MPV和P-LCR及NLR参数在新型冠状病毒肺炎中应用的研究

Expressions of MPV,P-LCR and NLR in patients with novel coronavirus disease 2019

本研究探讨平均血小板体积(mean platelet volume,MPV)和大血小板比率(platelet-large contrast ratio,P-LCR)及中性粒细胞/淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)在不同病情危重程度的新型冠状病毒肺炎(COVID-19)的表达水平及临床应用价值。采用回顾性分析方法,选取天津市第三中心医院和天津市津南医院2020年1至5月收治的69例COVID-19确诊患者作为研究对象,根据病情危重程度分为轻型组(15例)、普通型组(46例)、危重型组(8例),另选取同期70例已排除新型冠状病毒肺炎感染的患者作为对照组,分析各组白细胞总数(white blood cell count,WBC)、中性粒细胞绝对数(absolute neutrophil count,NE#)、淋巴细胞绝对数(absolute lymphocyte count,LY#)、中性粒细胞/淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)、红细胞计数(red blood cell count,RBC)、血红蛋白(hemoglobin,Hb)、血小板总数(platelet count,PLT)、平均血小板体积(mean platelet volume,MPV)、血小板体积分布宽度(platelet volume distribution width,PDW)、大血小板比率(platelet-large contrast ratio,P-LCR)各指标变化水平,并采用二元Logistic回归分析各项指标对危重型COVID-19的预测价值,利用受试者工作特征(ROC)曲线进一步分析MPV、P-LCR、NLR单独及联合对COVID-19的鉴别诊断价值。危重型患者WBC[11.98(8.21,13.43)×109/L]和NE#[7.31(5.18,9.68)×109/L]明显高于对照组[9.85(7.71,11.21)×109/L;5.55(4.21,6.12)×109/L],差异均有统计学意义(Z=-5.63,P<0.01;Z=-9.19,P<0.01),危重型患者LY#[1.41(1.07,2.17)×109/L]明显低于对照组[2.84(1.83,3.57)×109/L],差异有统计学意义(Z=-9.34,P<0.01)。NLR随病情加重而升高,危重型组[4.54(2.34,6.54)]明显高于对照组[1.77(1.34,2.24)],差异有统计学意义(Z=17.61,P<0.01);COVID-19患者PLT、PDW、MPV、P-LCR随病情加重而下降,各组间差异均有统计学意义(Z=9.47,P<0.01;Z=11.41,P<0.01;Z=16.76,P<0.01;Z=13.97,P<0.01)。二元Logistic回归分析显示MPV、P-LCR、NLR对危重型COVID-19具有预测价值,MPV、P-LCR与COVID-19患者的危重型呈负相关性(OR=1.004,P=0.034;OR=1.097,P=0.046),NLR与COVID-19患者的危重型呈正相关性(OR=1.052,P=0.016)。预后良好组治疗后MPV[11.2(8.5,12.6)fl]和P-LCR[14.7(12.4,17.5)%]明显高于治疗前[9.9(7.1,11.2)fl;12.2(10.2,16.4)%],差异均有统计学意义(Z=-6.47,P<0.01;Z=-5.36,P<0.01),NLR[1.76(1.15,2.49)]明显低于治疗前水平[2.48(1.79,4.12)],差异有统计学意义(Z=-8.13,P<0.01);预后不良组治疗后MPV[6.9(5.3,8.9)fl]和P-LCR[9.7(7.2,11.9)%]明显低于治疗前[8.8(6.4,10.2)fl]和[11.1(9.4,14.4)%],差异均有统计学意义(Z=-9.46,P<0.01;Z=-6.81,P<0.01),NLR[6.79(4.22,8.14)]明显高于治疗前[4.84(2.34,6.54)],差异有统计学意义(Z=-3.24,P<0.01);预后不良组治疗前与治疗后MPV、P-LCR、NLR与预后良好组比较,差异均有统计学意义(Z分别为9.84、14.21、8.54、13.24、10.71、22.87,P均<0.01)。MPV、P-LCR、NLR三项指标联合对于COVID-19诊断的ROC曲线下面积是0.931,敏感度91.5%,特异度94.1%,阳性预测值88.9%,阴性预测值87.4%,优于每项指标单独的检测结果。因此,外周血细胞参数变化可能与COVID-19病情变化相关,MPV、P-LCR联合NLR检测可能对COVID-19的鉴别诊断及预后评估具有辅助价值。

To provide new ideas for clinical diagnosis and treatment of coronavirus disease 2019(COVID-19),this study explore the expression level and prognostic value of platelet parameters in mild,moderate and severe COVID-19.This is a retrospective analysis.From January to May 2020,a total of 69 patients who were diagnosed with COVID-19 in the Third Central Hospital and the Jinnan Hospital(both situated in Tianjin)were enrolled in the disease group.According to the severity,these patients were divided into mild group(15 cases),moderate group(46 cases),and severe group(8 cases).In the same period,70 non-infected patients were enrolled in control group.The level of white blood cell count(WBC),absolute neutrophil count(NEU#),absolute lymphocyte count(LY#),neutrophil-lymphocyte ratio(NLR),red blood cell count(RBC),hemoglobin(Hb),platelet count(PLT),mean platelet volume(MPV),platelet distribution width(PDW),and platelet-large contrast ratio(P-LCR)before and after treatment were analyzed.Binary logistic regression analysis is used to establish a mathematical model of the relationship between these indexes and the outcome of severe COVID-19 patients.The receiver operating characteristic(ROC)curve is used to further explore the prognosis value of MPV,P-LCR,NLR separately and jointly in COVID-19 patients.Compare to the control group,WBC and NE#increase(Z=-5.63,P<0.01;Z=-9.19,P<0.01)and LY#decrease(Z=-9.34,P<0.01)in the severe group;NLR increase with the aggravation of the disease,there is significant difference between groups(Z=17.61,P<0.01);PLT,PDW,MPV and P-LCR decrease with the aggravation of the disease,there is significant difference between groups(Z=9.47,P<0.01;Z=11.41,P<0.01;Z=16.76,P<0.01;Z=13.97,P<0.01).Binary logistic regression analysis shows MPV,P-LCR and NLR have predictive value for severe COVID-19 patients.There is a negative correlation between MPV,P-LCR and severe COVID-19 patients(OR=1.004,P=0.034;OR=1.097,P=0.046).There is a positive correlation between NLR and severe COVID-19 patients(OR=1.052,P=0.016).MPV and P-LCR of patients with good prognosis after treatment were significantly higher than those before treatment(Z=-6.47,P<0.01;Z=-5.36,P<0.01).NLR was significantly lower than that before treatment(Z=-8.13,P<0.01).MPV and P-LCR in poor prognosis group were significantly lower than those before treatment(Z=-9.46,P<0.01;Z=-6.81,P<0.01).NLR was significantly higher than that before treatment(Z=-3.24,P<0.01).There were significant differences between good and poor prognosis groups before and after treatment in MPV,P-LCR and NLR(P<0.01).Combination of these three indexes,ROC shows the AUC is 0.931,the sensitivity is 91.5%,the specificity is 94.1%,the positive predictive value is 88.9%,and the negative predictive value is 87.4%,which is better than any of these indexes separately.Changes in these parameters are closely related to clinical stage of COVID-19 patients.MPV,P-LCR and NLR are of great value in the prediction and prognosis of severe COVID-19 patients.