糖尿病足溃疡截肢患者中性粒细胞淋巴细胞比值及C反应蛋白水平的比较

Comparison of neutrophil lymphocyte ratio and C-reactive protein levels in patients with diabetic foot ylcer undergoing amputation

目的探讨CRP和NLR与糖尿病足溃疡(DFU)截肢术后患者预后的关系,评价CRP和NLR对于DFU截肢术后患者不良预后的预测价值。方法选取2017年1月~2018年1月于本院确诊为糖尿病足溃疡并行截肢术治疗患者108例,记录其基线资料、DFU病程、空腹血糖、24h尿蛋白,CRP水平以及NLR。对所有患者进行为期1年的随访,随访过程结果中预后不良的患者归为预后不良组,病情有效控制患者均归为预后良好组,对影响DFU截肢术后患者预后的相关因素采进行单因素分析;采用Cox风险模型分析存在统计学意义的所有因素对DFU截肢术后患者预后的影响程度;t检验显示具有影响力的因素在两组间的分布差异;采用Logistic回归模型拟合预测指标或者联合诊断指标并构成新联合判断因素,采用ROC曲线对具有统计学意义的因素进行分析,通过曲线下面积判断相关因素对DFU截肢术后患者预后的影响。结果单因素分析结果显示:患者家族史、空腹血糖、CRP、NLR对DFU患者截肢预后有显著影响,差异有统计学意义(P<0.05);多因素Cox回归结果显示,空腹血糖、CRP、NLR对DFU患者截肢预后有显著影响,差异有统计学意义(P<0.05);预后不良组CRP水平、NLR水平显著高于预后良好组CRP水平,差异有统计学意义(P<0.05);而ROC曲线下CRP和NLR联合诊断的曲线下面积明显增大,其敏感性和特异性分别为71.2%,70.8%。结论CRP及NLR联合检测在DFU截肢术后患者预后评价中具有较好的预测效果,可以作为DFU截肢术后患者的常规检查标之一。

Objective To explore the relationship between CRP,NLR and the prognosis of patients with diabetic foot ulcers(DFU)after amputation and evaluate the predictive value of CRP and NLR for poor prognosis in patients after DFU amputation.Methods 108 patients who were diagnosed as diabetic foot ulcers and underwent amputation in our hospital from January 2017 to January 2018 were selected.Baseline data,DFU duration,fasting blood glucose,24 h urine protein,CRP levels and NLR were recorded.All patients were followed up for 1 year.Patients with poor prognosis in the follow-up were classified as poor prognosis group while patients with effective disease control were classified as good prognosis group.Univariate analysis was carried out on the related factors affecting the prognosis of DFU patients after amputation.Cox risk model was used to analyze the influence of all statistically significant factors on the prognosis of patients after DFU amputation.The t-test showed differences in the distribution of factors with significance between the two groups.Logistic regression model was used to fit the prediction index or joint diagnosis index and form the new joint judgment factor.The ROC curve was used to analyze the statistically significant factors,and the effect of relevant factors on the prognosis of patients after DFU amputation was determined by the area under the curve.Results Univariate analysis showed that family history,fasting blood glucose,CRP,and NLR had significant effects on the prognosis of patients with DFU,and the difference was statistically significant(P<0.05).Multivariate Cox regression showed that fasting blood glucose,CRP,and NLR had significant effects on the prognosis of patients with DFU and the difference was statistically significant(P<0.05).The levels of CRP and NLR in the poor prognosis group were significantly higher than those in the prognosis group,and the difference was statistically significant(P<0.05).However,the area under the ROC curve for CRP and NLR combined diagnosis increased significantly,with sensitivity and specificity of 71.2%and 70.8%,respectively.Conclusion The combined detection of CRP and NLR has a good predictive effect in the prognosis evaluation of patients after DFU amputation,which can be used as one of the routine examination targets for patients with DFU amputation.