全血细胞亚型比值预测脓毒症患者发生心肌损伤的临床价值

Clinical value of NLR PLR PNR in myocardial injuries of sepsis patients

目的探究中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)和血小板/中性粒细胞比值(platelet/neutrophil ratio,PNR)对脓毒症患者发生心肌损伤的预测价值。方法按照Sepsis 3.0诊断标准,连续纳入2017年1月至2019年8月重症监护病房(intensive care unit,ICU)收治的142例确诊脓毒症患者,采用回顾性队列研究。采集患者一般资料、既往病史、诊断为脓毒症时的血常规指标(中性粒细胞绝对值、淋巴细胞绝对值和血小板绝对值),计算NLR、PLR和PNR比值。根据心脏肌钙蛋白I(cardiac troponin I,c Tn I)水平,将患者分为非心肌损伤组74例和心肌损伤组68例。分析NLR、PLR、PNR与心肌损伤标志物的相关性;采用Logistic回归分析脓毒症发生心肌损伤的独立危险因素;绘制受试者工作特征(receiver operating characteristic,ROC)曲线,评估NLR、PLR及PNR比值对脓毒症患者发生心肌损伤的预测价值。结果与非心肌损伤组比较,心肌损伤组NLR明显增高,PLR、PNR明显降低(P <0.05)。相关分析显示,脓毒症患者NLR与CRP呈正相关(r=0.604,P <0.05);PLR与BNP、APACHEⅡ评分呈负相关(r=-0.884,r=-0.722,P <0.05);PNR与BNP、肌红蛋白、CRP和APACHEⅡ评分呈负相关(r=-0.783,r=-0.400,r=-0.609,r=-0.789,P <0.05)。Logistic回归结果示NLR、PLR与CK-MB、BNP、APACHEⅡ评分均为脓毒症患者发生心肌损伤的独立危险因素(OR=1.019、0.999、1.256、1.002、1.070,P <0.05)。ROC曲线显示,NLR、PLR和PNR对脓毒症患者心肌损伤均有一定预测价值,其中PNR预测效能最大,曲线下面积(area under curve,AUC)为0.818(P <0.001)。结论 NLR、PLR及PNR三者均对脓毒症患者发生心肌损伤具有一定预测价值,PNR预测能力相对更强。

Objective To investigate the clinical value of neutrophil/lymphocyte ratio( NLR),platelet/lymphocyte ratio( PLR) and platelet/neutrophil ratio( PNR) in judging the occurrence of myocardial injury in the patients with sepsis. Methods According to the gold standard Sepsis 3. 0,a total of 142 patients diagnosed with sepsis,treated in intensive care unit( ICU) of Peking University People’s Hospital from January 2017 to August 2019,were enrolled into this retrospective cohort study. We collected not only patients’ basic information and illness history,but also the blood routine indexes including neutrophil absolute value,lymphocyte absolute value,platelet absolute value,and calculated three ratios of NLR,PLR,PNR. Based on the result of cardiac troponin I( cTnI),142 patients with sepsis were divided into two groups,74 patients in normal group and 68 in injury group. Spearman correlation was used to analyze the correlation between three ratios and myocardial injury markers. Furthermore,Lo-gistic regression was used to analyze independent risk factors for myocardial injury among sepsis patients.Finally,receiver operating characteristic curve( ROC) analysis was used to evaluate the predictive value of these three ratios in myocardial injury among septic patients. Results There were significant differences in NLR,PLR,PNR between two groups. Compared with the normal group,NLR in the myocardial injury group was significantly increased,PLR and PNR were significantly reduced( P < 0. 05). Correlation analysis showed that NLR in patients with sepsis was positively correlated with CRP( r = 0. 604,P < 0. 05). PLR is negatively correlated with BNP and APACHEⅡ score( r =-0. 884,r =-0. 722,P < 0. 05). PNR was negatively correlated with BNP,MYO,CRP and APACHEⅡ score( r =-0. 783,r =-0. 400,r =-0. 609,r =-0. 789,P < 0. 05). Logistic regression showed that NLR,PLR,CK-MB、BNP、APACHEⅡ score were all independent risk factors for myocardial injury in patients with sepsis( OR = 1. 019,0. 999,1. 256,1. 002,1. 070,P < 0. 05). ROC curve analysis demostrated that NLR,PLR and PNR have certain predictive value for myocardial injury in patients with sepsis,AUC of which were 0. 799,0. 750,0. 818 respectively( P < 0. 001). Conclusions NLR,PLR and PNR all have a certain predictive value for myocardial injury in the patients with sepsis. The PNR predictive ability is relatively stronger.