NLR对急性胰腺炎患者病情严重程度及肝损伤风险的预测价值

Predictive value of NLR in severity and risk of liver injury in patients with acute pancreatitis

目的探讨中性粒细胞/淋巴细胞比值(NLR)对急性胰腺炎(AP)患者病情严重程度及发生肝损伤的预测价值。方法回顾性分析92例AP患者的临床资料。根据病情严重程度分组(重症组8例、中度组34例、轻症组50例),比较3组的一般情况、不同时间点的NLR值、白细胞计数等指标。比较肝损伤组、无肝损伤组的NLR值变化,绘制ROC曲线分析NLR对病情严重程度及肝损伤的预测效能。结果3组的WBC、中性粒细胞计数、入院即刻NLR、入院48 h NLR及淋巴细胞计数比较,差异均有统计学意义(P<0.05)。重症组入院即刻NLR显著高于中度组[15.24(8.01)比11.20(4.96),P<0.05],中度组与重症组的WBC[(14.26±4.39)×10^(9)/L比(15.32±5.79)×10^(9)/L]、中性粒细胞计数[11.96(5.24)×10^(9)/L比13.05(5.70)×10^(9)/L]、淋巴细胞计数[1.08(0.98)×10^(9)/L比0.85(0.32)×10^(9)/L]及入院48 h NLR[7.82(4.66)比8.21(6.54)]水平比较差异无统计学意义(P>0.05)。肝损伤组的WBC[(16.32±4.63)×10^(9)/L比(11.83±3.56)×10^(9)/L]、中性粒细胞计数[13.30(8.20)×10^(9)/L比9.36(4.56)×10^(9)/L]、入院即刻NLR[16.12(7.02)比6.54(3.96)]、入院48 h NLR[8.26(5.01)比8.26(5.01)]均显著高于无肝损伤组,淋巴细胞计数[0.84(0.25)×10^(9)/L比1.40(1.01)×10^(9)/L]显著低于无肝损伤组(P<0.05)。ROC曲线分析显示,入院即刻NLR对非轻症AP、并发肝损伤的预测效能最高(AUC=0.845、0.877,最佳截断值7.85、10.67),入院48 h NLR的预测效能次之(AUC=0.831、0.821,最佳截断值4.78、5.92)。结论中性粒细胞、淋巴细胞水平与AP病情严重程度及肝损伤的发生密切相关,监测患者入院时的NLR值对AP严重程度及并发肝损伤有较高的预测准确性。

Objective To investigate the predictive value of neutrophil/lymphocyte ratio(NLR)in the severity of acute pancreatitis(AP)and liver injury.Methods The clinical data of 92 patients with AP were collected and analyzed retrospectively.They were divided into severe,moderate and mild group according to the severity of the disease,and the general situation,NLR value and leukocyte count of the three groups at different time points were compared.According to whether there was liver injury(liver injury group and no liver injury group),we compared the changes of NLR value between the two groups,drew ROC curve,and analyzed the prediction efficiency of NLR on the severity of the disease and liver injury.Results There were significant differences in white blood cell(WBC),neutrophil count,NLR immediately after admission,NLR 48h after admission and lymphocyte count among the three groups(P<0.05).NLR immediately after admission in severe group was significantly higher than that in moderate group[15.24(8.01)vs 11.20(4.96),P<0.05].There were no significant difference in WBC[(14.26±4.39)×10^(9)/L vs(15.32±5.79)×10^(9)/L],neutrophil count[11.96(5.24)×10^(9)/L vs 13.05(5.70)×10^(9)/L],lymphocyte count[1.08(0.98)×10^(9)/L vs 0.85(0.32)×10^(9)/L]and NLR 48h after admission[7.82(4.66)vs 8.21(6.54)]between moderate group and severe group(P>0.05).Compared with the non liver injury group,the WBC[(16.32±4.63)×10^(9)/L vs(11.83±3.56)×10^(9)/L],neutrophil count[13.30(8.20)×10^(9)/L vs 9.36(4.56)×10^(9)/L],NLR immediately after admission[16.12(7.02)vs 6.54(3.96)]and NLR 48 h after admission[8.26(5.01)vs 8.26(5.01)]in the liver injury group were higher,and the lymphocyte count was lower[0.84(0.25)×10^(9)/L vs 1.40(1.01)×10^(9)/L,P<0.05].ROC curve analysis showed that NLR had the highest predictive efficacy for non mild AP and liver injury immediately after admission(AUC=0.845,0.877,the best cut-off values were 7.85 and 10.67),followed by NLR for 48 hours after admission(AUC=0.831,0.821,the best cut-off values were 4.78 and 5.92).Conclusion The levels of neutrophils and lymphocytes are closely related to the severity of AP and the occurrence of liver injury.Monitoring the NLR value at admission has high prediction accuracy for the severity of AP and liver injury.