中性粒细胞/淋巴细胞比值对慢性心力衰竭伴呼吸困难患者合并肺炎的诊断价值

Diagnostic value of neutrophil to lymphocyte ratio in patients with chronic heart failure and dyspnea complicated with pneumonia

目的 探讨中性粒细胞/淋巴细胞比值(NLR)对慢性心力衰竭(CHF)伴呼吸困难患者合并肺炎的诊断价值。方法 选取本院2019年1月—2021年12月收治的156例CHF伴呼吸困难患者,经倾向性评分匹配后比较肺炎组和非肺炎组各炎症指标的差异,并利用受试者工作特征曲线(ROC)评价不同指标对CHF伴呼吸困难患者合并肺炎的诊断价值。结果 匹配后,肺炎组的白细胞(WBC)、中性粒细胞计数、NLR、C-反应蛋白(CRP)水平均高于非肺炎组,淋巴细胞水平低于非肺炎组,差异均统计学意义(P<0.05)。ROC曲线分析显示,WBC、中性粒细胞、淋巴细胞、NLR和CRP诊断CHF伴有呼吸困难患者合并肺炎的最佳截断值分别为9.93×10^(9)/L、8.87×10^(9)/L、0.94×10^(9)/L、15.53、60.21 mg/L,其AUC分别为0.678、0.634、0.648、0.881、0.657。NLR的AUC高于其他4个指标(P<0.05)。结论 NLR诊断CHF伴呼吸困难患者合并肺炎的临床价值较高,值得临床推广。

Objective This study aims to evaluate the diagnostic value of neutrophil to lymphocyte ratio(NLR) in patients with chronic heart failure(CHF) and dyspnea complicated with pneumonia. Methods A total of 156 patients with CHF complicated with dyspnea treated in our hospital from January 2019 to December 2021 were selected. After propensity score matching, the differences of inflammatory indexes between pneumonia group and non-pneumonia group were compared, and the diagnostic value of different indexes in patients with CHF complicated with dyspnea and pneumonia was evaluated by receiver operating characteristic curve(ROC). Results After matching, the levels of leukocyte(WBC), neutrophil count, NLR and C-reactive protein(CRP) in pneumonia group were higher than those in non-pneumonia group, and the level of lymphocytes was lower than that in the non-pneumonia group, with the differences statistically significant(P<0.05). According to ROC curve analysis, the best cut-off values of WBC, neutrophils, lymphocytes, NLR and CRP in the diagnosis of CHF patients with dyspnea complicated with pneumonia were 9.93×10^(9)/L, 8.87×10^(9)/L, 0.94×10^(9)/L, 15.53 and 60.21 mg/L respectively, and their AUC were 0.678, 0.634, 0.648, 0.881 and 0.657 respectively. The AUC of NLR was significantly higher than that of the other four indexes(P<0.05). Conclusion NLR has high clinical value in the diagnosis of CHF patients with dyspnea complicated with pneumonia, which is worthy of clinical promotion.