NLR对初始治疗失败的社区获得性肺炎的预测价值及NGS在该疾病病原体中的应用  

Predictive value of NLR in community-acquired pneumonia with initial treatment failure and the use of NGS in this disease pathogen

作　　者：郭静璇 张维杰[2] GUO Jing-Xuan;ZHANG Wei-Jie(Changchun University of Traditional Chinese Medicine,Changchun 130117,Jilin,China)

机构地区：[1]长春中医药大学,吉林长春130117 [2]吉林省人民医院

出　　处：《吉林医学》2024年第5期1043-1048,共6页Jilin Medical Journal

基　　金：吉林省自然科学基金[项目编号:YDZJ202201ZYTS211]。

摘　　要：目的:评估中性粒细胞-淋巴细胞比值(NLR)对初始治疗失败的社区获得性肺炎(CAP)的预测价值,并探讨二代测序技术(NGS)在初始治疗失败的CAP病原体检测中的应用价值。方法:回顾性分析2023年1月~2024年1月188例在吉林省人民医院治疗的CAP患者。根据患者对初始治疗72 h后的反应,将患者分为初始治疗有效组(n=139)和初始治疗失败组(n=49),比较组间血常规、降钙素原(PCT)、NLR水平差异,并根据二分类Logistic回归法筛选出影响CAP患者发生初始治疗失败的危险因素。根据受试者工作特征(ROC)曲线分析NLR对初始治疗失败的CAP的预测价值,并与CURB-65评分进行比较。其中30例初始治疗失败的CAP患者同时行NGS和传统病原学检测,比较两种检测方法在病原体检测结果中的差异。结果:初始治疗失败组NLR、PCT、血白细胞计数(WBC)、中性粒细胞计数(NEU)高于初始治疗有效组,淋巴细胞计数(LYM)低于初始治疗有效组,差异有统计学意义(P<0.05);初始治疗失败组CURB-65评分高于初始治疗有效组,差异有统计学意义(P<0.05)。二分类Logistic回归显示NLR是初始治疗失败的CAP的独立预测因素。ROC曲线分析显示,与经典指标CURB-65评分比较,NLR对初始治疗失败的CAP具有更高的预测价值[曲线下面积(AUC):0.746 vs 0.698,均P>0.05]。本研究中当NLR截断值为6.62时,敏感度为65.3%,特异度为77.7%。与传统检测方法比较,NGS检测病原微生物阳性率更高,差异有统计学意义(66.7%vs 33.3%,P<0.05),微生物检出种类更多(35 vs 14)。结论:NLR是CAP患者发生初始治疗失败的独立危险因素,具有较高的独立预测价值。NGS作为新型病原体检测技术,与传统检测方法相比具有较高的阳性率,为初始治疗失败的CAP提供了更加快速准确的病原体检测技术,不仅提高了患者的治愈率,而且改善患者的远期预后。Objective To assess the predictive value of neutrophil-lymphocyte ratio(NLR)for community-acquired pneumonia(CAP)with initial treatment failure and to explore the value of second-generation sequencing technology(NGS)in the detection of CAP pathogens with initial treatment failure.Method Retrospective analysis of 188 patients with CAP treated at Jilin Provincial People′s Hospital from January 2023 to January 2024.Based on the patients'response to the initial treatment after 72 h,the patients were divided into the initial treatment effective group(n=139)and the initial treatment failure group(n=49),and the differences in the levels of blood,procalcitonin(PCT),and NLR were compared between the groups,and the risk factors affecting the occurrence of the initial treatment failure in patients with CAP were screened according to the dichotomous logistic regression method.The predictive value of NLR for CAP of initial treatment failure was analyzed based on subject work characteristics(ROC)curves and compared with CURB-65 scores.Thirty of these CAP patients who failed initial treatment underwent both NGS and conventional pathogenetic testing to compare the differences in pathogen detection results between the two testing methods.Results NLR,PCT,blood white blood cell count(WBC),and neutrophil count(NEU)were higher in the initial treatment failure group than in the initial treatment effective group,and lymphocyte count(LYM)was lower than in the initial treatment effective group(P<0.05);The CURB-65 score was higher in the initial treatment failure group than in the initial treatment effective group(P<0.05).Binary logistic regression showed that NLR was an independent predictor of CAP for initial treatment failure.ROC curve analysis showed that the NLR had a higher predictive value for CAP of initial treatment failure compared with the classical index CURB-65 score[area under the curve(AUC):0.746 vs 0.698,both P>0.05].In this study When the NLR cutoff value was 6.62,the sensitivity was 65.3%and the specificity was 77.7%.C

关 键 词：中性粒细胞-淋巴细胞比值 初始治疗失败 社区获得性肺炎 二代测序技术 

分 类 号：R563[医药卫生—呼吸系统]