外周血NLR、nCD64在HBV相关ACLF继发感染和短期预后中的诊断及预测价值

The value of peripheral blood neutrophil to lymphocyte ratio and neutrophil CD64 in diagnosing secondary infection and predicting short-term prognosis of patients with hepatitis B virus-related chronic and acute liver failure

目的探讨外周血中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞CD64(nCD64)在乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)继发感染和短期预后中的诊断及预测价值。方法回顾性分析2018年7月至2020年7月承德医学院附属医院收治的85例HBV-ACLF患者临床资料,根据是否继发感染分为感染组45例及非感染组40例;根据治疗3个月后的短期预后将感染组患者分为好转组(29例)及未好转组(16例)。采集所有患者入院24 h内的外周血检测NLR、nCD64水平。采用受试者工作特征曲线分析外周血NLR、nCD64联合检测对HBV-ACLF继发感染的诊断价值及短期预后预测价值。结果感染组患者外周血NLR为(10.33±3.16)%、nCD64为(74.41±19.06)%,均高于非感染组患者的(6.53±1.14)%和(43.49±13.27)%,差异均有统计学意义(t=7.197、8.575,均P<0.01)。ROC曲线显示,外周血NLR、nCD64对HBV-ACLF继发感染具有一定诊断价值(AUC=0.756、0.789,P<0.01),且两项联合(AUC=0.837,P<0.01)诊断价值较高。好转组患者外周血NLR为(9.24±2.46)%、nCD64为(72.67±15.71)%,明显低于未好转组患者的(11.54±3.11)%和(85.89±12.43)%,差异有统计学意义(t=2.731、2.898,P=0.009、0.006)。ROC曲线显示,外周血NLR、nCD64对HBV-ACLF继发感染短期预后具有一定预测价值(AUC=0.784、0.765,P<0.01),且两项联合(AUC=0.823,P<0.01)预测价值较高。结论外周血NLR、nCD64可作为HBV-ACLF继发感染的诊断及评估短期预后的指标,且两项联合检测价值更高。

Objective To explore the diagnostic and predictive value of peripheral blood neutrophil to lymphocyte ratio(NLR)and neutrophil CD64(nCD64)in the secondary infection and short-term prognosis of hepatitis B virus-related chronic and acute liver failure(HBV-ACLF).Methods The clinical data of 85 HBV-ACLF patients admitted between July 2018 and July 2020 was retrospective analyzed.They were divided into an infected group(45 cases)and a non-infected group(40 cases)according to whether they had secondary infection.Patients in the infected group were further divided into an improved group(29 cases)and a non-improved group(16 cases)based on the short-term prognosis of them after 3 months’treatment.The peripheral blood samples of all patients within 24 hours after admission were collected to detect the levels of NLR and nCD64.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value and short-term prognostic value of the combined detection of peripheral blood NLR and nCD64 for secondary infection in HBV-ACLF patients.Results The levels of peripheral blood NLR[(10.33±3.16)%]and nCD64[(74.41±19.06)%]in the infected group were significantly higher than those in the non-infected group[(6.53±1.14)%vs(43.49±13.27)%],The difference was statistically significant(P<0.05).ROC curve shows that peripheral blood NLR and nCD64 have a certain diagnostic value for secondary infection in HBV-ACLF patients(AUC=0.756,0.789,P<0.01),and the combination of the two(AUC=0.837,P<0.01)has a higher diagnostic value.The peripheral blood NLR[(9.24±2.46)%]and nCD64[(72.67±15.71)%]levels of HBV-ACLF patients in the improved group were significantly lower than those in the non-improved group[(11.54±3.11)%vs(85.89±12.43)%],The difference was statistically significant(P<0.05).ROC curve shows that peripheral blood NLR and nCD64 have a certain predictive value for the short-term prognosis of secondary infection in HBV-ACLF patients(AUC=0.784,0.765,P<0.01),and the combination of the two(AUC=0.823,P<0.01)has a higher predictive value.Conclusion Peripheral blood NLR and nCD64 can be used as indicators for the diagnosis of secondary infection in HBV-ACLF patients,and for the assessment of their short-term prognosis,and the efficacy is higher with a combined detection.