外周血NRL联合降钙素原检测对急性百草枯中毒患者早期预后评估的价值

Evaluation of early prognosis of acute paraquat poisoning in patients with acute paraquat poisoning by peripheral blood NRL combined with PCT

目的 探讨外周血中性粒细胞和淋巴细胞比值（NLR）联合降钙素原（PCT）检测对急性百草枯中毒患者早期预后评估的价值。方法 选取急性百草枯中毒患者60例，设为观察组；选取健康志愿者30例，设为对照组。于观察组入院后第1、3、7天，对照组于体检当日，检测血清NLR、PCT水平；随访患者中毒后1个月内的预后状况，据此分入存活组和死亡组。采用Spearman相关分析比较NLR与PCT的关系；使用受试者工作特征（ROC）曲线绘制血清NLR、PCT水平及两者联合检测对急性百草枯中毒患者死亡预测的价值，计算曲线下面积（AUC）、最佳临界值、敏感度、特异度、阳性预测值和阴性预测值。结果 观察组有效受试者58例，其中死亡组19例、存活组39例。入院第1天，死亡组、存活组血清NLR、PCT水平均明显高于对照组（P＜0.01）；第1、3、7天，死亡组血清NLR、PCT水平均逐渐增高（P＜0.05）；存活组第3天血清NLR、PCT水平均分别高于第1天、第7天（P＜0.05）；第1、3、7天，存活组血清NLR、PCT水平均分别低于死亡组（P＜0.05或P＜0.01）。Spearman相关分析显示，观察组血清NLR与PCT水平呈正相关（r=0.53，P＜0.01）。NLR联合PCT检测对急性百草枯中毒患者死亡预测的AUC和敏感度、特异度高于NLR、PCT（P＜0.05）；NLR、PCT、NLR＋PCT越高，急性百草枯中毒患者死亡的可能性越大。 结论 外周血NLR联合PCT检测简便、快捷，易于动态观察，且有较高的特异度和敏感度，对急性百草枯中毒患者的早期预后评估有较高的临床价值，对急性百草枯中毒患者的临床诊疗、病情评估、预后预测等具有一定的参考意义。

Objective To explore the value of peripheral blood neutrophil/lymphoeyte ratio （NLR） combined with proealcitonin （PCT） in the early prognosis of acute paraquat poisoning. Methods 60 cases of acute paraquat poisoning were selected as the observation group, and 30 healthy volunteers were selected as the control group. In the observation group, serum NLR and PCT levels were detected on the 1 st, 3rd and 7th day admitted to the hospital. The serum NLR and PCT levels were detected in the control group on the day of physical examination. The prognosis of the patients within 1 month after poisoning was followed up, and then the patients were divided into the survival group and the death group. Spearman correlation analysis was used to analyze the relationship between NLR and PCT. Receiver operating characteristic （ROC） curves of serum NLR, PCT and their combined detection were drawn in order to analyze their prediction value for patient＇s death after acute paraquat poisoning, and the area under the curve （AUC）, the optimal critical value and the sensitivity, specificity, positive predictive value and negative predictive value were respectively calculated. Results There were 58 effective subjects in the observation group, of which 19 were in the death group and 39 in the survival group. In the 1D group, death group and survival group serum NLR and PCT levels were significantly higher than those in control group （P 〈0.01 ） ; serum levels of NLR, PCT in death group on 1st, 3rd and 7th day were increased gradually （P 〈 0.05 ） ; in the survival group serum NLR, PCT levels on 3rd day were higher than those on 1 st day and 7th day （P 〈 0.05 ） ; serum NLR, PCT level in survival group on 1st, 3rd and 7th day were lower than the death group level （P 〈 0.01 ）. Spearman correlation analysis showed that the level of serum NLR in the observation group was positively correlated with the level of PCT （ r = 0.53, P 〈 0.01 ）. The area under the ROC curve predicted, sensitivity and specificity by NLR ＋ PCT for patients with acute paraquat poisoning was significantly different from that of NLR and PCT （P 〈 0.05）. The higher the NLR, PCT and NLR ＋ PCT were, the greater possibility of death were in patients with acute paraquat poisoning. Conclusion Peripheral blood NLR combined with PCT detection is simple and convenient, easy to observe, and has high specificity and sensitivity of acute paraquat poisoning early prognosis assessment of patients with a high chnical value for patients with acute paraquat poisoning, clinical diagnosis, condition assessment, prognosis has certain reference significance.