中性粒细胞/淋巴细胞比值对高三酰甘油血症性胰腺炎持续性器官衰竭预测价值

Analysis of predictive value of neutrophil-lymphocyte ratio to persistent organ failure in patients with hypertriglyceridemic pancreatitis

[目的]探讨中性粒细胞与淋巴细胞计数比值(NLR)对高三酰甘油血症性胰腺炎(HTGP)住院期间发生持续性器官衰竭(POF)的预测价值。[方法]选择HTGP患者92例,其中轻症组29例、中重症组35例、重症组28例。收集所有患者病史资料,入院后检测外周血白细胞计数和分类、超敏C反应蛋白(hsCRP)、血清淀粉酶和脂肪酶水平等指标,并计算出NLR。观察并记录其住院期间POF的发生。采用SPSS19.0软件对结果进行统计学分析。[结果]随着HTGP严重程度分级的上升,NLR升高,轻症组NLR为[6.98(2.975)],中重症组为[9.76(6.8)],重症组为[11.725(6.083)],各组比较差异有统计学意义(P<0.05)。Logistic回归分析显示,NLR、APACHE II评分是HTGP发生POF的独立危险因素[NLR(OR=1.221;95%CI:1.018~1.465;P<0.05);APACHE II评分(OR=1.289;95%CI:1.062~1.564;P<0.05)]。ROC曲线分析NLR、APACHE II评分、NLR+APACHE II评分对发生POF的预测价值,曲线下面积(AUC)分别为:0.778(95%CI:0.686~0.871)、0.790(95%CI:0.696~0.883)、0.825(95%CI:0.742~0.907)。NLR预测HTGP患者发生POF的最大约登指数为0.438,其对应的最佳界值为7.135,敏感度、特异度分别为90.7%、53.1%。[结论]作为一项简便易获取的常规检验指标,NLR可应用于对HTGP发生POF的预测,有助于对该类患者进行危险分层。

[Objective]To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR)on persistent organ failure(POF)in patients with hypertriglyceridemic pancreatitis(HTGP)during hospital period.[Methods]HTGP patients(n=92)were chosen from Oct.2014 to Nov.2019,the patients were divided into mild group(n=29),moderately severe group(n=35)and severe group(n=28).The materials including medical history,history of alcohol abuse and family history were collected from the patients.The levels of white blood cell count(WBC),neutrophil count,lymphocyte count were detected after hospitalization and NLR level was calculated.The hypersensitivity C-reactive protein(hsCRP),serum levels of amylase and lipase were detected after admission.The incidence of persistent organ failure(POF)was recorded during the hospital period.The results were analyzed with SPSS 19.0 statistical software.[Results]NLR level was[6.98(2.975)]in mild group,[9.76(6.8)]in moderately severe group and[11.725(6.083)]in severe group.As the severity of HTGP increased,NLR level increased(all P<0.05).Logistic regression analysis showed that NLR and APACHE II scores were independent risk factors for POF in patients with HTGP[NLR(OR=1.221;95%CI:1.018-1.465;P<0.05);APACHE II scores(OR=1.289;95%CI:1.062-1.564;P<0.05)].The receiver operating curve(ROC)was used to analyze the predictive value of NLR,APACHE II scores,and NLR+APACHE II scores on the occurrence of POF,and the area under the curve(AUC)was 0.778(95%CI:0.686-0.871),0.790(95%CI:0.696-0.883),and 0.825(95%CI:0.742-0.907),respectively.The maximum Youden’s index of NLR to predict the occurrence of POF in HTGP patients was 0.438,then the best cut off value was 7.135 with 90.7%sensitivity and 53.1%specificity.[Conclusion]As a easy and regular tool,NLR can be used as a predictor for POF in HTGP patients and to assist refining the management of risk stratification in these patients.