中性粒细胞与淋巴细胞比值及血小板与淋巴细胞比值对接受体外膜肺氧合治疗者28 d死亡的预测价值  

Predictive value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for 28-day death in patients treated with extracorporeal membrane oxygenation

作　　者：袁佳辉 许强宏[1] Yuan Jiahui;Xu Qianghong(Department of Critical Care Medicine,Zhejiang Hospital,Hangzhou 310030,China)

机构地区：[1]浙江医院重症医学科,杭州310030

出　　处：《中华内科杂志》2023年第3期310-315,共6页Chinese Journal of Internal Medicine

基　　金：浙江省医药卫生科技计划项目(2022KY489)。

摘　　要：评估中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)对接受体外膜肺氧合(ECMO)治疗者28 d死亡的预测价值。回顾性分析。选2019年1月至2022年2月浙江医院重症医学科收治的接受ECMO治疗者53例。以患者开始接受ECMO治疗的时间为研究起点,28 d死亡为研究终点,将患者分为存活者和死亡者。收集所有患者开始接受ECMO治疗后24 h内外周血中性粒细胞计数、淋巴细胞计数和血小板计数等实验室检查指标,分别计算NLR及PLR。通过logistic回归分析影响预后的危险因素。分析NLR、PLR与急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)的相关性。绘制受试者操作特征曲线(ROC曲线),评价NLR和PLR对接受ECMO治疗者28 d死亡的预测价值。采用Kaplan-Meier法分析患者28 d累积生存情况。结果显示,53例患者中存活者20例,死亡者33例。死亡者NLR、PLR均高于存活者(NLR:30.67±14.48比17.41±7.06;PLR:303.34±159.23比191.54±106.03;均P<0.001)。NLR、PLR与APACHEⅡ呈正相关(r值分别为0.296、0.284,均P<0.05)。ROC曲线分析显示,NLR预测接受ECMO治疗者28 d死亡的曲线下面积(AUC)为0.805,最佳截止值为18.93,敏感度为80.0%,特异度为75.8%;PLR预测接受ECMO治疗者28 d死亡的AUC为0.714,最佳截止值为253.0,敏感度为80.0%,特异度为57.6%。NLR≥18.93者28 d病死率高于NLR<18.93者[86.20%(25/29)比33.33%(8/24),χ^(2)=15.625,P<0.01],PLR≥253.0者28 d病死率高于PLR<253.0者[82.61%(19/23)比46.67%(14/30),χ^(2)=7.158,P<0.01]。Kaplan-Meier生存曲线显示,NLR≥18.93者28 d生存时间短于NLR<18.93者[9.00(2.00,19.50)d比28.00(10.75,28.00)d,Z=-3.124,P<0.01],PLR≥253.0者28 d生存时间短于PLR<253.0者[6.00(2.00,19.00)d比28.00(6.25,28.00)d,Z=-2.673,P<0.01]。NLR及PLR对接受ECMO治疗者28d死亡有良好的预测价值。The study aimed to evaluate the predictive value of the neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)for 28-day mortality in patients treated with extracorporeal membrane oxygenation(ECMO).Patients receiving ECMO treatment were selected from the Department of Intensive Care Medicine of Zhejiang Hospital from January 2019 to February 2022.The moment when patients started receiving ECMO treatment was set as the starting point,and death at 28 days was set as the endpoint.The patients were divided into survivors and deaths.Laboratory tests,such as neutrophil,lymphocyte,and platelet counts,using the peripheral blood of all patients were collected within 24 h after ECMO treatment.NLR and PLR were calculated.The risk factors influencing prognosis were analyzed by logistic regression.The correlation between NLR,PLR,acute physiology,and chronic health scoreⅡ(APACHEⅡ)was investigated.Receiver operating characteristic(ROC)curve analysis was used to analyze the value of NLR and PLR in predicting the 28-day mortality of patients treated with ECMO.Kaplan-Meier method was used to analyze the cumulative survival of patients at 28 days.The results showed that of 53 patients,20 survived,and 33 died.The NLR and PLR of the deceased were higher than those of the survivors(NLR:30.67±14.48 vs.17.41±7.06;PLR:303.34±159.23 vs.191.54±106.03;P<0.001).NLR and PLR were positively correlated with APACHEⅡ(r=0.296,r=0.284,P<0.05).ROC curve analysis showed that the area under the curve(AUC)of NLR and PLR to predict the 28 d death of ECMO-treated patients was 0.805 and 0.714,respectively,and the optimal cutoff values of NLR and PLR were 18.93 and 253.0,respectively.The 28-day fatality rate in patients with NLR≥18.93 was higher than that in patients with NLR<18.93[86.20%(25/29)vs.33.33%(8/24),χ^(2)=15.625,P<0.01],that in patients with a PLR≥253.0 was higher than that in patients with PLR<253.0[82.61%(19/23)vs.46.67%(14/30),χ^(2)=7.158,P<0.01].Kaplan-Meier survival curve showed that the 28-day cumulative s

关 键 词：中性粒细胞与淋巴细胞比值 血小板与淋巴细胞比值 体外膜氧合作用 病死率 

分 类 号：R459.7[医药卫生—急诊医学]