慢性肾衰脓毒症患者NLR、CD64及CRP/Alb比值对细菌感染的早期诊断价值

The value of NLR,CD64,CRP/Alb ratio in the early diagnosis of bacterial infection in patients with chronic renal failure and sepsis

目的探讨慢性肾衰脓毒症患者外周血中性粒细胞/淋巴细胞比值(NLR)、簇分化抗原64(CD64)指数、C反应蛋白/白蛋白(CRP/Alb)比值对细菌感染的早期诊断价值。方法选择2019年1月-2021年6月本院收治的慢性肾衰合并脓毒症患者82例作为观察对象,根据患者细菌培养结果分为非细菌感染组35例和细菌感染组47例。采用全自动血细胞分析仪检测血常规,计算NLR;流式细胞仪检测CD64指数;酶联免疫吸附试验(ELISA)检测血清CRP、Alb含量,计算CRP/Alb比值;ROC曲线分析NLR、CD64指数、CRP/Alb比值对慢性肾衰脓毒症患者细菌感染的早期诊断价值。结果细菌感染组患者外周血NLR、CD64指数、CRP/Alb比值分别为7.51±1.83、4.55±1.21、3.21±0.62,显著高于非细菌感染组的4.21±1.32、2.24±0.63、2.34±0.55(均P<0.05);NLR、CD64指数、CRP/Alb比值及其联合诊断慢性肾衰脓毒症患者早期细菌感染的敏感度分别为80.00%、77.14%、71.43%、91.43%,特异度分别为76.60%、78.72%、82.98%、93.62%,曲线下面积分别为0.867、0.827、0.833、0.952,三项指标联合诊断的敏感度与特异度均高于单独指标诊断。结论慢性肾衰脓毒症细菌感染患者外周血NLR、CD64指数、CRP/Alb比值升高,三者联合诊断慢性肾衰脓毒症患者早期细菌感染具有较高的临床应用价值。

Objective To investigate the value of peripheral blood neutrophil-lymphocyte-ratio(NLR),cluster of differentiation antigen 64(CD64)index and C-reactive protein/albumin(CRP/Alb)ratio in the early diagnosis of bacterial infections in patients with chronic renal failure and sepsis.Methods In the period of January 2019 to June 2021,82 patients with chronic renal failure and sepsis admitted to our hospital were selected as observation objects.According to the results of bacterial culture,the patients were divided into 35 cases of non-bacterial infection group and 47 cases of bacterial infection group.Automatic blood cell analyzer was used to determine blood routine and calculate NLR;flow cytometry was used to detect CD64 index;enzyme-linked immunosorbent assay(ELISA)was used to detect serum CRP and Alb contents,and calculate the ratio of CRP/Alb;ROC curve was used to analyze the diagnostic value of NLR,CD64 index,and CRP/Alb ratio for early bacterial infection in patients with chronic renal failure and sepsis.Results The peripheral blood NLR,CD64 index,and CRP/Alb ratio of the bacterial infection group were 7.51±1.83,4.55±1.21,3.21±0.62,respectively,which were significantly higher than the 4.21±1.32,2.24±0.63,2.34±0.55 of the non-bacterial infection group(P<0.05);The sensitivity of NLR,CD64 index,CRP/Alb ratio,and their combined diagnosis for early bacterial infection in patients with chronic renal failure and sepsis were 80.00%,77.14%,71.43%,91.43%,respectively,and the specificities were 76.60%,78.72%,82.98%,93.62%,respectively.the area under the curve were 0.867,0.827,0.833,0.952,respectively.The sensitivity and specificity of the combined diagnosis of the three indicators are higher than those of the single indicator diagnosis.Conclusion The peripheral blood NLR,CD64 index,and CRP/Alb ratio of patients with chronic renal failure and sepsis are elevated.The combination of the three has high value in the diagnosis of early bacterial infections in patients with chronic renal failure and sepsis,and has certain clinical application significance.