外周血中性粒细胞淋巴细胞比值与糖尿病酮症酸中毒感染的相关性

Correlation between peripheral blood neutrophil to lymphocyte ratio and diabetic ketoacidosis

目的探讨外周血中性粒细胞淋巴细胞比值(NLR)对糖尿病酮症酸中毒(DKA)患者感染的相关性。方法选取2016年1月-2018年1月天津市第四中心医院内分泌科收治的DKA患者,根据有无发生感染将其分为DKA感染组和DKA未感染组。另选取同期非DKA糖尿病患者为对照组,测定3组患者入院时白细胞(WBC)、中性粒细胞比率(NEU%)、淋巴细胞比率(LYM%)、中性粒细胞淋巴细胞比值(NLR)、谷丙转氨酶(ALT)、天冬氨酸氨基转移酶(AST)、血淀粉酶、尿淀粉酶、血乳酸水平;分析以上指标与DKA患者感染相关性。结果两组DKA患者外周血WBC、NEU%、NLR、AST、ALT、血乳酸、血淀粉酶、尿淀粉酶高于对照组(P<0.05);与DKA未感染组相比,DKA感染组外周WBC、NEU%、NLR、AST、ALT、血乳酸水平较高,尿淀粉酶水平较低(P<0.05);DKA两组LYM%低于对照组(P<0.05);以NLR>2.35作为预测DKA感染的临界点,敏感度为89.2%,特异度为93.5%,其敏感度、特异度高于WBC、NEU%、LYM%。结论DKA感染率与NLR水平呈正相关,NLR可作为炎性指标预测DKA感染患者的预后,AST、ALT及血乳酸与NLR水平具有一定相关性,检测以上指标有利于临床医生对DKA感染患者做出正确判断。

OBJECTIVE To explore the correlation between the peripheral blood neutrophil to lymphocyte ratio(NLR)and diabetic ketoacidosis(DKA).METHODS The DKA patients who were treated in endocrinology department of Tianjin Fourth Central Hospital from Jan 2016 to Jan 2018 were enrolled in the study and divided into the infection group and the non-infection group according to the status of infection,meanwhile,non-DKA patients were assigned as the control group.The white blood cell(WBC)counts,percentage of neutrophils(NEU%),percentage of lymphocytes(LYM%),NLR,alanine aminotransferase(ALT)level,aspartate aminotransferase(AST)level,blood amylase level,urine amylase level and serum lactic acid level of the three groups of patients were determined at the time of admission to hospital,and the correlation between the above indexes and the DKA was analyzed.RESULTS The levels of peripheral blood WBC,NEU%,NLR,AST,ALT,blood lactic acid,blood amylase and urine amylase of the infection group and the non-infection group were significantly higher than those of the control group(P<0.05).The levels of peripheral blood WBC,NEU%,NLR,AST,ALT and blood lactic acid of the infection group were significantly higher than those of the non-infection group,while the urine amylase level of the infection group was significantly lower than that of the non-infection group(P<0.05).The LYM%of the infection group and the non-infection group was significantly lower than that of the control group(P<0.05).Set NLR more than 2.35 as the critical point for prediction of DKA,the sensitivity was 89.2%,the specificity 93.5%;the sensitivity and specificity of the NLR were higher than those of the WBC,NEU%and LYM%.CONCLUSION The incidence of DKA is positively correlated with the NLR level,NLR can be taken as an inflammatory indicator for prediction of prognosis of the patients with DKA,there is certain correlation between the AST,ALT,blood lactic acid and the NLR level,and the detection of the above indexes may help the clinicians to make correct judgement for the DKA patients.