外周血中性粒细胞与淋巴细胞比值在急性呼吸窘迫综合征中的临床价值

Clinical value of peripheral blood neutrophil to lymphocyte ratio in patients with acute respiratory distress syndrome

目的:探讨外周血中性粒细胞与淋巴细胞比值(NLR)在急性呼吸窘迫综合征患者中的临床意义,同时比较NLR与降钙素原(PCT)在急性呼吸窘迫综合征患者预后中的作用。方法:选取本院呼吸科2015年10月至2017年12月诊治的ARDS患者79例作为病例组,并选取本院同期79例健康体检人群作为对照组;根据患者28天的死亡情况将ARDS病例分为生存组(38例)和死亡组(41例)。研究对象检测外周血白细胞计数(WBC)、中性粒细胞计数(NC)、淋巴细胞计数(LC)、血清PCT水平,并计算NLR。通过受试者工作特征曲线(ROC)和曲线下面积(AUC)评价NLR和PCT在急性呼吸窘迫综合征患者中的临床价值。应用Kaplan-Merier法绘制患者ARDS患者生存曲线。结果:ARDS患者WBC、NC、NLR和PCT水平显著高于对照组(P<0. 05),而LC水平显著低于对照组(P<0. 05)。生存组患者NLR和PCT水平明显低于死亡组(P<0. 05)。NLR和PCT评价ARDS患者预后曲线下面积分别为0. 786、0. 689,灵敏度分别为0. 780、0. 759,特异度分别为0. 789、0. 763。Kaplan-Meier生存曲线分析,NLR≥13. 80和PCT≥4. 01μg/L时,ARDS患者28 d存活率较NLR≤13. 8和PCT≤4. 01μg/L者显著降低(P<0. 001)。结论:NLR和PCT可以作为评价ARDS患者预后的生物标志物,但是NLR效果优于PCT。

Objective:To investigate the clinical value of peripheral blood neutrophil to lymphocyte ratio(NLR)in patients with acute respiratory distress syndrome,and to compare the role of NLR and procalcitonin(PCT)in the prognosis of patients with acute respiratory distress syndrome.Methods:From October 2015 to December 2017,79 cases of ARDS patients were selected as case group,and 79 health examination persons were also selected as control group.According to the situation of death in 28 days of the ARDS patients were divided into survival group(38 cases)and death group(41 cases).The peripheral blood white blood cell count(WBC),neutrophils count(NC),lymphocyte count(LC)and serum PCT level were detected,and calculate NLR.The clinical value of NLR and PCT in patients with acute respiratory distress syndrome(NLR)were evaluated by receiver operating characteristic curve(ROC)and the area under the curve(AUC).The Kaplan-Merier method was used to analyze survival rate of patients with ARDS.Results:The levels of WBC,NC,NLR and PCT in ARDS patients were significantly higher than those of the control group(P<0.05),while the level of LC was significantly lower than that of the control group(P<0.05).The level of NLR and PCT in the survival group were significantly lower than those in the death group(P<0.05).The AUC of NLR and PCT for evaluating the prognosis of ARDS patients were 0.786 and 0.689 respectively.With Kaplan-Meier analysis of survival curves,ARDS patients whose NLR≥13.80 and PCT≥4.01μg/L had lower 28 day survival rate as compared with those with NLR<13.80 and PCT<4.01μg/L(P<0.001).Conclusion:The NLR and PCT could be used as biomarkers for evaluating the prognosis of ARDS patients,but the effect of NLR is better than that of PCT.