LWR、PLR、PWR动态改变在新型冠状病毒肺炎重型和危重型患者救治中的临床意义  

Cinical significance of dynamic changes of LWR,PLR and PWR in treatment of severe and critical coronavirus disease 2019 patients

作　　者：李祥 马龙[1] 于朝霞[1] 张大权[2] 权荣喜 王娟[1] 侯芳[1] 马晶[1] 杨毅宁[4] 于湘友[1] Li Xiang;Ma Long;Yu Zhaoxia;Zhang Daquan;Quan Rongxi;Wang Juan;Hou Fang;Ma Jing;Yang Yining;Yu Xiangyou(Intensive Care Medicine Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous Region,China;Department of Intensive Care Medicine,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,Xinjiang Uygur Autonomous Region,China;Department of Intensive Care Medicine,the Third Affiliated Teaching Hospital of Xinjiang Medical University(Affiliated Tumor Hospital),Urumqi 830011,Xinjiang Uygur Autonomous Region,China;Heart Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第一附属医院重症医学中心,新疆维吾尔自治区乌鲁木齐830054 [2]新疆维吾尔自治区人民医院重症医学二科,新疆维吾尔自治区乌鲁木齐830001 [3]新疆医科大学第三附属(肿瘤)医院重症医学科,新疆维吾尔自治区乌鲁木齐830011 [4]新疆医科大学第一附属医院心脏中心,新疆维吾尔自治区乌鲁木齐830054

出　　处：《中国中西医结合急救杂志》2021年第3期261-266,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家临床重点专科建设项目(2011-368);中国医学科学院医学与健康科技创新工程重大协同创新项目(2020-12M-2-005)。

摘　　要：目的分析新型冠状病毒肺炎(新冠肺炎)重型、危重型患者的临床特点,探讨外周血淋巴细胞/白细胞比值(LWR)、血小板/淋巴细胞比值(PLR)、血小板/白细胞比值(PWR)在重型、危重型患者救治中的临床意义.方法选择2020年7月15日至9月7日新疆维吾尔自治区新冠肺炎医疗救治定点医院重症监护病房(ICU)收治的新冠肺炎患者作为研究对象,根据诊断标准分为重型和危重型.收集所有患者的人口学资料、基础疾病、入院症状、治疗方式、治疗时间、呼吸支持等基本情况;收集患者入ICU 1、3、7 d的白细胞计数(WBC)、D-二聚体、LWR、PLR、PWR等指标.绘制重型、危重型患者的受试者工作特征曲线(ROC),计算ROC曲线下面积(AUC),分析上述指标对疾病分型的诊断价值.同时以是否进行体外膜肺氧合(ECMO)治疗作为临床结局,绘制PLR预测危重型患者应用ECMO治疗的ROC曲线,分析PLR对危重型患者临床结局的预测价值.结果①基本情况:共纳入新冠肺炎患者75例,其中重型56例,危重型19例(包括包括常规治疗11例、常规+ECMO治疗8例).入院症状主要为咳嗽、发热和咳痰,72%的患者具有1种或多种基础疾病,以高血压和糖尿病最常见.危重型患者患有冠心病、发热以及应用免疫疗法、激素疗法和抗菌药物治疗的比例均明显高于重型患者,发病至入院时间和ICU住院时间均较重型患者明显延长,且危重型患者使用呼吸支持比例更高.②外周血指标对新冠肺炎分型的诊断价值:入ICU 1 d时,外周血D-二聚体、LWR对重型和危重型分型均有预测效能〔D-二聚体:AUC=0.726,95%可信区间(95%CI)为0.581~0.872,P<0.01;LWR:AUC=0.693,95%CI为0.556~0.830,P=0.01〕.入ICU 3 d时,WBC、LWR、PWR对重型和危重型分型均具有预测效能(WBC:AUC=0.838,95%CI为0.730~0.947,P<0.01;LWR:AUC=0.849,95%CI为0.747~0.950,P<0.01;PWR:AUC=0.846,95%CI为0.752~0.940,P<0.01).入ICU 7 d时,WBC、D-二聚体、LWR、PLR、PWR�Objective To analyze the clinical characteristics of severe and critical patients with coronavirus disease 2019(COVID-19)and explore the clinical significances of peripheral blood white blood cell count(WBC),D-dimer,lymphocyte/white blood cell ratio(LWR),platelet/lymphocyte ratio(PLR)and platelet/white blood cell ratio(PWR)in the rescue of severe and critical patients.Methods The patients with COVID-19 admitted into the intensive care unit(ICU)of the designated hospital for the treatment of COVID-19 in the Xinjiang Urumqi Autonomous Region from July 15 to September 7,2020 were selected as the research objects.According to the standard diagnostic criteria,the patients were divided into two types,the severe and critical cases with COVID-19.The demographic data,basic diseases,admission symptoms,treatment methods,treatment time,respiratory support and other basic information,and the laboratory results of WBC,D-dimer,LWR,PLR,PWR and other indicators on the 1st,3rd,and 7th days after entering the ICU of all patients were collected.The receiver operating characteristic(ROC)curves were drawn for the severe and critical patients,the areas under the ROC curves(AUC)were calculated and the diagnostic values of the above indicators for disease classification were analyzed.Meanwhile,whether apply or not apply the extracorporeal membrane lung oxygenation(ECMO)was realized as the clinical outcome;the ROC curve of PLR predicting the use of ECMO for treatment in the critically ill patient was drawn to analyze the predicting value of PLR for the clinical outcome in critically ill patients.Results①Basic information:a total of 75 patients with COVID-19 were enrolled,including 56 cases of severe patients and 19 cases of critical patients(11 cases using conventional treatment,8 cases with conventional treatment+ECMO).The main symptoms on admission were cough,fever and sputum.72%of the patients had one or more underlying diseases and the most common ones were hypertension and diabetes.The proportions of critical patients suffering fro

关 键 词：淋巴细胞/白细胞比值 血小板/淋巴细胞比值 血小板/白细胞比值 新型冠状病毒肺炎 

分 类 号：R73[医药卫生—肿瘤]