应用中性粒细胞与淋巴细胞比例早期诊断输尿管结石并发的尿源性脓毒血症的价值

The value of neutrophil to lymphocyte ratio in the early diagnosis of ureteral stones and urosepsis

目的比较应用中性粒细胞与淋巴细胞比例(NLR)早期预测输尿管结石并发尿源性脓毒血症的应用价值。方法回顾性分析142例输尿管结石患者的临床资料,其中92例输尿管结石患者无发热及泌尿系感染表现作为对照组,40例输尿管结石伴发脓毒血症但未出现感染性休克作为轻症脓毒血症组,10例输尿管结石伴发脓毒血症及感染性休克作为感染性休克组。比较3组患者血常规中性粒细胞百分比(N%)、NLR的差异,应用Logistic回归分析上述炎性指标与脓毒血症的相关性,评价炎性指标对感染严重程度的预测价值。结果142例患者的平均年龄(53.22±13.66)岁,其中男性85例、女性57例。N%、NLR在3组患者中的表达差异均具有统计学意义,并且随着感染程度加重而升高。NLR诊断脓毒血症的受试者操作特征曲线下面积(AUC)=0.9404,高于N%的AUC=0.8853。以NLR=6.15作为诊断的临界值,其敏感度和特异度分别为86%和85.9%。结论应用NLR能够早期预测上尿路结石并发尿源性脓毒血症的发生,相较于N%效果更好、速度更快。

Objective To explore the value of neutrophil to lymphocyte ratio(NLR)in the early diagnosis of ureteral stones and urosepsis.Methods Clinical data of 142 cases of ureteral stones were retrospectively analyzed.The patients were divided into three groups:control group(n=92)had no fever or urinary infection,mild sepsis group(n=40)had urosepsis but no septic shock,and septic shock group(n=10)had both urosepsis and septic shock.Percentage of neutrophils(N%)and NLR were compared among the three groups.The correlation between N%and NLR and urosepsis was analyzed with Logistic regression model.The prediction value of them on the severity of inflammation was also analyzed.Results There were 85 males and 57 females included,and the average age was(53.22±13.66)years.There were significant differences in N%and NLR among the three groups(P<0.05),and the expressions increased with the severity of inflammation.The area under receiver operating characteristic curve(AUC)for NLR in the diagnosis of urosepsis was 0.9404,higher than that of N%,which was 0.8853.With NLR=6.15 as the cut-off value,the sensitivity and specificity of NLR in the diagnosis of urosepsis were 86%and 85.9%,respectively.Conclusion Peripheral NLR level is a useful infection biomarker in the early diagnosis of urosepsis in patients with ureteral stones.It is faster and has better effects than N%.