RAR、NLR、PLR对VV-ECMO支持下重度ARDS患者预后的预测价值  

Predictive value of RAR, NLR, and PLR for prognosis of patients with severe ARDS supported by VV-ECMO

作　　者：李宜恒 宋豆豆 王文涛[1] 闫绿茵 祁绍艳[1] Li Yiheng;Song Doudou;Wang Wentao;Yan Lvyin;Qi Shaoyan(Department of Critical Care Medicine,The Second Affiliated Hospital of Zhengzhou University,Henan,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院重症医学科,郑州450014

出　　处：《疑难病杂志》2025年第4期456-462,共7页Chinese Journal of Difficult and Complicated Cases

基　　金：河南省医学科技攻关计划项目(LHGJ20230363)。

摘　　要：目的探讨红细胞分布宽度与白蛋白比值(RAR)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)对静脉—静脉体外膜肺氧合(VV-ECMO)支持下重度急性呼吸窘迫综合征(ARDS)患者28 d死亡的预测价值。方法回顾性选取2019年8月—2024年2月郑州大学第二附属医院重症医学科收治的接受VV-ECMO治疗的ARDS患者161例的临床资料。以患者开始接受VV-ECMO治疗的时间为研究起点,根据治疗28 d后生存情况分为生存组49例和死亡组112例。Pearson相关系数分析RAR、NLR、PLR与急性生理与慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)的相关性;多因素Logistic回归分析重度ARDS患者预后的影响因素;受试者工作特征(ROC)曲线评价RAR、NLR、PLR对接受VV-ECMO治疗的ARDS患者28 d死亡的预测价值;Kaplan-Meier法分析不同RAR、NLR、PLR水平重度ARDS患者28 d累积生存情况。结果死亡组RAR、NLR、PLR高于生存组(t/P=6.802/<0.001,4.847/<0.001,2.936/<0.001);接受VV-ECMO治疗的ARDS患者RAR与APACHEⅡ评分、SOFA评分呈正相关(r/P=0.175/0.027,0.250/0.001),PLR与APACHEⅡ评分、SOFA评分呈负相关(r/P=-0.190/0.016,-0.397/<0.001);多因素Logistic回归分析结果显示,年龄高、APACHEⅡ评分高、SOFA评分高、RAR高、NLR高是接受VV-ECMO治疗的ARDS患者28 d死亡的独立危险因素[OR(95%CI)=1.055(1.001~1.111),1.235(1.029~1.482),1.284(1.022~1.614),3.135(1.163~8.448),1.059(1.002~1.120)],ICU入住时间长为独立保护因素[OR(95%CI)=0.758(0.664~0.866)];RAR、NLR、PLR及三者联合预测接受VV-ECMO治疗的ARDS患者28 d死亡的曲线下面积(AUC)分别为0.774、0.716、0.584、0.848,三者联合预测优于各自单独预测(Z/P=2.581/0.010,3.947/<0.001,5.487/<0.001);Kaplan-Meier生存分析示,RAR≥0.49者28 d累计生存率低于RAR<0.49者(8.33%vs.48.31%,χ^(2)/P=30.050/<0.001);NLR≥24.64者28 d累计生存率低于NLR<24.64者(10.61%vs.44.21%,χ^(2)/P=20.772/<0.001);PLR≥401.31者28 d累计�Objective To investigate the predictive value of Red blood cell distribution width to albumin ratio(RAR)and neutrophil-to-lymphocyte ratio(NLR)for28 d of death in patients with severe acute respiratory distress syndrome(ARDS)supported by veno-venous extracorporeal membrane pulmonary oxygenation(VV-ECMO).Methods Clinical data of VV-ECMO-supported ARDS patients admitted to the intensive care unit(ICU)of the Second Affiliated Hospital of Zhengzhou University from August 2019 to February2024 were retrospectively selected.The time of patients'initiation of VV-ECMO therapy was used as the starting point of the study,and they were divided into 49 cases in the survival group and 112 cases in the death group based on survival after 28 d of treatment.Pearson correlation coefficients were used to analyze the correlation between RAR,NLR,and PLR and APACHEⅡscore and SOFA score;multifactorial logistic regression was used to analyze the factors influencing the prognosis of patients with severe ARDS;and subject work characteristics(ROC)curves were used to evaluate the predictive value of RAR,NLR,and PLR on the death of 28-d mortality in those treated with VV-ECMO;Kaplan-Meier method to analyze 28 d cumulative survival of severe ARDS patients with different RAR,NLR,and PLR levels.Results RAR,NLR,and PLR were higher in the death group than in the survival group(t/P=6.802/<0.001,4.847/<0.001,2.936/<0.001);RAR was positively correlated with APACHEⅡscores and SOFA scores in ARDS patients treated with VV-ECMO(r/P=0.175/0.027,0.250/0.001),and PLR was negatively correlated with APACHE II score and SOFA score(r/P=-0.190/0.016,-0.397/<0.001);the results of multifactorial logistic regression analysis showed that high age,APACHE II score,SOFA score,RAR,and NLR were the main factors in the VV-ECMO-treated independent risk factors for 28-d death in ARDS patients[OR(95%CI)=1.055(1.001-1.111),1.235(1.029-1.482),1.284(1.022-1.614),3.135(1.163-8.448),and 1.059(1.002-1.120)],and that ICU hospitalization prolonged duration was independent prote

关 键 词：急性呼吸窘迫综合征 红细胞分布宽度与白蛋白比值 中性粒细胞与淋巴细胞比值 血小板与淋巴细胞比值 静脉—静脉体外膜肺氧合 病死率 预后 

分 类 号：R563.8[医药卫生—呼吸系统] R654.1[医药卫生—内科学]