PCT与NLR对脓毒症患者心肌损伤的诊断及预后预测价值分析

Diagnosis and prognostic value of PCT and NLR of myocardial injury in patients with sepsis

目的 探究分析降钙素原(PCT)与和外周血中性粒细胞与淋巴细胞比值(Neutrophil to lymphocyte ratio, NLR)对脓毒症患者心肌损伤的诊断及预后预测价值。方法 选取于2020年1月至2023年1月在郑州大学第一附属医院重症医学科就诊的脓毒症患者96例作为研究对象,根据心肌肌钙蛋白I(cTn-I)水平将患者纳入心肌损伤组(51例)和心肌正常组(45例)。在患者治疗前检测PCT及NLR指标,治疗期间对所有患者进行脓毒症原发病处理,治疗28d后对所有患者进行复诊,检测患者相应指标。根据心肌损伤组患者的生存状况将患者分为生存组及死亡组,采用Pearson相关性分析脓毒症患者心肌损伤预后结果与PCT、NLR的相关性,并通过绘制受试者工作曲线(ROC)曲线分析各指标预测脓毒症患者心肌损伤的效能。结果 心肌损伤组的PCT、NLR水平均明显高于心肌正常组,差异具有统计学意义(P<0.05);心肌损伤组不同预后患者的PCT、NLR指标之间差异均显著(P<0.05),PCT、NLR与水平脓毒症患者心肌损伤预后结果均呈非常显著的正相关性(P<0.05)。ROC分析结果显示,PCT与NLR及联合指标预测脓毒症患者心肌损伤的ROC曲线下面积AUC分别为0.870、0.840、0.913。其中PCT指标的灵敏度和特异度分别为82.4%、77.8%;NLR指标的灵敏度和特异度分别为98%、53.3%;两项指标联合后的灵敏度和特异度分别为80.4%、91.1%。PCT与NLR预测脓毒症患者心肌损伤的效能可观,且两项联合指标预测脓毒症患者心肌损伤的价值更高。结论 PCT与NLR对脓毒症患者心肌损伤的诊断及预后预测均有较高的准确性,有较高的推广价值。

Objective To explore the predictive value of procalcitonin(PCT)and Neutrophil to lymphocyte ratio in the diagnosis and prognosis of myocardial injury in patients with sepsis.Methods Ninety-six cases of sepsis patients who were admitted to the Intensive Care Unit of our hospital from January 2020 to January 2023,they were included in the myocardial injury group(51 patients)and normal group(45 patients)based on cardiac troponin I(cTn-I).PCT and NLR indexes were measured before treatment,all patients were treated with sepsis primary disease during treatment,and all patients were re-diagnosed after 28 days of treatment,and corresponding indexes were measured.According to the survival status of patients with myocardial injury,patients were divided into survival group and death group.Pearson correlation analysis was used to analyze the correlation between prognosis of myocardial injury and PCT,NLR in patients with sepsis.Results The mean value of PCT and NLR in myocardial injury group was significantly higher than that in normal group(P<0.05),and the mean value of PCT and NLR in myocardial injury group was significantly higher than that in normal group(P<0.05).The results of ROC analysis showed that the AUC under the ROC curve of PCT,NLR and combination index were 0.870,0.840 and 0.913,respectively.The sensitivity and specificity of PCT were 82.4%and 77.8%,that of NLR were 98%and 53.3%,and that of NLR were 80.4%and 91.1%.The efficacy of PCT and NLR in predicting myocardial injury in patientswithsepsisis considerable,and thetwocombined indices are more valuable in predicting myocardial injury in patients with sepsis.Conclusion PCTandNLRhave high accuracy in the diagnosis and prognosis of myocardial injury in patients with sepsis.