炎性指标与血常规对病毒和细菌性肺炎患者鉴别诊断及并发症预测中的作用

Value of inflammatory indexes and blood routine in differential diagnosis of viral and bacterial pneumonia patients and in prediction of complications

目的探讨血常规及炎症指标变化在不同病原菌肺炎患者鉴别诊断及并发症预测方面的应用。方法选取2014年1月-2017年1月在医院诊断并进行治疗的肺炎患者382例作为研究对象,其中诊断为细菌性肺炎患者192例,病毒性肺炎患者190例,回顾性分析两组患者临床特征和相关炎症指标。结果细菌性肺炎患者白细胞计数(WBC)、中性粒细胞计数(N)、中性粒细胞计数/淋巴细胞计数(N/L)、C-反应蛋白/平均血小板体积(CRP/MPV)比值、C-反应蛋白(CRP)和血沉(ESR)指标均高于病毒性肺炎患者(P<0.05);合并并发症肺炎患者中性粒细胞/淋巴细胞、CRP/MPV比值和CRP指标均高于无并发症肺炎患者(P<0.05);N/L比值诊断细菌性肺炎敏感性和特异性均>70%,CRP/MPV诊断细菌性肺炎的敏感性和特异性均>80%,;诊断细菌性肺炎的临界值分别为1.7和2.6;N/L和CRP/MPV比值诊断肺炎并发症的敏感性和特异性均>75%,N/L和CRP/MPV诊断肺炎并发症的临界值分别为2.7和7.8。结论联合检测N/L和CRP/MPV比值可用于细菌性肺炎和病毒性肺炎鉴别诊断及并发症预测。

OBJECTIVE To explore the value of blood routine and inflammatory indexes in differential diagnosis of patients with pneumonia caused by different species of pathogens and in prediction of complications.METHODS A total of 382 patients who were diagnosed with pneumonia and treated in hospitals from Jan 2014 to Jan 2017 were recruited as the study objects,192 of whom were diagnosed with bacterial pneumonia,and 190 were diagnosed with viral pneumonia.The clinical features and inflammatory indexes of the two groups of patients were retrospectively analyzed.RESULTS The white blood cell（WBC）counts,neutrophil（N）counts,neutrophils counts/lymphocytes counts（N/L）,C-reactive protein/mean platelet volume（CRP/MPV）ratio,C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）of the patients with bacterial pneumonia were significantly higher than those of the patients with viral pneumonia（P〈0.05）.The N/L ratio,CRP/MPV ratio and CRP level of the pneumonia patients with complications were significantly higher than those of the pneumoniae patients without complications（P〈0.05）.The sensitivity and specificity of the N/L ratio were more than 70%in the diagnosis of bacterial pneumonia,the sensitivity and specificity of the CRP/MPV were more than 80%in the diagnosis of bacterial pneumonia.The critical values of the N/L ratio and CRP/MPV ratio were respectively 1.7 and 2.6 in diagnosis of bacterial pneumonia.The sensitivity and specificity of the N/L ratio and CRP/MPV were more than 75%in the diagnosis of pneumonia-induced complications,and the critical values of the N/L and CRP/MPV were respectively 2.7 and 8 in the diagnosis of pneumonia-induced complications.CONCLUSIONThe joint detection of the N/L ratio and CRP/MPV ratio can be used for the differential diagnosis of bacterial pneumonia and viral pneumonia and prediction of complications.