that the area under ROC curve(AUC)of N/LPR for predicting 28-day death of sepsis patients was 0.827,it was higher than that of NLR(AUC=0.762).Base on N/LPR≥15.48 as a predictor of cut-off value of death in 28 days of sepsis pat

关 键 词：脓毒症 中性粒细胞计数与淋巴细胞和血小板计数比值 病死率 

分 类 号：R459.7[医药卫生—急诊医学]