外周血血小板/淋巴细胞比值和中性粒细胞/淋巴细胞比值对早产儿动脉导管未闭的早期预测价值

Early predictive value of peripheral blood platelet/lymphocyte ratio and neutrophil/lymphocyte ratio for patent ductus arteriosus in premature infants

目的探讨外周血血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)单独及联合检测对早产儿动脉导管未闭(PDA)的早期预测价值。方法选取2016年5月-2017年12月台州市妇女儿童医院收治的65例确诊为PDA早产儿作为PDA组,同期70例出生的无PDA早产儿作为对照组,收集两组早产儿一般资料。采用全自动血细胞分析仪及配套试剂检测中性粒细胞、淋巴细胞计数,并计算NLR;采用目测镜检法检测血小板计数,并计算PLR。使用彩色多普勒超声诊断仪,检测并计算动脉导管(DA)内径、左房内径(LAD)、主动脉直径(AOD)及左室射血分数(LVEF)。采用Pearson检验分析PDA组早产儿外周血PLR、NLR与超声指标相关性;并绘制受试者工作特征曲线(ROC曲线),分析外周血PLR、NLR及两者联合对早产儿PDA的早期预测价值。结果两组早产儿一般资料相比,差异均无统计学意义(均P>0.05)。PDA组早产儿外周血中性粒细胞数、PLR及NLR均明显高于对照组(P<0.05),淋巴细胞数、血小板数均显著低于对照组(P<0.05)。PDA组早产儿LAD/AOD值、DA内径均明显高于对照组(P<0.05);两组LVEF相比,差异无统计学意义(P>0.05)。PDA组早产儿外周血PLR、NLR与LAD/AOD值、DA内径均呈正相关(P<0.05),与LVEF关系不显著(P>0.05)。外周血PLR、NLR单独预测PDA的曲线下面积(AUC)分别为0.778、0.851,最佳截断值分别为53.07、3.22;外周血PLR联合NLR早期预测早产儿PDA的AUC高于外周血PLR、NLR单独预测,其预测灵敏度高达91.40%,特异度为78.50%。结论 PDA早产儿外周血PLR、NLR明显升高,两者联合可提高对早产儿PDA的早期预测价值。

Objective To explore the early predictive value of peripheral blood platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) for patent ductus arteriosus (PDA) in premature infants. Methods From May 2016 to December 2017,65 premature infants diagnosed as PDA definitely treated in Taizhou Women and Children’s Hospital were selected as PDA group,70 premature infants without PDA born during the same period in this hospital were selected as control group. The general data of premature infants in the two groups were collected. The counts of neutrophils and lymphocytes were detected by automatic blood cell analyzer and matching reagents,NLR was calculated. Platelet counts were detected by visual microscopy,PLR was calculated. The diameter of ductus arteriosus (DA),left atrial diameter (LAD),aortic diameter (AOD),and left ventricular ejection fraction (LVEF) were measured and calculated by color Doppler ultrasonography. Pearson test was used to analyze the correlations between PLR,NLR in peripheral blood and ultrasound indexes of preterm infants in PDA group,receiver operating characteristic curve (ROC curve) was drawn,the early predictive value of peripheral blood PLR,NLR and their combination for PDA in premature infants were analyzed. Results There was no statistically significant difference in general data between the two groups (P>0. 05). The number of neutrophils,PLR,and NLR in peripheral blood of preterm infants in PDA group were statistically significantly higher than those in control group (P< 0. 05),while the numbers of lymphocyte and platelets in PDA group were statistically significantly lower than those in control group (P<0. 05). LAD/AOD value and DA inner diameter of preterm infants in PDA group were statistically significantly higher than those in control group (P < 0. 05);there was no statistically significant difference in LVEF between the two groups (P>0. 05). PLR and NLR in peripheral blood of preterm infants in PDA group were positively correlated with LAD/AOD value and DA inner diameter (P < 0. 05),which were not correlated with LVEF (P > 0. 05). The areas under ROC curve (AUC) of peripheral blood PLR and NLR for predicting PDA were 0. 778 and 0. 851,respectively,the optimal cut-off values were 53. 07 and 3. 22,respectively. AUC of peripheral blood PLR combined with NLR for early predicting PDA in preterm infants was higher than those of peripheral blood PLR and NLR alone, the predictive sensitivity and specificity were 91. 40% and 78. 50%, respectively.Conclusion PLR and NLR in peripheral blood of preterm infants with PDA increase significantly. The combination of PLR and NLR can improve the early predictive value of PDA in preterm infants.