急性生理与慢性健康评估评分联合中性粒细胞/淋巴细胞比值、高迁移率族蛋白B1检测在评估老年重症肺炎患者预后中的价值

The value of APACHE score combined with NLR and HMGB1 in evaluating the prognosis of elderly patients with severe pneumonia

目的研究急性生理与慢性健康评估评分(APACHE评分)、中性粒细胞/淋巴细胞比值(NLR)和高迁移率族蛋白B1(HMGB1)水平在老年重症肺炎患者中的意义及预后判断价值。方法回顾性分析2017年1月-2019年12月来本院呼吸科治疗的老年重症肺炎患者148例,根据预后情况分为预后良好组116例和预后不良组32例,记录比较分析2组研究对象APACHE评分、NLR和HMGB1水平,以ROC曲线分析3组指标对预测重症肺炎患者预后的诊断价值。结果预后不良组重症肺炎患者的APACHE评分、NLR和HMGB1均明显高于预后良好组(P <0.01),差异有统计学意义(P <0.01)。Pearson相关分析结果显示,重症肺炎患者NLR和HMGB1水平与APACHEⅡ评分均呈正相关(P <0.05)。Logicstics回归分析显示,APACHE评分≥21分、HMGB1≥4.25 ng/ml和NLR≥3.96是重症肺炎患者预后不良的高危因素(P <0.05)。NLR、HMGB1和APACHE评分评估预测重症肺炎患者预后的敏感度分别为0.664、0.586、0.767,特异度分别为0.694、0.823、0.806,当联合应用NLR、IL-6及PCT 3项指标,诊断的灵敏度上升为0.836,特异度为0.742,ROC曲线下面积(AUC)升高为0.853,诊断效率均优于单一指标。结论 APACHE评分、NLR和HMGB1与重症肺炎患者病情严重程度密切相关,可以用来评估患者预后,联合应用可以提高对重症肺炎患者预后的诊断价值。

Objective To study the significance of acute physiology and chronic health assessment score( APACHE score),neutrophil/lymphocyte ratio( NLR) and high mobility group protein B1( HMGB1) levels in elderly patients with severe pneumonia and their prognostic value. Methods A retrospective analysis of 148 elderly patients with severe pneumonia who came to our hospital’s respiratory department for treatment from January 2017 to December 2019 were divided into two groups according to the prognosis: 116 cases in favourable prognosis group and 32 cases in poor prognosis group. The study subjects’ APACHE score,NLR and HMGB1 levels were used to analyze the diagnostic value of the three groups of indicators in predicting the prognosis of patients with severe pneumonia by ROC curve. Results The APACHE score,NLR and HMGB1 of patients with severe pneumonia in the poor prognosis group were significantly higher than those in the good prognosis group( P < 0. 01),and the difference was statistically significant( P < 0. 01). The results of Pearson correlation analysis showed that the levels of NLR and HMGB1 in patients with severe pneumonia were positively correlated with APACHEⅡ score( P < 0. 05). Logistics regression analysis showed that APACHE score≥21 points,HMGB1≥4. 25 ng/ml and NLR≥3. 96 were high risk factors for poor prognosis in patients with severe pneumonia( P < 0. 05). The sensitivities of NLR,HMGB1 and APACHE scores to predict the prognosis of patients with severe pneumonia are 0. 664,0. 586,0. 767,respectively,and the specificities are 0. 694,0. 823,0. 806,respectively. When the three indicators of NLR,IL-6 and PCT are combined,the sensitivity of diagnosis increased to0. 836,the specificity was 0. 742,the area under the ROC curve( AUC) increased to 0. 853,and the diagnostic efficiency was better than a single index. Conclusion The APACHE score,NLR and HMGB 1 are closely related to the severity of patients with severe pneumonia,and can be used to assess the prognosis of patients. The combined application of the three can improve the diagnostic value of the prognosis of patients with severe pneumonia.