中性粒细胞/淋巴细胞比值与急性肺栓塞患者危险分层及预后相关性分析  

Correlation analysis of neutrophil/lymphocyte ratio with risk stratification/prognosis in patients with acute pulmonary embolism

作　　者：李旭亮[1] 刘艳[1] 赵永旺[1] 石茂静[2] 高伟波[2] 刘元生[2] Li Xuliang;Liu Yan;Zhao Yongwang;Shi Maojing;Gao Weibo;Liu Yuansheng(Emergency Medicine Center,Shanxi Provincial People's Hospital,Taiyuan 030012,China;Emergency Medicine Center,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]山西省人民医院急诊科,太原030012 [2]北京大学人民医院急诊科,北京100044

出　　处：《中华急诊医学杂志》2023年第7期927-933,共7页Chinese Journal of Emergency Medicine

摘　　要：目的对182例急性肺栓塞(acute pulmonary embolism,APE)患者的临床特征、危险分层进行分析,探讨中性粒细胞(N)与淋巴细胞(L)比值(NLR)和危险分层及预后的相关性。方法回顾性收集北京大学人民医院2015年1月至2021年3月收治的182例APE患者的临床资料,包括年龄、性别、症状体征、血压、血气分析、血常规相关参数、心脏生物标记物、出凝血参数、影像学右心参数等。依据入院时危险分层及院内预后进行分组,采用χ^(2)检验、t检验或非参数检验,分析组间临床特征、血常规相关参数、出凝血、血气分析参数等差异,并对存活组、死亡组间差异有统计学意义的变量进行多因素逻辑回归分析,研究APE预后的独立危险因素。结果182例患者中,男性79例,女性103例,高危组23例,中高危组51例,中低危组46例,低危组62例;死亡27例,存活155例。高/中高危组呼吸频率比低危/中低危组明显增加,高危组较其他三组pH、氧分压(PO2)、血氧饱和度(SO2)明显下降(均P<0.05)。高危组/中高危组与中低危组/低位组比较,WBC、N、NLR水平差异有统计学意义(均P<0.05),但PLT、PLT/MPV和PLT/PDW以及出凝血相关参数PT、FIB、APTT、D-D组间差异无统计学意义(均P>0.05),MPV、PDW仅在高危组与中低危组/低危组之间比较差异有统计学意义(均P<0.05)。存活组与死亡组比较,进行多因素逻辑回归分析,结果表明NLR(OR=1.179,95%CI:1.029~1.410,P=0.039)与pH(OR=1.156,95%CI:1.031~1.522,P=0.041)是APE院内死亡的独立预测因素。通过ROC曲线分析NLR对于APE死亡的预测价值,AUC为0.824,95%CI:0.829~0.913,截断值为8.38,敏感度为0.831,特异度为0.887。结论NLR与APE的危险分层及预后存在相关性,是预后不良的独立危险因素。Objective To analyze the clinical characteristics and risk stratification of 182 patients with acute pulmonary embolism(APE),and to investigate the correlation of neutrophil(N)/lymphocyte(L)ratio(NLR)and risk stratification/prognosis.Methods The clinical data of 182 APE patients admitted to Peking University People’s Hospital from January 2015 to March 2021 were retrospectively collected,including age,sex,symptoms and signs,blood pressure,blood gas analysis,blood routine parameters,cardiac biomarkers,coagulation parameters,and right ventricular imaging parameters.The patients were divided into groups according to the risk stratification at admission and prognosis in hospital.χ^(2) test,t test or nonparametric test were used to analyze the differences in clinical characteristics,blood routine parameters,blood gas analysis,coagulation parameters and other parameters between the groups.Multivariate logistic regression analysis was used to study the independent risk factors for the prognosis of APE.Results Among the 182 patients,79 were male and 103 were female,23 were in the high-risk group,51 were in the intermediate-high-risk group,46 were in the intermediate-low risk group,and 62 were in the low-risk group.There were 27 deaths and 155 survivors.The respiratory rate of the high/intermediate-high-risk group was significantly higher than that of the low/intermediate-lowrisk group.Compared with the other three groups,pH,oxygen partial pressure(PO2)and blood oxygen saturation(SO2)in the high-risk group were significantly lower(both P<0.05).There were statistically significant differences in WBC,N,and NLR levels between the high/intermediate-high-risk group and low/intermediate-low-risk group(both P<0.05).However there were no significant differences in PLT,PLT/MPV,PLT/PDW,and coagulation related parameters PT,FIB,APTT and D-D between groups(all P>0.05).MPV and PDW were only significantly different between the low-risk group,intermediate-lowrisk group and high-risk group(both P<0.05).Multivariate logistic regression

关 键 词：急性肺栓塞 危险分层 中性粒细胞/淋巴细胞比值 预后 

分 类 号：R563.5[医药卫生—呼吸系统]