NLR对区分老年吸入性肺炎不同病原菌感染的价值  

Value of NLR in distinguishing the infection of different pathogens in elderly patients with aspiration pneumonia

作　　者：卢水焕 唐伟雄 刘学员 廖立 林仁生 蔡质梅 朱中权 LU Shuihuan;TANG Weixiong;LIU Xueyuan;LIAO Li;LIN Rensheng;CAI Zhimei;ZHU Zhongquan(Department of Geriatrics,No.924 Hospital of People’s Liberation Army(PLA)Joint Logistic Support Force,Guangxi,Guilin 541002,China;Department of Cardiothoracic Surgery,No.924 Hospital of People’s Liberation Army(PLA)Joint Logistic Support Force,Guangxi,Guilin 541002,China)

机构地区：[1]解放军联勤保障部队第九二四医院老年病科,广西桂林541002 [2]解放军联勤保障部队第九二四医院心胸外科,广西桂林541002

出　　处：《中国医药科学》2023年第11期12-16,共5页China Medicine And Pharmacy

基　　金：广西壮族自治区桂林市科学研究与技术开发计划项目(20190218-9-5)。

摘　　要：目的研究中性粒细胞/淋巴细胞比值(NLR)对区分老年吸入性肺炎不同病原菌感染的价值。方法纳入2018年9月至2021年9月在解放军联勤保障部队第九二四医院老年病科住院的老年吸入性肺炎患者103例,进行痰培养及药敏试验,根据检出的病原菌分为革兰氏阴性(G^(-))菌组和革兰氏阳性(G^(+))菌组、细菌组和真菌组、多重耐药(MDR)菌组和非MDR菌组。收集各组一般资料、感染指标,包括白细胞总数(WBC)、中性粒细胞数量(N)、淋巴细胞数量(L)、C反应蛋白(CRP),计算NLR,进一步检测外周血淋巴细胞亚群。采用t检验比较各组感染指标及淋巴细胞亚群,采用ROC曲线分析NLR单独及联合CRP区分G^(-)菌与G^(+)菌、细菌与真菌、MDR菌与非MDR菌感染的价值。结果G^(-)菌组与G^(+)菌组的感染指标比较,差异无统计学意义(P>0.05),G^(-)菌组CD3^(+)细胞比例高于G^(+)菌组,差异有统计学意义(P<0.05)。真菌组NLR高于细菌组,而CD4^(+)/CD8^(+)、CD3-CD19^(+)细胞比例低于细菌组,差异有统计学意义(P<0.05)。MDR菌组的WBC、N、NLR、CRP及CD3^(+)CD8^(+)细胞比例均高于非MDR菌组,差异有统计学意义(P<0.05)。ROC曲线分析显示,NLR单独及NLR联合CRP诊断G^(+)菌、真菌、MDR菌的曲线下面积分别是0.601、0.781、0.713、0.615、0.813、0.789,联合诊断的曲线下面积大于单独诊断(P<0.05)。结论NLR对于区分老年吸入性肺炎真菌、MDR菌感染具有一定价值,联合CRP可提高诊断的敏感度和特异度。Objective To investigate the value of neutrophil/lymphocyte ratio(NLR)in distinguishing the infection of different pathogens in elderly patients with aspiration pneumonia.Methods A total of 103 elderly patients with aspiration pneumonia who were hospitalized in the Department of Geriatrics of No.924 Hospital of People’s Liberation Army(PLA)Joint Logistic Support Force from September 2018 to September 2021 were included for sputum culture and drug sensitivity test.According to the detected pathogens,the patients were divided into the Gram-negative(G^(-))bacteria group and the Gram-positive(G^(+))bacteria group,the bacteria group and the fungi group,the multidrug-resistant(MDR)bacteria group and the non-MDR bacteria group.The general data and infection indices(including the total number of white blood cells[WBC],the number of neutrophils[N],the number of lymphocytes[L]and C-reactive protein[CRP])of each group were collected to calculate NLR,thus further detecting the peripheral blood lymphocyte subsets.The t test was used to compare the infection indices and lymphocyte subsets of each group,and ROC curve was used to analyze the value of NLR alone and NLR combined with CRP in distinguishing G^(-)bacteria from G^(+)bacteria,bacteria from fungi,MDR bacterial from non-MDR bacterial infection.Results There were no statistically significant differences in infection indices between the G^(-)bacteria group and the G^(+)bacteria group(P>0.05).And the proportion of CD3^(+)cells in the G^(-)bacteria group was higher than that in the G^(+)bacteria group,with statistically significant difference(P<0.01).The NLR of the fungi group was higher than that of the bacteria group,while the proportions of CD4^(+)/CD8^(+)and CD3-CD19^(+)cells of the fungi group were lower than those of the bacteria group,with statistically significant differences(P<0.05).The percentages of WBC,N,NLR,CRP and CD3^(+)CD8^(+)cells in the MDR bacteria group were all higher than those in the non-MDR bacteria group,with statistically significant differences(P

关 键 词：中性粒细胞/淋巴细胞比值 吸入性肺炎 病原菌 老年 诊断 

分 类 号：R563.1[医药卫生—呼吸系统]