外周血与胸腔积液中性粒细胞和淋巴细胞比值对积液性质及耐药判断的临床意义

The clinical significance of the peripheral blood and pleural effusion neutrophilic granulocyte/lymphocyte ratio in determining the effusion property and drug-resistance

目的探讨外周血中性粒细胞和淋巴细胞比值(NLR)及胸腔积液NLR在积液性质及是否耐药结核鉴别中的临床价值。方法回顾性分析135例胸腔积液患者,其中恶性胸腔积液、类肺炎胸腔积液、结核性胸腔积液各45例,结核性胸腔积液病例根据结核菌培养及药敏结果,进一步分为耐药组20例和非耐药组25例。采集胸腔积液及外周血进行血常规检测中性粒细胞(Neu)、淋巴细胞计数(Lym)和外周血血小板计数(PLT),获得外周血NLR、血小板与淋巴细胞比值(PLR),以及胸腔积液NLR并进行各组间的比较分析。结果外周血Neu、NLR、Lym及PLR在恶性、肺炎性与结核性胸腔积液组间差异有统计学意义(P<0.05)。其中结核性胸腔积液组外周血NLR为2.88±1.28,明显低于恶性胸腔积液组的4.83±1.16及类肺炎胸腔积液组的5.12±1.36(P<0.05)。胸腔积液Neu、WBC、NLR在恶性、类肺炎性与结核性胸腔积液组间呈递减趋势,Lym呈递增趋势(P<0.05),其中恶性胸腔积液组NLR为3.71±1.26,明显高于类肺炎胸腔积液组的2.38±0.71及结核性胸腔积液组的1.31±0.24,而后者同时也明显低于类肺炎胸腔积液组(P<0.05)。受试者工作特征(ROC)曲线下面积(AUC)结果显示在判断良(结核与肺炎)恶性中,AUC胸腔积液NLR=0.897,AUC外周血NLR=0.768,AUC外周血PLR=0.702,AUC胸腔积液NLR最高。耐药组血常规PLT及PLR水平分别为(241.13±53.17)×10^(9)·L^(-1)和133.22±24.19,明显低于非耐药组的(291.56±53.08)×10^(9)·L^(-1)和168.21±34.93,差异有统计学意义(P<0.01)。耐药组胸腔积液Neu及PLR水平分别为(3.04±0.72)×1012·L-1和1.35±0.31,明显高于非耐药组的(2.52±0.63)×1012·L-1和1.17±0.21,差异有统计学意义(P<0.05)。结论外周血NLR及胸腔积液NLR均可较为准确地预测积液性质,也与耐药关系密切,且在判断积液良恶性中的表现更佳,值得推广。

Objective To investigate the clinical significance of peripheral neutrophilic granulocyte/lymphocyte ratio(NLR)and pleural effusion NLR in the differentiation of effusion properties.Methods A retrospective analysis was made on 135 patients with pleural effusions from 2018.1.1 to 2019.6.30 in Guangzhou Chest hospital,including 45 patients with malignant pleural effusions,45 patients with pneumonia-like pleural effusions and 45 patients with tuberculosis pleural effusions.Among the 45 patients with tuberculosis pleural effusions,there were 20 drug resistant patients and 25 non-drug resistant patients.Neutrophil(Neu)and lymphocyte count(Lym)were detected in the pleural effusions and peripheral blood,and the NLR between peripheral blood and the pleural effusion were calculated and compared.Results Neu and NLR in peripheral blood showed a decreasing trend in malignant,pneumonia and tuberculosis(P<0.05),and the ratio of Lym and platelet to lymphocyte(PLT)was increasing(P<0.05).The NLR of peripheral blood in tuberculosis pleural effusion group was 2.88±1.28,which was significantly lower than those in malignant pleural effusion group(4.83±1.16)and pneumonia-like pleural effusion group(5.12±1.36,P<0.05).There was a decreasing trend of Neu,WBC,NLR in malignant,pneumonia-like and tuberculosis,and an increasing trend in Lym.NLR in malignant pleural effusion group was 3.71±1.26,which was significantly higher than those in pneumonia-like pleural effusion group(2.38±0.71)and tuberculosis pleural effusion group(1.31±0.24),while the latter was also significantly lower than that in pneumonia-like pleural effusion group(P<0.05).Area under the working curve of the subjects(AUC)for differentiation between benign and malignant effusion of pleural effusion NLR was 0.897;of peripheral blood NLR was 0.768;and of peripheral blood PLR was 0.702.The platelet and PLR levels of the drug resistant group were 241.13±53.17 and 133.22±24.19,respectively;significantly lower than those of the non-drug resistant group(291.56±53.08 and 168.21±34.93,respectively,P<0.01).The Neu and PLR levels of pleural effusion in the drug resistant group were 3.04±0.72 and 1.35±0.31,respectively;significantly higher than those in the non-drug resistant group(2.52±0.63 and 1.17±0.21,respectively,P<0.05).Conclusion Both peripheral blood NLR and pleural effusion NLR can accurately predict the property of pleural effusion.They are also associated with drug resistance,and pleural effusion indexes provide better performance in judging the benign and malignant effusion.