中性粒细胞与淋巴细胞比值诊断Ⅰ型心肾综合征的临床价值

Diagnostic Value of Neutrophil/Lymphocyte Ratio in TypeⅠCardiorenal Syndrome

目的探讨中性粒细胞与淋巴细胞比值(NLR)诊断Ⅰ型心肾综合征的临床价值。方法回顾性分析2012年1月—2019年12月我院急诊重症监护室(ICU)收治的急性心脏功能下降(急性失代偿性心力衰竭、急性冠脉综合征、心源性休克)病人312例,根据2012年全球肾脏病预防组织(KDIGO)标准判断病人是否发生急性肾损伤,并分为对照组和观察组,比较两组NLR水平,绘制受试者工作特征(ROC)曲线分析NLR对Ⅰ型心肾综合征发生的预测价值,并进行二元Logistic回归分析。结果观察组NLR水平高于对照组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示:ROC曲线下面积(AUC)为0.745,灵敏度为62.8%,特异度为77.3%。Logistic回归分析显示:机械通气、脑钠肽、糖尿病、NLR水平升高是Ⅰ型心肾综合征发生的独立危险因素。结论急性心脏功能下降病人NLR升高提示Ⅰ型心肾综合征发生风险增高,NLR可判断急性心脏功能下降后Ⅰ型心肾综合征的发生,并指导临床诊断。

Objective To investigate the diagnostic value of neutrophil/lymphocyte ratio(NLR)in patients with typeⅠcardiorenal syndrome.Methods Three hundred and twelve patients with acute cardiac dysfunction(acute decompensated heart failure,acute coronary syndrome,and cardiogenic shock)were divided into the control group and the observation group according to the 2012 KDIGO criteria.The levels of NLR between two groups were compared.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of NLR for typeⅠcardiorenal syndrome,and binary Logistic regression analysis was performed.Results The level of NLR in observation group was higher than that in control group,and the difference was statistically significant(P<0.05).ROC curve analysis results showed that the area under ROC curve(AUC)was 0.745,the sensitivity was 62.8%,and the specificity was 77.3%.Logistic regression analysis showed that mechanical ventilation,brain natriuretic peptide,diabetes,the increase of NLR were independent risk factors for patients with typeⅠcardiorenal syndrome.Conclusion The increase of NLR in patients with acute cardiac dysfunction could indicate the increased risk of typeⅠcardiorenal syndrome.NLR could be used to indicate the occurrence of typeⅠcardiorenal syndrome after acute heart function decline,which could provide guidance for clinical diagnosis.