糖皮质激素治疗后中性粒细胞/淋巴细胞比值对慢加急性肝衰竭预后的预测价值

Prognostic value of neutrophil-to-lymphocyte ratio （NLR） in patients with acute-on-chronic liver failure （ACLF） after glucocorticoid therapy

目的 探讨中性粒细胞/淋巴细胞比值（NLR）对糖皮质激素治疗后慢加急性肝衰竭（ACLF）预后的预测价值.方法 收集明确诊断慢加急性肝衰竭应用糖皮质激素治疗患者36例,包括存活组23例、死亡组13例,观察激素治疗前、过程中、治疗后WBC、N、L、NLR、TBil、PTA、INR等指标变化,分析NLR与慢加急性肝衰竭预后的关系.结果 糖皮质激素治疗后NLR,存活组3.95±2.65,死亡组12.79±10.66,差异有统计学意义（P＜0.01）;单因素及多因素回归分析表明,NLR是评价激素治疗后慢加急性肝衰竭预后的独立危险因素之一.NLR预测慢加急性肝衰竭预后时,ROC曲线的曲线下面积（AUC）0.868（95％ CI：0.743～0.993）,激素治疗后NLR＜ 3.315慢加急性肝衰竭患者3个月内生存率越高.结论 对于应用激素治疗的慢加急性肝衰竭患者,NLR是评估其预后的重要指标之一.

Objective To evaluate the prognostic value of neutrophil-to-lymphocyte ratio （NLR） in patients with acute-on-chronic liver failure （ACLF） after glucocorticoid therapy.Methods Thirty-six patients with acute-on-chronic liver failure （ACLF） were treated with glucocorticoid therapy,of whom 23 patients in the survival group and the other in the deceased group （n =13）.The changes of white blood cells,neutrophils,lymphocytes,NLR,total bilirubin （TBil）,prothrombin activity （PTA）,international normalized ratio （INR） were observed before,during and after treatment,and the relationship between NLR and prognosis was analyzed.Results NLR after glucocorticoid treatment,the survival group 3.95 ± 2.65,the deceased group 12.79 ± 10.66,there was significant difference between the two groups （P ＜ 0.001）.According to univariate and multivariate logisitic regression analysis,NLR ratio was one of the independent factor in ACLF.ROC curve showed the AUC of NLR in patients with ACLF 0.868 （95 ％ CI：0.743-0.993）.After glucocorticoid treatment,the survival rate of NLR ＜ 3.315 patients with acute liver failure was high.Conclusions NLR is one of the important indexes for evaluating the prognosis of ACLF patients with ACLF due to glucocorticoid therapy.