中性粒细胞与淋巴细胞比值对脑卒中相关性肺炎的预测价值

Predictive value of neutrophils-lymphocytes ratio in stroke-associated pneumonia

目的探讨血清中性粒细胞与淋巴细胞比值(NLR)对高血压病性脑出血患者发生卒中相关性肺炎(SAP)的预测价值。方法采用回顾性研究方法,选取2015年1月-2016年11月南华大学附属南华医院重症医学科收治的年龄在50~80岁,且住院时间≥7 d的118例高血压病性脑出血患者。根据患者入院后<7 d是否发生SAP将所有患者分为SAP组及非SAP组。比较两组患者的一般临床信息,分析入院时APACHEⅡ评分与入院后第1、3及5天的NLR值及白细胞(WBC)值的相关性,并评价两组患者在入院后第1、3及5天的WBC及NLR的变化以及组间差异,绘制受试者工作特征曲线(ROC曲线),评价不同时间各个指标对SAP发生的预测价值。结果入院时APACHEⅡ评分与入院后第3、5天的NLR水平第3天(r=0.360,P=0.000);第5天(r=0.390,P=0.000)及WBC水平第3天(r=0.220,P=0.015);第5天(r=0.200,P=0.031)呈正相关。SAP患者在入院后的第1、3及5天的NLR值分别为(10.89±3.05)、(12.42±3.75)及(9.28±3.31)。其中,第3天的NLR值达到最高峰。且在第3、5天中,SAP组的WBC与NLR值均大于同期的非SAP组(P<0.05)。入院后第3、5天的NLR及WBC均能很好地预测SAP(P<0.05),2个时间的预测价值差异无统计学意义。且NLR的曲线下面积(AUC)(第3天为0.943,第5天为0.924)大于同期WBC的AUC值(第3天为0.823,第5天为0.809)。将NLR与WBC联合后不能增加曲线下面积。结论入院后第3、5天的NLR值对于评估SAP在临床上有很好的预测价值。

Objective To assess the predictive value of neutrophils-lymphocytes ratio （NLR） in the stroke-associated pneumonia （SAP） of patients with intracerebral hemorrhage. Methods The clinical data for 118 patients with intracerebral hemorrhage who were treated in our ICU from Jannary 2015 to November 2016 were retrospectively extracted. All of them were between 50 and 80 years old, and their ICU lengths of stay were at least 7 days. Based on the occurrence of SAP in the first 7 days of admission, these patients were divided into SAP group and non-SAP group. The clinical information were analysed, as well as the correlation of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score with NLR and white blood cell （WBC）. The characteristics of NLR score and WBC score on the first, the third, the fifth days were compared, and the significant changes of them across groups were observed. The prognostic value of WBC and NLR at each time points in SAP were evaluated using receiver operating characteristic curve （ROC curve）. Results The APACHE Ⅱ score was significantly positively related to the level of NLR 3 d （ =0.360, =0.000）; 5 d （ =0.390, =0.000） and WBC 3 d （ =0.220, =0.015）; 5 d （ =0.200, P=0.031） at third and fifth days. The NLR levels on the first day, the fifth day, the fifth day after admission in SAP group were （10.89 ＆#177; 3.05）;（12.42 ＆#177; 3.75）; （9.28 ＆#177; 3.31） respectively, and the NLR on the third day was the highest. The WBC and NLR levels in SAP group were significantly higher than those in non-SAP group after the treatment for 3 days at the same time point （ 〈0.05）. The area under the curve （AUC） of NLR and WBC on the third day and on the fifth day for SAP prediction were greater than that on the first day （ 〈0.05）. There was no significant difference in prediction value of SAP between two time points. The NLR （AUC： 3 d 0.943; 5 d 0.924） were superior to WBC （AUC： 3 d 0.823; 5 d 0.809） for predicting SAP. The combination of NLR and WBC could not increase the AUC. Conclusion NLR score on the third, the fifth day is a certain indicator for predicting SAP in clinical practice.