早期乳酸清除率、降钙素原、中性粒细胞和淋巴细胞比值与重症肺炎严重程度及预后的相关性

Correlation of early lactate clearance rate,procalcitonin,NLR with the severity and prognosis of severe pneumonia

目的分析和探讨早期乳酸清除率、降钙素原、中性粒细胞和淋巴细胞比值(NLR)与重症肺炎患者疾病严重程度及预后的相关关系。方法 80例重症肺炎患者根据APACHE II评分分为重度组(≥15分) 47例和轻度组(<15分) 33例,根据28 d内存活情况分为存活组(56例)和死亡组(24例)。检测和比较患者的乳酸清除率、降钙素原、NLR水平的组间差异,并分析检测指标与患者的疾病严重程度及预后的相关性。结果重度组的乳酸清除率低于轻度组,降钙素原和NLR高于轻度组,差异有统计学意义(P<0.05)。APACHE II评分与乳酸清除率呈负相关(r=-0.462,P<0.001),与降钙素原(r=0.461,P<0.001)、NLR(r=0.300,P<0.001)呈正相关。死亡组的APACHE II评分、降钙素原水平和NLR均高于存活组,而乳酸清除率低于存活组,差异有统计学意义(P<0.05)。早期乳酸清除率、降钙素原、NLR预测重症肺炎患者预后的最佳临界点分别为24.31%、2.80 ng/m L、9.73,其对应的敏感性分别为0.446、0.625、0.625,特异性分别为0.833、0.821、0.750。结论早期乳酸清除率、降钙素原、NLR在判断重症肺炎患者的疾病严重程度及评估预后方面具有较高的临床价值。

Objective To explore the correlation of early lactate clearance rate,procalcitonin,neutrophil to lymphocyte ratio( NLR) with the severity and prognosis of patients with severe pneumonia. Methods Eighty patients with severe pneumonia were divided into a severe group( ≥15 points)( n = 47) and a mild group( <15 points)( n = 33) according to the APACHE II score. According to the 28 d survival,these patients were divided into survival group( n = 56) and death group( n = 24).The level of lactate clearance rate,procalcitonin,NLR was detected and compared between groups,and the correlation between detection indexes and disease severity and prognosis was analyzed. Results The lactate clearance rate of the severe group was lower than that of the mild group,procalcitonin and NLR were higher than those of the mild group,differences were statistically significant( P<0. 05).The APACHE II score was negatively correlated with lactate clearance rate( r =-0. 462,P<0. 001),and positively correlated with procalcitonin( r = 0. 461,P<0. 001) and NLR( r = 0. 300,P<0. 001).The APACHE II score,procalcitonin level,and NLR of the death group were higher than those of the survival group,while the lactate clearance rate of the death group was lower than that of the survival group( P< 0. 05). The optimal cut-off points of early lactate clearance rate,procalcitonin,and NLR in predicting the prognosis of patients with severe pneumonia were 24. 31%,2. 80 ng/m L,and 9. 73,respectively. The corresponding sensitivities were 0. 446,0. 625,and 0. 625,and the specificities were 0. 833,0. 821,and 0. 750,respectively. Conclusions Early lactate clearance rate,procalcitonin,and NLR have high clinical value in predicting the severity and evaluating the prognosis of patients with severe pneumonia.