免疫炎症相关指数与重症肺炎转归相关性分析  

Correlational analysis of immune-inflammatory markers with the clinical outcomes of severe pneumonia

作　　者：冀鹏磊 高崴崴 李佳霖 刘待见[1] 王昱林 JI Penglei;GAO Weiwei;LI Jialin;LIU Daijian;WANG Yulin(Department of Respiratory and Critical Care Medicne,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,China)

机构地区：[1]郑州大学第二附属医院呼吸与危重症医学科,河南郑州450000

出　　处：《中国现代医生》2024年第35期50-54,共5页China Modern Doctor

摘　　要：目的对比分析不同免疫炎症参数对重症社区获得性肺炎(severe community-acquired pneumonia,SCAP)不良结局的预测价值。方法选取2021年5月至2024年4月郑州大学第二附属医院收治的196例重症肺炎患者作为研究对象,根据28d住院结局分为预防良好组(n=107)与预后不良组(n=89),收集实验室指标并计算中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、NLR与血红蛋白比值(NLR to hemoglobin ratio,NLR/Hb)等炎症指标。采用Logistic回归分析SCAP预后不良的独立危险因素,并构建回归模型。使用受试者操作特征曲线评价NLR/Hb对SCAP发生预后不良的诊断效能。结果预防良好组患者住院期间NLR均高于预后不良组。预防良好组血红蛋白(hemoglobin,Hb)均高于预后不良组,且入院患者的Hb值整体呈下降趋势。预防良好组患者住院期间血小板计数(platelet,PLT)值整体呈升高趋势,预后不良组则呈下降趋势。NLR/Hb 7d在多模型的多因素Logistic回归分析表现的最为稳定(P<0.001)。将有差异的指标纳入多因素Logistic回归模型中,结果显示NLR/Hb 7d、D-二聚体、有创机械通气是预后不良的危险因素,血小板计数7d是预后不良的保护因素(P<0.05)。结论临床动态监测血常规十分必要,NLR/Hb有望成为判断重症肺炎患者预后不良的有效指标。Objective To compare and analyze the predictive value of different immune-inflammatory parameters for adverse outcomes in severe community-acquired pneumonia(SCAP).Methods A total of 196 severe pneumonia patients admitted to the Second Affiliated Hospital of Zhengzhou University from May 2021 to April 2024.Patients were divided into good prognosis group(n=107)and poor prognosis group(n=89)based on the 28-day hospital outcome.Laboratory indicators were collected and inflammatory indices such as neutrophil-to-lymphocyte ratio(NLR)and NLR to hemoglobin ratio(NLR/Hb)were calculated.Logistic regression analysis was used to identify independent risk factors for poor prognosis in SCAP and to construct a regression model.The diagnostic efficacy of NLR/Hb for adverse outcomes in SCAP was evaluated using the receiver operating characteristic curve.Results NLR during hospitalization in good prognosis group was higher than that in poor prognosis group.Hemoglobin(Hb)in good prognosis group was higher than that in poor prognosis group,and Hb value of admitted patients generally showed a downward trend.platelet(PLT)count in good prognosis group showed an overall upward trend during hospitalization,while poor prognosis group showed a downward trend.NLR/Hb at day 7 showed the most stable significance in multi-model multi-factor Logistic regression analysis(P<0.001).The indicators with differences were included in multi-factor Logistic regression model.NLR/Hb at day 7,D-dimer,and invasive mechanical ventilation were risk factors for poor prognosis,and platelet count at day 7 was a protective factor for poor prognosis(P<0.05).Conclusion Dynamic monitoring of blood routine is very necessary in clinical practice,and NLR/Hb is expected to become an effective indicator for judging the poor prognosis of severe pneumonia patients.

关 键 词：重症肺炎 中性粒细胞 淋巴细胞 血红蛋白 

分 类 号：R563[医药卫生—呼吸系统]