急性创伤后早期中性粒细胞/淋巴细胞与创伤后应激障碍发病的关系研究  

Relationship between neutrophil to lymphocyte ratio and post-traumatic stress disorder in early stage after acute trauma

作　　者：张梦 姚爱明 刘林 冯斌 刘筱 燕宪亮 花嵘 许铁 Zhang Meng;Yao Aiming;Liu Lin;Feng Bin;Liu Xiao;Yan Xianliang;Hua Rong;Xu Tie(Emergency Medicine Department,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Graduate School of Xuzhou Medical University/Department of Emergency and Rescue Medicine,Xuzhou Medical University,Xuzhou 220002,China;Jiangsu Provincail Institute of Health Emergency,Xuzhou 220002,China;Emergency Department,the Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China)

机构地区：[1]江苏省徐州医科大学附属医院急诊医学科,221002 [2]江苏省徐州医科大学研究生院/急救与救援医学系,221002 [3]江苏省卫生应急研究所,徐州221002 [4]江苏省南京医科大学附属江宁医院急诊科,211100

出　　处：《中华急诊医学杂志》2021年第4期479-484,共6页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金(81772065)。

摘　　要：目的探讨急性创伤后早期炎症水平变化与创伤后应激障碍(posttraumatic stress disorder,PTSD)发病的关系。方法选2018年1月至2020年6月因急性创伤至徐州医科大学附属医院就诊患者为研究对象。于入院当天及伤后第3天、第7天采集患者外周静脉血检测血常规、C-反应蛋白(C-reaction protein,CRP)及降钙素原(procalcitonin,PCT)等检验指标,计算中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR),1个月后使用PCL-5量表评估患者PTSD症状,以38分为界将患者分为PTSD组与非PTSD组。分析PTSD组和非PTSD组的NLR变化规律。结果纳入创伤患者91例,其中PTSD组23例,非PTSD组68例。与健康对照组相比,91例创伤患者入院当天、第3天、第7天的NLR水平均升高(均P<0.01),PTSD组在创伤后第7天的NLR值明显高于非PTSD组(P=0.025);而非PTSD组则呈下降趋势,在创伤后第7天非PTSD组NLR值已明显低于入院当天(P=0.001)。此外,伤后7 d的NLR高水平(β=0.206,P=0.01)是影响PTSD发病的危险因素。结论动态监测急性创伤后的NLR值变化,对创伤后PTSD的早期预警具有重要的临床价值。Objective To investigate the relationship between the changes in inflammatory markers levels and the onset of post-traumatic stress disorder(PTSD)in the early stage of acute trauma..Methods From January 2018 to June 2020,patients with acute trauma who were admitted to the Affiliated Hospital of Xuzhou Medical University were selected as subjects.Peripheral venous blood was collected on admission,on the 3rd and 7th day after trauma for routine blood test,C-reactive protein(CRP)and procalcitonin(PCT).The neutrophil to lymphocyte ratio(NLR)was calculated.The PCL-5 scale was used to evaluate PTSD symptoms one month later.The patients were divided into the PTSD group and non-PTSD group with the score of 38 as the boundary.The change rule of NLR in the PTSD group and the non-PTSD group were analyzed.Results Ninety-one trauma patients were enrolled,including 23 patients in the PTSD group and 68 patients in the non-PTSD group.Compared with the healthy control group,the NLR of 91 trauma patients on admission,on the 3rd and 7th day were significantly higher(all P<0.01).The NLR of the PTSD group was increased on the 7th day after trauma,which was significantly higher than that of the non-PTSD group(P=0.025).The non-PTSD group showed a decreasing trend,of which NLR on the 7th day was significantly lower than that on admission(P=0.001).In addition,high level of NLR on the 7th day after trauma(β=0.206,P=0.01)was a risk factor for PTSD onset.Conclusions Dynamic monitoring of the changes in NLR after acute trauma would be of great clinical value to early warning of PTSD.

关 键 词：创伤后应激障碍 急性创伤 炎症 中性粒细胞 淋巴细胞 危险因素 中性粒细胞/淋巴细胞 PCL-5评分 

分 类 号：R749.5[医药卫生—神经病学与精神病学]