CRP联合NLR对新型冠状病毒肺炎预后的评估价值  

Evaluation value of C-reactive protein combined with neutrophil/lymphocyte ratio in assessing prognosis of coronavirus disease 2019

作　　者：吕慧 谢云 滕晓蕾 陈道南 王涛[1] 赵奇 Lyu Hui;Xie Yun;Teng Xiaolei;Chen Daonan;Wang Tao;Zhao Qi(Department of Emergency and Critical Care Medicine,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine(originally named"Shanghai First People's Hospital"),Shanghai 201620,China)

机构地区：[1]上海交通大学医学院附属第一人民医院急诊危重病科,上海201620

出　　处：《中国中西医结合急救杂志》2022年第4期391-394,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：(2020-2022年)公共卫生重点学科项目-灾难医学与卫生应急管理(GWV-10.1-XK25)。

摘　　要：目的总结分析新型冠状病毒肺炎(新冠肺炎)的临床特征,评价C-反应蛋白(CRP)联合中性粒细胞与淋巴细胞比值(NLR)在预测新冠肺炎患者预后的价值,寻找提高预测新冠肺炎患者预后的方法。方法回顾性分析上海交通大学援鄂医疗队2020年1月31日至2月29日在武汉金银潭医院重症监护病房(ICU)收治的55例新冠肺炎患者的临床资料。所有患者均符合2020版新冠肺炎诊断标准,记录患者的性别、年龄、发热、咳嗽、咳痰、胸闷、基础疾病,记录患者入院当天治疗前及治疗7 d后外周静脉血白细胞总数(WBC)、中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、C-反应蛋白(CRP),计算NLR。结果55例患者中死亡21例,存活34例。死亡患者男性、高龄以及发热、咳嗽、咳痰、腹泻的发生率及合并高血压、冠心病、恶性肿瘤及慢性阻塞性肺疾病等基础疾病的比例均多于存活组;存活患者入院时WBC、NEU、CRP、NLR均明显低于死亡患者,而LYM明显高于死亡患者(均P<0.05);入院治疗7 d后死亡患者WBC、NEU、NLR较入院当日进一步升高,LYM、CRP进一步降低,两组比较差异均有显著的统计学意义。新冠肺炎患者入院时早期LYM预测患者死亡的受试者工作特征曲线(ROC曲线)下面积(AUC)为0.286,无预测价值;WBC预测患者死亡的AUC为0.646〔95%可信区间(95%CI):0.484~0.809〕,其截断值为7.550时,敏感度为38.1%,特异度为97.1%;NEU预测患者死亡的AUC为0.725(95%CI:0.586~0.865),其截断值为5.150时,敏感度为47.6%,特异度为88.2%;年龄预测患者死亡的AUC为0.719(95%CI:0.577~0.861),其截断值为41.500时,敏感度为90.5%,特异度为52.9%;NLR预测患者死亡的AUC为0.804(95%CI:0.680~0.928),其截断值为4.515时,敏感度为71.4%,特异度为82.4%;CRP预测患者死亡的AUC为0.861(95%CI:0.768~0.955),其截断值为25.990时,敏感度为95.2%,特异度为67.6%。NLR联合CRP预测新冠肺炎患者死亡的AUC最大,为0.868(95%CI:0.778~0.95Objective To summarize and analyze the clinical characteristics of coronavirus disease 2019(COVID-19)and evaluate the value of C-reactive protein(CRP)combined with neutrophil/lymphocyte ratio(NLR)in predicting the prognosis of patients with COVID-19 to look for a method that may elevate the ability of predicting the prognosis of patients with COVID-19.Methods A retrospective study was conducted;during the coronavirus epidemic period in Wuhan,Hubei,China,a medical team of Shanghai Jiao Tong University went to Wuhan Jinyintan Hospital for medical support and worked.The clinical data of 55 COVID-19 patients admitted to the intensive care unit(ICU)of Jinyintan Hospital from January 31,2020 to February 29,2020 were analyzed.All the COVID-19 patients'diagnosis was in accord with the diagnostic standard creteria of 2020 edition of COVID-19,the patient's gender,age,fever,cough,sputum,chest tightness,basic diseases were recorded,and the laboratory results of peripheral venous blood leucocyte count(WBC),neutrophil count(NEU),lymphocyte count(LYM),the levels of CRP,NLR of the patients on the day of admission before treatment and 7 days after treatment were detected.Results A total of 55 patients were enrolled,21 cases died and 34 cases survived.The average age was older and the proportion of male patients was higher in the death group than those in the patients of survival group;the incidence of fever,cough,expectoration and diarrhea was higher in patients of death group than that in patients of survival group;the proportion of survival patients with basic diseases such as hypertension,coronary heart disease,malignant tumor,chronic obstructive pulmonary disease,etc.was higher than that of death patients with above mentioned diseases.The levels of WBC,NEU,CRP and NLR of survival patients were significantly lower than those in dead patients at admission,while LYM level was significantly higher than that of dead patients(P<0.05);after treatment for 7 days in the hospital after admission,the levels of WBC,LYM,NEU and NLR in the

关 键 词：新型冠状病毒 肺炎 中性粒细胞/淋巴细胞比值 

分 类 号：R563.1[医药卫生—呼吸系统]