中性粒细胞与淋巴细胞比值作为重症急性胰腺炎早期预测指标的临床研究

Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker in patients with severe acute pancreatitis

目的研究中性粒细胞-淋巴细胞比率(NLR)在重症急性胰腺炎患者中的的预测价值。方法本回顾性研究于2017年1月至2020年5月在我院急诊诊断为急性胰腺炎的患者。根据修订后的《亚特兰大急性胰腺炎分类》,将患者分为轻度(MAP)及中度重症组(MASP)和重症组(SAP)。以临床特征和实验室血检参数为自变量。采用卡方检验和t检验对自变量进行分析,确定两组间差异有统计学意义。进行Logistic回归分析和观测者操作特性曲线分析,评价显著性差异变量的预测值。结果94例患者中,重症组29例(30.9%)。重症组心动过速、发热、白细胞计数(WBC)、NLR、c-反应蛋白(CRP)、降钙素原(PCT)、D-二聚体、乳酸脱氢酶(LDH)、甘油三酯,血糖、总胆红素均显著增高,血钙显著降低。其中NLR(adjusted odds ratio[aOR]:1.379;95%置信区间[CI]:1.120-1.698),D-二聚体(aOR:1.493;95%CI:1.038~2.148),CRP(aOR:1.014;95%CI:1.000~1.027),血钙([aOR]:0.040;95%CI:0.003~0.469)在logistic回归分析中显著。NLR的敏感性(86.0%)和特异性(72%)较高,曲线下面积最高(0.814)。结论NLR升高与重症急性胰腺炎有关。NLR有望成为急诊科的急性胰腺炎患者病情严重程度的预后因子。

Objective To explore the Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatis.Methods This retrospective study was conducted on patients with acute pancreatitis who were diagnosed in the emergen-cy department,from January 2017 to May 2020.We investigated the predictive values of the neutrophil-lymphocyte ratio(NLR)as an indicator for severe acute pancreatitis in the emergency department patients.Patients were classified into either mild-to-moderate severe group or severe group according to the Revised Atlanta Classfcation for Acute Pancreatitis.Clinical features and laboratory blood test paramelers were considered as independent variables.Independent variables were analyzed using the Chi-square test and Mann-Whitney U-test to determine statistically significant differences between the two groups.Logstic regression analysis and receiver operating char-acteristic analysis were perforned to evaluate the predictive values of significantly different variables.Results Of the 94 patients,29(30.9%)were classified into the severe group.Tachyeardia,fever,white blood cell count,NLR,C-reactive protein(CRP),Procal-citonin(PCT),D-dimer,lactate dehydrogenase,triglyceride,blood glucose and total bilirubin were significantly higher,blood calcium significantly decreased in the severe group.Among them,NLR(adjusted odds ratio[aOR]:1.379;95% confidence interval[CI]:1.120~1.698),D-dimer(aOR:1.493;95%CI:1.038~2.148),CRP(aOR:1.014;95%CI:1.000~1.027),andBlood caleium(aOR:0.040;95%CI:0.003~0.469)were significant in the logistic regression analysis.NLR showed relatively high sensitivity(86.0%)and specificity(72%)and showed the highest area under the curve(0.814).Conclusion The increase in NLR was as-sociated with severe acute pancreatitis.NLR is expected to be useful as a prognostic factor in patients with acute pancreatitis who are visiting the emergency department.