中性粒细胞与淋巴细胞比值联合D-二聚体、ISS对多发伤患者预后的预测价值  

Predictive value of neutrophil-to-lymphocyte ratio combined with D-dimer and injury severity score on prognosis of patients with multiple injuries

作　　者：康超 谢昭君 范家伟[1] 许泰瑞 马友运 张波[1] Kang Chao;Xie Zhaojun;Fan Jiawei;Xu Tairui;Ma Youyun;Zhang Bo(Department of Emergency,the Second People’s Hospital of Liaocheng,Liaocheng,Shandong Province 252600,China)

机构地区：[1]聊城市第二人民医院急诊外科,山东聊城252600

出　　处：《创伤外科杂志》2024年第12期941-945,共5页Journal of Traumatic Surgery

摘　　要：目的探讨多发伤患者入院初期中性粒细胞与淋巴细胞比值(NLR)、血浆D-二聚体含量、ISS及三者联合对预后的预测价值。方法回顾性分析2022年1月—2023年12月聊城市第二人民医院急诊外科收治符合严重多发伤诊断的成年患者198例,男性137例,女性61例;年龄18~86岁,平均56.5岁。根据28 d内预后结局分为死亡组(55例)和存活组(143例),采集两组患者的性别、年龄、受伤部位及损伤程度等一般资料,收集血常规(包括:WBC、中性粒细胞计数、淋巴细胞计数、PLT、Hb)和D-二聚体结果,计算NLR和ISS,利用回归分析和受试者工作特征(ROC)曲线分析各项指标对严重多发伤患者预后的预测价值。结果两组患者淋巴细胞计数、Hb、NLR、D-二聚体和ISS比较差异有统计学意义(P<0.05),其余指标差异无统计学意义(P>0.05)。利用回归分析法筛选对严重多发伤患者预后有影响的指标,结果显示NLR、D-二聚体和ISS是影响严重多发伤患者预后的独立影响因素;ROC分析结果显示曲线下面积(AUC)分别为0.818(95%CI:0.757~0.869)、0.787(95%CI:0.724~0.842)和0.734(95%CI:0.667~0.795),三者之间差异无统计学意义(D-二聚体vs.ISS:P=0.350;D-二聚体vs.NLR:P=0.490;ISS vs.NLR:P=0.170),三者联合AUC为0.883(95%CI:0.841~0.932),明显高于单一因素AUC(P<0.05)。结论入院初期NLR、D-二聚体和ISS是影响严重多发伤患者预后的独立危险因素,三者预测价值无明显差异,三者联合的预测价值明显高于单一因素的预测价值。Objective To explore the predictive value of early neutrophil-to-lymphocyte ratio(NLR)and D-dimer(early stage of hospitalization),injury severity score(ISS)and theiRcombination on the prognosis of patients with multiple trauma.Methods This retrospective analysis was conducted on data of 198 adult patients with multiple trauma admitted to ouRhospital from Jan.2022 to Dec.2023,including 137 males and 61 females aged 18-86(mean 56.5)years.Based on the 28-d outcomes,patients were divided into non-survival group(n=55)and survival groups(n=143).General data(gender,age,injury site,and injury severity),routine laboratory tests(white blood cell count,neutrophil count,lymphocyte count,platelet count,hemoglobin,NLR,and D-dimer),and ISS were collected for all patients.The predictive value of these factors for the prognosis of patients with multiple trauma was analyzed using logistic regression analysis and ROC curve analysis.Results Among the factors analyzed,lymphocyte count,hemoglobin,NLR,D-dimer,and ISS showed significant differences between the two groups(all P<0.05),while the others showed no significant differences(all P>0.05).Logistic regression analysis identified NLR,D-dimer,and ISS as independent factors affecting the prognosis of patients with multiple trauma.ROC analysis showed that the area undeRthe curve(AUC)was 0.818(95%CI:0.757-0.869)for NLR,0.787(95%CI:0.724-0.842)for D-dimer,and 0.734(95%CI:0.667-0.795)for ISS,with no significant differences between any of the three factors(D-dimeRvs.ISS,P=0.350;D-dimeRvs.NLR,P=0.490;ISS vs.NLR,P=0.170).The combined use of the three factors showed an AUC of 0.883(95%CI:0.841-0.932),significantly higheRthan any factors alone(all P<0.05).Conclusion In the early stages of hospitalization,the NLR,D-dimer,and ISS can help predict the outcome of patients with severe multiple injuries,especially when they were used combinedly.

关 键 词：多发伤 ISS 预后 中性粒细胞与淋巴细胞比值 D-二聚体 

分 类 号：R641[医药卫生—外科学]