中性粒细胞与淋巴细胞比值及红细胞分布宽度对脓毒症患者预后评估价值性  

The value of neutrophil to lymphocyte ratio and red blood cell distribution width in the prognostic evaluation of patients with sepsis

作　　者：王卿语 陈新军[1] 武冬[1] 薛辉[1] 杨丹 刘丹平[1] WANG Qingyu;CHEN Xinjun;WU Dong;XUE Hui;YANG Dan;LIU Danping(Department of Emergency,Shaanxi Provincial People’s Hospital,Xi,an,710068,China;Xi’an International Medical Center Cardiology Department)

机构地区：[1]陕西省人民医院急诊内科,西安710068 [2]西安国际医学中心心脏病院

出　　处：《临床急诊杂志》2021年第2期136-140,共5页Journal of Clinical Emergency

摘　　要：目的:探讨中性粒细胞与淋巴细胞比值(NLR)、红细胞分布宽度(RDW)对脓毒症患者预后的评估价值。方法:回顾性研究2019年8月—2020年3月陕西省人民医院收治的102例脓毒症患者的临床资料,记录患者入院时的血常规、肾功能、动脉血气分析等,并计算患者入院24小时内APACHEⅡ、SOFA评分最差值。根据患者预后分为生存组、死亡组,采用T检验比较两组的差异,对死亡组的危险因素进行多因素Logistic回归分析,评价RDW、NLR、APACHEⅡ、SOFA评分与预后的关系,采用受试者工作特征曲线(ROC曲线)评价RDW、NLR、SOFA评分对脓毒症患者出院结局的预测价值,Spearman相关分析检验NLR与RDW的联合预测因子与SOFA评分的相关性。结果:(1)RDW、NLR、APACHEⅡ、SOFA评分的升高同脓毒症入院后24小时内病死率的发生相关;(2)Logistic回归分析显示RDW、NLR、SOFA评分是脓毒症预后不良的独立危险因素;(3)RDW的敏感度为81.1%,特异度为81.5%;NLR的敏感度为83.8%,特异度为86.2%;NLR联合RDW的敏感度为86.5%,特异度为89.2%。(4)NLR及RDW联合预测因子与SOFA评分的相关性最强(rs=0.54,P<0.01)。结论:RDW联合NLR对入院24小时内脓毒症患者预后具有较高的预测价值。Objective:To explore the evaluation value of neutrophil to lymphocyte ratio(NLR),red blood cell distribution width(RDW)and prognosis of patients with sepsis.Methods:A retrospective study was conducted to investigate clinical data of 102 patients with sepsis treated in Shaanxi Provincial People’s Hospital from August 2019 to March 2020,recording blood routine,renal function,arterial blood gas analysis,etc.The worst APACHEⅡSOFA score within 24 hours upon admission was calculated.According to the prognosis of patients,they were divided into survival group and death group.T test was used to compare the differences in RDW,NLR,and APACHEⅡscores between the two groups.Multivariate logistic regression analysis was performed on the risk factors of the death group to evaluate relations between RDW,NLR,and APACHEⅡscores and prognosis.The receiver operating characteristic curve(ROC curve)was used to evaluate the predictive value of RDW,NLR and SOFA score on the discharge outcome of patients with sepsis.Spearman correlation analysis was used to test the correlation between the combined predictor of NLR,RDW and the SOFA score.Results:(1)The increase in RDW,NLR,APACHEⅡ,and SOFA scores was related to the incidence of mortality within 24 hours after admission of sepsis;(2)Logistic regression analysis showed that RDW,NLR,and SOFA scores were independent risk factors of poor prognosis of sepsis patients.(3)The sensitivity of RDW was 81.1%and the specificity was 81.5%;the sensitivity of NLR was 83.8%and the specificity was 86.2%;the sensitivity of NLR combined with RDW was 86.5%and the specificity was 89.2%.(4)The NLR and RDW combined predictors manifested the strongest correlation with the SOFA score(rs=0.54,P<0.01).Conclusion:RDW combined with NLR has a high predictive value for the prognosis of sepsis patients within 24 hours after admission.

关 键 词：脓毒症 红细胞分布宽度 中性粒细胞与淋巴细胞比值 

分 类 号：R631.2[医药卫生—外科学]