血小板与中性粒细胞计数比值在重度脓毒症性脑病患者中的临床意义  

Clinical significance of the platelet-to-neutrophil ratio in patients with the severe abnormal septic encephalopathy

作　　者：余诗凯 刘慧强 林青伟 邓星平 周叶 彭恩兰 宋景春[1] Yu Shikai;Liu Huiqiang;Lin Qingwei;Deng Xingping;Zhou Ye;Peng Enlan;Song Jingchun(Department of Critical Care Medicine,908th Hospital of PLA Joint Logistic Support Force,Nanchang,330002,China;Key Laboratory of Thrombosis and Hemostasis,Nanchang 330002,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院重症医学科/南昌市血栓与止血学重点实验室,南昌330002

出　　处：《血栓与止血学》2024年第4期175-180,共6页Chinese Journal of Thrombosis and Hemostasis

基　　金：江西省卫健委科技计划(SKJP_202311373)。

摘　　要：目的探讨血小板与中性粒细胞计数比值(PNR)在脓毒症性脑病(SAE)中的诊断价值。方法回顾性分析解放军联勤保障部队第九〇八医院重症医学科2019年03月至2021年09月收治的111例SAE患者,根据脑电图分级将患者分为轻度异常组(n=53)和重度异常组(n=58)。收集患者入科2h内的血常规、凝血功能、血栓弹力图指标,并应用Logistic回归分析重度SAE的危险因素,通过受试者工作特征(ROC)曲线评价PNR对重度SAE的预测价值,并采用Kaplan-Meier法绘制生存曲线。结果与SAE轻度异常组比较,重度异常组患者的中性粒细胞计数、中性粒细胞/淋巴细胞计数比值(NLR)、SOFA评分、ICU病死率明显升高,PT、TT、TEG-K时间值明显延长,血小板计数、PNR、GCS评分显著降低(P<0.05)。单因素联合多因素Logistic回归分析显示PT及PNR为发生重度SAE的独立危险因素(P<0.05)。PNR诊断重度SAE的曲线下面积为0.680(95%CI:0.581~0.680),敏感度60.4%,特异度74.15%,最佳截断值为25.5。生存分析结果显示,PNR<25.5组与PNR≥25.5组的患者生存率差异有统计学意义(P<0.05)。结论PNR与重度SAE发生风险显著相关,重度SAE患者的PNR可显著降低,PNR<25.5时轻度SAE可能发展为重度SAE。Objective To investigate the diagnostic value of the platelet-to-neutrophil ratio(PNR)in sepsis-associated encephalopathy(SAE).Methods A retrospective analysis was conducted on 111 patients with SAE admitted to the intensive care unit(ICU)of the Department of Intensive Care Medicine,No 908th hospital of the Joint Logistic Support Force of the PLA from March 2019 to September 2021.The patients were divided into the mild abnormal group(n=53)and the severe abnormal group(n=58)according to the electroencephalogram(EEG)grading.Blood routine,coagulation function,and thrombelastogram(TEG)indexes of patients within 2 h of admission were collected,and the risk factors of the severe abnormal SAE were analyzed by Logistic regression.The predictive value of PNR for the severe abnormal SAE was evaluated by the area under the receiver-operating characteristic curve(AUC),and the survival curve was drawn by the Kaplan-Meier method.Results Compared with the mild abnormal group of the severe abnormal SAE,the severe abnormal group had significantly higher levels of neutrophil counts,neutrophil-to-lymphocyte ratio(NLR),SOFA score,ICU mortality rate,significantly prolonged prothrombin time(PT),thrombin time(TT),and TEG-K time value,and significantly lower platelet count,PNR,and Glasgow Coma Scale(GCS)score(P<0.05).Univariate and multivariate Logistic regression analysis showed that PT and PNR were independent risk factors for the severe abnormal SAE(P<0.05).The AUC of PNR for diagnosing the severe abnormal SAE was 0.680(95%CI 0.581~0.680),with a sensitivity of 60.4% and a specificity of 74.15%,and an optimal cut-off value was 25.5.Survival analysis showed a statistically significant difference in the survival rate of the patients in the group of PNR<25.5 versus the group of PNR≥25.5(P<0.05).Conclusion PNR is significantly associated with the risk of the severe abnormal SAE,which can be significantly reduced in patients with the severe abnormal SAE,and patients with sepsis may develop severe abnormal SAE when PNR<25.5.

关 键 词：脓毒症 脓毒症相关性脑病 脑电图 血小板计数 中性粒细胞计数 

分 类 号：R459.7[医药卫生—急诊医学]