SⅡ与d-NLR在诊断成人社区获得性肺炎中的价值

The value of SⅡ and d-NLR in the diagnosis of community-acquired pneumonia in adults

目的探讨全身免疫炎症指数(SⅡ)及衍生中性粒细胞淋巴细胞比值(d-NLR)在诊断成人社区获得性肺炎(CAP)感染革兰阴性细菌与成人CAP感染非革兰阴性细菌中价值,为临床在诊断成人CAP方面提供新的诊断思路。方法回顾性分析2020年1月至2021年12月在衡水市第六人民医院经影像学检查确诊为成人CAP的住院患者174例(CAP组)作为研究对象。根据CAP组感染的细菌种类,将其分为革兰阴性细菌组109例、非细菌组65例;又根据CURB-65评分法将CAP组分为重症组与非重症两组。另选取同期健康体检人群174例作为对照组。利用SPSS26.0及Graphpad prism9.0对结果进行数据统计及作图处理。Spearman相关系数分析指标相关性,二元Logistic回归分析CAP的危险因素,受试者工作特征(ROC)曲线分析SⅡ与d-NLR对CAP的单独及联合诊断效能,以及SⅡ在成人CAP感染革兰阴性细菌中的诊断效能。结果CAP组SⅡ及d-NLR显著高于对照组,差异有统计学意义(P<0.05);革兰阴性细菌组SⅡ显著高于非细菌组,差异有统计学意义(P<0.05)。经Spearman相关分析证明SⅡ与d-NLR均与CAP呈正相关(r=0.678、0.647,P<0.001)。SⅡ与d-NLR联合检测诊断CAP的曲线下面积为0.911,灵敏度及特异度分别为97.13%与81.03%,显著高于单指标检测的诊断价值(P<0.0001)。二元Logistic回归分析显示,SⅡ>2464×10^(9)与性别为男性均为成人CAP感染革兰阴性细菌的独立危险因素。结论SⅡ与d-NLR可以作为成人CAP诊断的参考指标。

Objective To investigate the value of systemic immune-inflammation index(SⅡ)and derived neutrophil lymphocyte ratio(d-NLR)in the diagnosis of gram-negative bacteria in adults with community-acquired pneumonia(CAP)and non-gram-negative bacteria in adults with CAP,and to provide a new diagnostic idea for the diagnosis of CAP in adults.Methods Totally 174 inpatients(CAP group)diagnosed with adult CAP by imaging examination in the Sixth People's Hospital of Hengshui from January 2020 to December 2021 were retrospectively analyzed as subjects.According to the species of bacteria infected in CAP group,109 cases were divided into Gram-negative bacteria group and 65 cases were non-bacterial group.The CAP group was divided into severe group and non-severe group according to CURB-65 score.A total of 174 healthy subjects were selected as control group.SPSS26.0 and Graphpad prism9.0 were used for data statistics and mapping.Spearman correlation coefficient analysis index correlation,the risk factors of CAP were analyzed by binary Logistic regression,and the diagnostic efficacy of SⅡ and d-NLR alone and in combination with CAP were analyzed by receiver operating characteristic(ROC)curve,as well as the diagnostic efficacy of SⅡ in adults infected with Gram-negative bacteria with CAP.Results SⅡ and d-NLR in CAP group were significantly higher than those in control group,the difference was statistically significant(P<0.05).The SⅡ of Gram-negative bacteria group was significantly higher than that of non-bacteria group,and the difference was statistically significant(P<0.05).Spearman correlation analysis showed that SⅡ and d-NLR were positively correlated with CAP(r=0.678,0.647,P<0.001).The combined detection of SⅡ and d-NLR showed an area under the curve of 0.911,and the sensitivity and specificity were 97.13% and 81.03%,respectively,which were significantly higher than the diagnostic value of single index detection(P<0.0001).Binary Logistic regression analysis showed that SⅡ>2464×10^(9) and male were independent risk factors for adult CAP infection with Gram-negative bacteria.Conclusion SⅡ and d-NLR can be used as reference indexes for the diagnosis of adult CAP.