中性粒细胞/淋巴细胞比值对新型冠状病毒肺炎患者疾病分型的诊断价值

Value of neutrophil-to-lymphocyte ratio in the classification diagnosis of coronavirus disease 2019

目的探讨中性粒细胞/淋巴细胞比值(NLR)在新型冠状病毒肺炎(简称新冠肺炎)患者疾病分型中的临床价值。方法回顾性分析2020年2月至3月援鄂期间在华中科技大学同济医学附属协和医院肿瘤中心重症病区收治的72例新冠肺炎患者,按疾病分型分为普通型(纳入非重症组)和重型/危重型(纳入重症组)。收集两组患者入院第2天白细胞计数(WBC)、中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、白细胞介素-6(IL-6)和D-二聚体水平,并计算NLR。绘制受试者工作特征曲线(ROC),评估WBC、NEU、LYM、IL-6、D-二聚体和NLR对新冠肺炎疾病分型的诊断价值。结果 72例新冠肺炎患者均纳入分析,其中普通型52例,重型17例,危重型3例。患者的常见临床表现为发热(70.8%)、咳嗽(36.1%)、胸闷气喘(37.5%)、腹泻(15.3%)、乏力(15.3%)及恶心呕吐(11.1%)等,偶尔伴有急性呼吸困难(2.8%),仅1例(1.4%)患者无任何临床症状。重症组患者WBC、NEU、IL-6、D-二聚体水平和NLR均明显高于非重症组〔WBC(×109/L):7.81±3.65比5.34±1.69,NEU(×109/L):5.83±3.13比3.24±1.53,IL-6(ng/L):133.63(71.09,249.61)比28.05(6.41,101.24),D-二聚体(mg/L):0.86(0.31,2.56)比0.33(0.20,0.71),NLR:6.14±4.75比2.66±1.93,均P<0.05〕,LYM水平明显低于非重症组(×109/L:1.09±0.56比1.49±0.74,P<0.05)。ROC曲线分析显示,WBC、NEU、LYM、IL-6、D-二聚体和NLR诊断新冠肺炎疾病分型的ROC曲线下面积(AUC)分别为:WBC 0.790 〔95%可信区间(95%CI)为0.684~0.897〕,NEU 0.869(95%CI为0.789~0.949),LYM 0.719(95%CI为0.592~0.847),IL-6 0.790(95%CI为0.682~0.898),D-二聚体0.676(95%CI为0.526~0.827),NLR 0.888(95%CI为0.814~0.963),以NLR的AUC最大,说明NLR的诊断价值最大;当NLR的最佳截断值为3.00时,其敏感度为100%,特异度为73.1%。结论 NLR可作为一种独立预测新冠肺炎患者病情严重程度的生物标志物,能够为新冠肺炎患者的疾病分型管理提供理论依据。

Objective To investigate the clinical significance of neutrophil-to-lymphocyte ratio(NLR)in classification of patients with coronavirus disease 2019(COVID-19).Methods A retrospective analysis was performed on 72 patients with COVID-19 admitted to the critical ward of Cancer Center of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in Wuhan from February to March in 2020.The patients were divided into two groups:moderate type(non-severe group)and severe/critical type(severe group).The results of white blood cell count(WBC),neutrophil count(NEU),lymphocyte count(LYM),interleukin-6(IL-6)and D-dimer were collected at the 2nd day after admission from the two groups,and the NLR was calculated.The diagnostic value of WBC,NEU,LYM,IL-6,D-dimer and NLR on COVID-19 classification was evaluated by the receiver operating characteristic(ROC)curve.Results A total of 72 COVID-19 patients were enrolled,among whom 52 were moderate,17 were severe,and 3 were critical.The most common clinical manifestations of patients were fever(70.8%),cough(36.1%),chest tightness and breathlessness(37.5%),diarrhea(15.3%),fatigue(15.3%),vomiting and nausea(11.1%),occasionally accompanied by acute dyspnea(2.8%),and only one patient had no clinical symptom(1.4%).The levels of WBC,NEU,IL-6,D-dimer and NLR in the severe group were significantly higher than those in the non-severe group[WBC(×109/L):7.81±3.65 vs.5.34±1.69,NEU(×109/L):5.83±3.13 vs.3.24±1.53,IL-6(ng/L):133.63(71.09,249.61)vs.28.05(6.41,101.24),D-dimer(mg/L):0.86(0.31,2.56)vs.0.33(0.20,0.71),NLR:6.14±4.75 vs.2.66±1.93,all P<0.05],and the level of LYM was significantly lower than that in the non-severe group(×109/L:1.09±0.56 vs.1.49±0.74,P<0.05).The results of ROC curve analysis showed that the areas under ROC curve(AUC)of WBC,NEU,LYM,IL-6,D-dimer and NLR for COVID-19 classification were 0.790[95%confidence interval(95%CI)was 0.684-0.897),0.869(95%CI was 0.789-0.949),0.719(95%CI was 0.592-0.847),0.790(95%CI was 0.682-0.898),0.676(95%CI was 0.526-0.827),and 0.888(95%CI was 0.814-0.963)respectively.The AUC of NLR was the highest,which was of high diagnostic value;when the optimum cut-off value of NLR was 3.00,the sensitivity was 100%,and the specificity was 73.1%.Conclusion NLR can be used as a biomarker to predict classification of COVID-19 patients independently,which can provide a theoretical basis for the classification management of COVID-19 patients.