中性粒细胞/淋巴细胞比率和血小板/淋巴细胞比率对急性肺栓塞患者短期死亡率预测作用研究

Role of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in predicting short-term mortality in patients with acute pulmonary embolism

目的探讨中性粒细胞/淋巴细胞比率(NLR)和血小板/淋巴细胞比率(PLR),对急性肺栓塞患者短期死亡率的预测作用。方法收集188例上海闵行区中心医院2013年1月-2015年12月的急性肺栓塞患者诊断记录,采用多元风险模型检测NLR、PLR对急性肺栓塞死亡率的预测作用,并使用受试者工作特征曲线(ROC曲线)进行评估。结果共有144例患者符合本研究标准,其中13例在入院30 d内死亡。死亡患者存在4周以上的制动史,有较低的收缩压、舒张压,血氧饱和度较低,伴随着高心率、高呼吸频率、lgBNP和C-反应蛋白显著升高,同时NLR以及PLR比例也升高明显。PLR、NLR以及二者结合(PLR-NLR)3个指标的AUC值分别为0.752、0.758、0.750。结论 NLR、PLR对肺栓塞患者短期死亡率具有独立预测作用,NLR、PLR可以指导肺栓塞严重程度分级并进一步指导肺栓塞临床治疗。

Objective To explore the prognostic values of neutrophil to lymphocyte ratio （NLR） and platelet to lymphocyte ratio （PLR） for mortality in patients with acute PE. Methods 188 patients with acute pulmonary embolism diagnosed from January 2013 to December 2015 in Minhang District Central Hospital were selected. Multivariate risk models were used to examine the predictive effect of NLR and PLR on mortality in patients with acute pulmonary embolism. Receiver operating characteristic curve was used to evaluate the results. Results A total of 144 patients met the criteria for this study. Thirteen of patients died within 30 days of admission. Death patients often have a history of surgery or immobilization during the past 4 weeks, with lower systolic and diastolic blood pressure, lower blood oxygen saturation, higher heart rate, higher respiratory rate, higher lgBNP and CRP, also the neutrophil to NLR and PLR are higher. The results of the three prediction curves are that： AUC （PLR） = 0. 752, AUC （NLR） =0. 758, AUC （PLR- NLR） = 0. 750. Conclusion PLR and NLR have independent predictive effects on short - term mortality of patients with pulmonary embolism. PLR and NLR are readily available predicator for short - term mortality. It could be a useful indicator for identifying high risk population and guiding clinical management of acute PE.