单核细胞与淋巴细胞比值与社区获得性肺炎严重程度评分的关系

Relationship between monocyte to lymphocyte ratio and score for disease severity in patients with community-acquired pneumonia

目的探讨单核细胞与淋巴细胞比值(MLR)和社区获得性肺炎严重程度评分(CURB-65)之间的关系。方法回顾性分析安徽省第二人民医院2018年1月至2019年4月收治的82例社区获得性肺炎(CAP)病人、40例健康受试者的临床资料和实验室指标结果,根据CURB-65评分系统将82例CAP分为低危CAP组42例和中高危CAP组40例。采用希森美康全自动血细胞分析仪XT-4000i和全自动凝血分析仪CS-5100、日立全自动生化仪008AS检测各项实验室指标,采用回归和相关分析MLR与白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、纤维蛋白原(FIB)和CURB-65评分的相关性,采用ROC曲线比较MLR、单核细胞计数(M)曲线下面积(AUC)评估其在预测CAP是否严重诊断中的预测效能。结果研究发现CAP病人的MLR(0.67±0.63)高于健康对照组(0.17±0.05)(P<0.05);低危CAP病人的MLR(0.45±0.29)高于对照组(0.17±0.05)(P<0.05),与低危CAP病人MLR(0.45±0.29)相比,中高危CAP病人的MLR(0.90±0.79)进一步升高(P<0.05);MLR与WBC、hs-CRP、FIB及CURB-65评分呈正相关(P<0.05);预测CAP严重的ROC曲线中,MLR的AUC大于M;MLR与CAP严重风险提高相关(OR=23.206,95%CI:1.339-402.275,P=0.031);结论MLR可能是评估CAP严重程度的新的炎症标志物,其快速、廉价、简便,值得临床推广应用。

Objective To investigate the relationship between monocyte to lymphocyte ratio(MLR)and community-acquired pneumonia severity score(CURB-65).Methods Clinical data and laboratory indicators of 82 patients with community-acquired pneumonia(CAP)and 40 healthy subjects admitted to Anhui No.2 Provincial People’s Hospital from January 2018 to April 2019 were analyzed retrospectively.Eighty-two patients with CAP were assigned into two groups according to the CURB-65 scoring system:the low-risk CAP group(42 cases)and the medium-high-risk CAP group(40 cases).The automatic blood cell analyzer XT-4000 i and automatic blood coagulation analyzer CS-5100 of SYSMEX,the automatic biochemical analyzer 008 AS of HITACHI were employed to detect laboratory indicators.Regression and correlation analysis were used to analyze the correlation among MLR,WBC,hs-CRP,FIB and CURB-65.The predictive efficacy of MLR,M in the diagnosis of severity of CAP was evaluated by comparing the area under the curve(AUC)of ROC curve.Results MLR(0.67±0.63)in patients with CAP were higher than that in the normal control group(0.17±0.05)(P<0.05).MLR(0.45±0.29)in patients with low-risk CAP were higher than that in the normal control group(0.17±0.05)(P<0.05).MLR(0.90±0.79)in patients with medium-high-risk CAP were further increased than that in patients with low-risk CAP(0.45±0.29)(P<0.05).MLR were positively correlated with WBC,hs-CRP,FIB and CURB-65 scores(P<0.05).In the receiver operating characteristic(ROC)curve for predicting severe CAP,the area under the curve(AUC)of MLR was greater than M.MLR was also an independent risk factor for severe CAP(OR=23.206,95%CI:1.339-402.275,P=0.031).Conclusion MLR,which may be a inflammatory markers that can be used to evaluate the severity of CAP,are rapidly detected,inexpensive and simple,and worthy of clinical application.