早期中性粒细胞/淋巴细胞与血小板比值对发热伴血小板减少综合征患者病情及预后判断的价值分析

The prognostic value of neutrophils to lymphocytes and platelets ratio in patients with severe fever with thrombocytopenia syndrome

目的研究早期中性粒细胞/淋巴细胞与血小板比值(N/LP)在发热伴血小板减少综合征(SFTS)成人患者中对疾病严重程度及预后的影响。方法回顾性分析2020年5月至2021年6月于安徽医科大学第二附属医院住院治疗的SFTS成人患者38例的临床资料。比较轻症组(n=23)和重症组(n=15)患者的基线资料差异,分析相关的危险因素,采用ROC曲线计算N/LP最佳临界值。结果重症组患者较轻症组SFTS患者的年龄大、热程长、入住ICU风险高(P<0.05)。在临床症状方面,重症组患者较症型组易出现肝损伤、急性胰腺炎(P<0.05),并且特别容易出现中毒性脑病、心肌损伤以及肺部感染(P<0.01)。N/LP预测患者病情严重程度的曲线下面积(AUC)较大,为0.745,最佳临界值为5.57,其敏感度为78.3%,特异度为73.3%。当N/LP>5.57时,可判别为重症SFTS患者,而当N/LP≤5.57时,可判别为轻症SFTS患者(P<0.05)。而且当N/LP>5.57时,重症患者的存活率显著下降(P<0.01)。结论SFTS患者早期N/LP的升高与病情严重程度及不良预后相关。

Objective To analyze the potential role and prognostic value of neutrophils to lymphocytes and platelets ratio(N/LP)at an early stage in patients with severe fever with thrombocytopenia syndrome(SFTS).Methods A Total of 38 adult SFTS patients hospitalized in the Second Affiliated Hospital of Anhui Medical University from May 2020 to June 2021 was retrospectively analyzed.Baseline characteristics between the mild group(n=23)and the severe group(n=15)were compared to analyze the related risk factors,and the optimal threshold of N/LP was calculated by ROC curve.Results Compared with mild SFTS group,patients in severe group had older age,longer heat duration and higher risk of admission to ICU(P<0.05).In terms of clinical symptoms,SFTS patients in severe group were susceptible to liver injury,acute pancreatitis(P<0.05),more prone to toxic encephalopathy,myocardial injury and pulmonary infection(P<0.01)than those in mild group.The cut-off value of N/LP was 5.57[sensitivity:78.3%,specificity:73.3%,and area under the curve(AUC):0.745].When N/LP>5.57,severe SFTS could be identified,while those could be identified in mild group.When N/LP>5.57,the survival rate of severe patients decreased significantly(P<0.01).Conclusion The elevation of N/LP in early SFTS patients is related to the severity of disease and poor prognosis.