NLR与老年吸入性肺炎严重程度及预后的相关性研究

Correlation of NLR with Aspiration Pneumonia Severity and Prognosis in Elderly Patients

目的:研究中性粒细胞/淋巴细胞比值(NLR)与白细胞计数(WBC)不升高的老年吸入性肺炎严重程度及预后的相关性。方法:选取2018年9月-2021年9月在中国人民解放军联勤保障部队第九二四医院就诊WBC不升高的老年肺炎患者110例,按照有无误吸史分为吸入性肺炎组和非吸入性肺炎组各55例,收集两组患者入院2 h内C反应蛋白(CRP)、降钙素原(PCT)、淋巴细胞亚群、WBC、中性粒细胞数量(N)、淋巴细胞数量(L)等,计算NLR,入院6 h内完成胸部影像学检查、肺炎严重程度评分(PSI)。将吸入性肺炎患者病情严重程度根据PSI分为死亡低风险者和死亡中高风险者,随访30 d,记录病情转归为好转或恶化。结果:吸入性肺炎组N、NLR、CRP水平及CD3^(+)CD8^(+)T抑制细胞比例高于非吸入性肺炎组,而CD3-CD19^(+)B淋巴细胞比例低于非吸入性肺炎组,差异有统计学意义(P<0.05)。吸入性肺炎组CD3^(+)CD8^(+)T抑制细胞比例高于非吸入性肺炎组,而CD3-CD19^(+)B淋巴细胞比例低于非吸入性肺炎组,差异有统计学意义(P<0.05)。吸入性肺炎死亡低风险患者与中高风险患者WBC、N、L、NLR、CRP及PCT比较,差异均无统计学意义(P>0.05)。吸入性肺炎病情恶化患者NLR显著高于好转患者,差异有统计学意义(P<0.05)。结论:WBC不升高的老年吸入性肺炎患者入院时NLR水平较高,且与病情预后密切相关。

Objective:To investigate the correlation between neutrophil/lymphocyte ratio(NLR)and the severity and prognosis of aspiration pneumonia in elderly patients without elevated white blood cell count(WBC).Methods:From September 2018 to September 2021,110 elderly patients with pneumonia and without elevated WBC who were treated in the No.924 Hospital of Chinese PLA Joint Logistics Support Force were selected.They were divided into the aspiration pneumonia group and non aspiration pneumonia group according to the history of aspiration,with 55 cases in each group.C-reactive protein(CRP),procalcitonin(PCT),lymphocyte subsets,WBC,number of neutrophils(N)and number of lymphocytes(L)within 2 hours after admission were collected from the two groups.NLR was calculated,the chest imaging examination and pneumonia severity score(PSI)were completed within 6 hours after admission.The patients with aspiration pneumonia were divided into those with low risk of death and those with medium and high risk of death according to the severity of the disease.The patients were followed up for 30 days,and the disease outcomes were recorded as improved or worsened.Results:The levels of N,NLR,CRP and the proportion of CD3^(+)CD8^(+)T suppressor cells in the aspiration pneumonia group were higher than those in the non-aspiration pneumonia group,while the proportion of CD3-CD19^(+)B lymphocytes was lower than that in the non-aspiration pneumonia group(P<0.05).The proportions of CD3^(+)and CD8^(+)T suppressor cells in the aspiration pneumonia group were higher than those in the non-aspiration pneumonia group,while the proportions of CD3-and CD19^(+)B lymphocytes were lower than those in the non-aspiration pneumonia group,and the difference was statistically significant(P<0.05).There was no significant difference in WBC,N,L,NLR,CRP and PCT between aspiration pneumonia patients with low risk of death and with medium and high risk(P>0.05).The NLR of aspiration pneumonia patients with worsening was significantly higher than that of patients with improvement,and the difference was statistically significant(P<0.05).Conclusion:Elderly patients with aspiration pneumonia without elevated WBC have higher NLR levels at admission,which are closely related to the prognosis of the disease.