中性粒细胞计数与淋巴细胞和血小板计数比值在儿童脓毒症预后中的预测价值  

Predictive value of neutrophil to lymphocyte and platelet ratio in prognosis of children with sepsis

作　　者：常晨阳 胡绍雯 邓国平 朱惠芳 罗开源[1] CHANG Chenyang;HU Shaowen;DENG Guoping;ZHU Huifang;LUO Kaiyuan(Department of Pediatrics,the First Affiliated Hospital of Gannan Medical University,Ganzhou 341400,China;不详)

机构地区：[1]赣南医学院第一附属医院儿科,江西赣州341400 [2]赣南医学院第一附属医院儿童医学研究所,江西赣州341400 [3]赣州市儿童白血病肿瘤免疫治疗药物研发重点实验室,江西赣州341400

出　　处：《实用医学杂志》2023年第22期2958-2963,共6页The Journal of Practical Medicine

基　　金：江西省医药卫生科技计划项目(编号:20204503)。

摘　　要：目的探讨中性粒细胞计数与淋巴细胞和血小板计数比值(N/LPR)在脓毒症患儿预后中的预测价值。方法回顾性收集2018年1月1日至2022年11月30日赣南医学院第一附属医院儿童重症监护病房(PICU)收治的171例脓毒症患儿的临床资料。记录入院24 h内的小儿危重病例评分法(PCIS);收集确诊脓毒症24 h内的降钙素原(PCT)、C反应蛋白(CRP)、血小板(PLT)计数;计算N/LPR、血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)和中性粒细胞与前白蛋白比值(NPRI)。根据患儿预后结局将其分为存活组(n=110)和死亡组(n=61)。比较两组N/LPR、PLR、NLR、NPRI、PCIS评分、PCT、CRP和PLT差异;绘制受试者工作特征(ROC)曲线分析N/LPR、PLR和PCIS评分预测脓毒症患儿28 d死亡风险的准确性;根据三者ROC曲线的截断值对患儿28 d死亡风险进行亚组分析,同时使用Kaplan-Meier法对各亚组脓毒症患儿进行生存分析。根据PCIS评分对脓毒症患儿进行危险分层(非危重组、危重组和极危重组),评估N/LPR和PLR与疾病严重程度的关系。结果死亡组的PCT、CRP、N/LPR水平均较存活组高,PLT、PLR和PCIS水平均低于存活组,且差异有统计学意义(P<0.05)。ROC曲线结果显示:N/LPR、PLR和PCIS评分预测脓毒症患儿28 d死亡风险的ROC曲线下面积(AUC)分别为0.659、0.595和0.716。亚组分析表明,N/LPR≥1.5组患儿死亡风险大于N/LPR<1.5组(χ^(2)=11.224,P=0.001);PLR<85.58组患儿死亡风险大于PLR≥85.58组(χ^(2)=5.708,P=0.017),PCIS<84组患儿死亡风险大于PCIS≥84组(χ^(2)=19.312,P=0.000)。生存分析结果与亚组分析结果一致。此外,N/LPR可能与脓毒症患儿的危险分层相关。结论N/LPR对脓毒症患儿28 d死亡风险具有一定的预测价值。Objective To investigate the predictive value of neutrophil to lymphocyte and platelet ratio(N/LPR)in the prognosis of children with sepsis.Methods Clinical data of 171 children with sepsis admitted to the pediatric intensive care unit(PICU)of the First Affiliated Hospital of Gannan Medical University from January 1st,2018 to November 30th,2022 were retrospectively collected.The pediatric clinical illness score(PCIS)within 24 hours after admission was recorded.Procalcitonin(PCT),C-reactive protein(CRP)and platelet(PLT)count were collected within 24 hours after diagnosis of sepsis.N/LPR,platelet to lymphocyte ratio(PLR),neutro-phil to lymphocyte ratio(NLR),and neutrophil to prealbumin ratio(NPRI)were calculated.According to the prognosis,the children were divided into survival group(n=110)and death group(n=61).The difference of N/LPR,PLR,NLR,NPRI,PCIS,PCT,CRP and PLT was compared between the two groups.Receiver operating characteristic(ROC)curve was plotted to analyze the accuracy of N/LPR,PLR and PCIS in predicting 28-day mortality risk in children with sepsis.According to the cut-off value of ROC curve,the 28-day mortality risk of children was analyzed in the subgroups,and the Kaplan-Meier method was used to analyze the survival of children with sepsis in each subgroup.According to PCIS,children with sepsis were divided into three groups(non-critical group,critical group and extremely critical group),and the relationship between N/LPR,PLR and disease severity was evaluated.Results The level of PCT,CRP and N/LPR in the death group were higher than that in the survival group,while the level of PLT,PLR and PCIS was lower than that in the survival group,and the difference was statistically significant(P<0.05).ROC curve showed that the area under curve(AUC)of N/LPR,PLR and PCIS for predicting the 28-day mortality risk of children with sepsis was 0.659,0.595 and 0.716,respectively.Subgroup analysis showed that the risk of death in N/LPR≥1.5 group was higher than that in N/LPR<1.5 group(χ^(2)=11.224,P=0.001);that in

关 键 词：脓毒症 中性粒细胞计数与淋巴细胞和血小板计数比值 预后 儿童 

分 类 号：R725.9[医药卫生—儿科]