NLR、RDW、PCT及IL-6联合在预测急性反流性胆管炎并发脓毒血症中的临床意义  

Clinical significance of combination of NLR,RDW,PCT and IL-6 in prediction of sepsis associated with acute reflux cholangitis

作　　者：巫泓生 廖碧玲 张薇 曹天生[1] 嵇腾飞 罗玉媚[1] 马克强 WU Hongsheng;LIAO Biling;ZHANG Wei;CAO Tiansheng;JI Tengfei;LUO Yumei;MA Keqiang(Department of Hepatobiliary and Pancreatic Surgery,Huadu District People’s Hospital of Guangzhou,Guangzhou,Guangdong 510800,China)

机构地区：[1]广州市花都区人民医院肝胆胰外科,广东广州510800

出　　处：《肝胆胰外科杂志》2024年第11期673-678,共6页Journal of Hepatopancreatobiliary Surgery

基　　金：广州市花都区基础与应用基础研究区院联合项目(23HDQYLH06)。

摘　　要：目的探讨炎性指标中性粒细胞-淋巴细胞比值(NLR)、红细胞分布宽度(RDW)、降钙素原(PCT)及白介素6(IL-6)在预测急性反流性胆管炎并发脓毒血症中的临床意义。方法对2019年1月至2021年12月广州市花都区人民医院肝胆胰外科收治的98例急性反流性胆管炎患者临床资料进行回顾性分析。根据患者发病24 h内是否并发脓毒血症分为脓毒血症组(n=37)和对照组(n=61)。运用单因素分析法对患者一般资料、入院时收缩压、心率、身体质量指数(BMI),发病6 h内实验室检查以及急性胆管炎病情严重程度评分(TG18分级)进行分析。应用二元Logistic回归对单因素分析中具有统计学意义(P<0.05)的风险因素进行多因素分析。运用ROC曲线计算NLR、RDW、PCT及IL-6各独立风险因素及四者联合的诊断灵敏度、特异度、最佳截断值及曲线下面积(AUC)。最后根据NLR、RDW、PCT、IL-6各独立风险因素及四者联合做出相应的列线图。结果单因素分析结果显示,在糖尿病、冠心病、白细胞计数(WBC)、NLR、RDW、C反应蛋白(CRP)、PCT、谷草转氨酶(AST)及IL-6方面,脓毒血症组和对照组间的差异均有统计学意义(P<0.05);多因素Logistic回归结果显示,NLR、RDW、PCT及IL-6是反流性胆管炎并发脓毒血症的独立风险因素(P<0.05)。ROC分析结果显示,PCT、RDW、NLR及IL-6四者联合的预测灵敏度及特异度均比单一指标要高,分别达到87.0%和86.9%;同样地,四者联合的AUC均比单一指标的要高,达到0.938。结论NLR、RDW、PCT及IL-6的升高和急性反流性胆管炎患者并发脓毒血症关系密切,其在预测急性反流性胆管炎并发脓毒血症中具有重要的临床意义。Objective To investigate the clinical significance of inflammatory markers neutrophil-tolymphocyte ratio(NLR),red blood cell distribution width(RDW),procalcitonin(PCT)and interleukin 6(IL-6)in prediction of sepsis associated with acute reflux cholangitis.Methods The clinical data of 98 patients with acute reflux cholangitis,who admitted to the Huadu District People’s Hospital of Guangzhou between Jan.2019 and Dec.2021,were retrospectively analyzed.According to whether complicated with sepsis onset within 24 h,patients were divided into the sepsis group(n=37)and the control group(n=61).Univariate analysis was applied on patients’general data,the examination values of systolic blood pressure,heart rate,and body mass index(BMI)upon admission,the laboratory test indexes[white blood cell(WBC)count,platelet count,lymphocyte count,NLR,RDW,C-reactive protein(CRP),PCT,arterial blood lactate concentration,prothrombin time(PT),international normalized ratio(INR),fibrinogen(FIB),D-2 aggregates,alanine aminotransferase(ALT),aspartate transaminase(AST),total bilirubin,and IL-6 within 6 h of the onset].Disease condition score according to the Tokyo Guideline 2018(TG18)classification.Based on the univariate analysis,risk factors which had statistical significance(P<0.05)were further analyzed by binary Logistic regression.ROC curves were used to calculate the diagnostic sensitivity,specificity,optimal cut-off value,and area under the curve(AUC),for each independent risk factor NLR,RDW,PCT,and IL-6,and the combination of above 4 factors.Finally,a nomogram was constructed and the corresponding scoring criteria were produced.Results Univariate analysis results showed that,the differences of diabetes mellitus,coronary heart disease,WBC,NLR,RDW,CRP,PCT,AST and IL-6 were statistically significant between the sepsis group and the control group(P<0.05).The binary Logistic regression results showed that,NLR,RDW,PCT and IL-6 were independent factors of sepsis associated with acute reflux cholangitis(P<0.05).The ROC analysis showed that

关 键 词：急性反流性胆管炎 并发症 脓毒血症 中性粒细胞-淋巴细胞比值 红细胞分布宽度 降钙素原 白介素6 预测价值 

分 类 号：R657.4[医药卫生—外科学]