NLRPLR及PCT对小儿绞窄性肠梗阻的诊断价值

The diagnostic value of NLR, PLR and PCT in children with strangulated intestinal obstruction

目的探讨中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及降钙素原（PCT）对小儿绞窄性肠梗阻的早期诊断价值。方法选择西南医科大学附属医院2015-03-2018-03年行手术治疗的肠梗阻患儿76例，根据是否绞窄分为单纯组（n=46）和绞窄组（n=30），进一步将绞窄组分为缺血组（n=13）和坏死组（n=17），所有研究对象均在术前12h内检测外周血NLR、PLR及PCT水平。结果术前绞窄组患儿血清NLR、PLR及PCT显著高于单纯组患儿，绞窄组亚组间坏死组显著高于缺血组；Pearson相关分析提示，NLR与PLR呈中度正相关（r=0．462，P〈0．05），NLR、PLR与PCT均呈低度正相关（r=0．287，r=0．232，均P〈0．05）；用单个指标诊断绞窄性肠梗阻时，PCT的诊断价值最大，其AUC、特异度、准确度分别为0．807、78．91％、77．80％；三个指标联合检测的诊断价值优于单个或两两检测，其AUC、特异度、准确度分别为0．888、95．65％、85．20％。结论NLR、PLR及PCT均可作为诊断小儿绞窄性肠梗阻的有效指标，多个指标联合检测可以提升小儿绞窄性肠梗阻的诊断效能。

Objective We investigated the value of diagnosis of neutrophil - lymphocyte ratio （NLR）, platelet- lymphocyte ratio （PLR）, and procalcitonin to predict early strangulated bowel obstruction in children, providing references for clinical work. Methods 76 cases of intestinal obstruction in children were included in our hospital from March 2015 to March 2018, including 46 cases of simple intestinal obstruction （simple group ） and 30 cases of strangulated intestinal obstruction （strangulation group） ; the strangulation group was divided into ischemic group （n = 13 ） arid necrotic group （n = 17） , furtherly. All subjects were studied the levels of peripheral blood NLR, PER and PCT levels 12 hours before operation. Results The values of serum NLR, PLR, and PCT in children with preoperative strangulated intestinal obstruction were significantly higher than those in children with simple intestinal obstruction. There were also statistically significant differences between two subgroups （intestinal ischemia and intestinal necrosis） in the strangulation group, values in the intestinal necrosis group were significantly higher than it in the ischemia group. A Pearson correlation analysis was used to find a moderate positive correlation between NLR and PLR （ r = 0. 462, P 〈 0.05 ） , and NLR, PLR and PCT showed low positive correlations （ r = 0. 287, r = 0. 232, both P 〈 0.05 ）. The diagnostic value of PCT was the highest value in the diagnosis of strangulated intestinal obstruction by single index, and its AUC, specificity and accuracy were 0. 807, 78.91% and 77.80% , respectively. We found that the diagnostic value of the combined detection of the three indicators was better than the single or twoindicators when combined detection with muhiple inflammatory indicators, and the AUC, specificity and accuracy were 0. 888, 95.65% and 85.20%, respectively. Conclusion Our study demonstrates that multiple inflammatory indexes NLR, PLR and PCT can be used as effective indicators for the diagnosis of stenotic intestinal obstruction in children. Combined detection of muhiple indicators can improve the diagnostic efficacy of children with stenotic intestinal obstruction.