中性粒细胞与淋巴细胞比值及C-反应蛋白在早产儿呼吸机相关性肺炎早期诊断和预后评估中的价值

Value of neutrophil to lymphocyte ratio and C-reactive protein in early diagnosis and prognostic evaluation of ventilator-associated pneumonia in preterm infants

目的 分析联合检测外周血中性粒细胞与淋巴细胞比值(NLR)及C-反应蛋白(CRP)在早产儿呼吸机相关性肺炎(VAP)早期诊断和预后评估中的价值。方法 连续选取2019年1月—2022年6月徐州医科大学附属医院和南京医科大学第四附属医院收治的115例接受机械通气的新生儿,根据是否发生VAP,分为VAP组(33例)和非VAP组(82例)。比较两组新生儿机械通气开始及72 h时NLR、CRP及简化临床肺部感染评分(sCPIS评分),采用受试者工作特征(ROC)曲线分析上述指标对新生儿VAP的诊断效能。比较VAP组治疗7 d时预后不良亚组与预后良好亚组NLR、CRP及sCPIS评分。结果 机械通气72 h时,VAP组NLR、CRP及sCPIS评分[(4.46±0.86)、(10.13±4.79)mg/L、(5.68±1.29)分]均高于非VAP组[(3.04±0.95)、(5.23±2.41)mg/L、(3.32±1.20)分],差异均有统计学意义(t=7.444、5.672、9.368,均P<0.05)。NLR、CRP及sCPIS评分联合诊断新生儿VAP的ROC曲线下面积(AUC)为0.970,95%CI为0.945~0.995,灵敏度为0.971,特异度为0.889。经过7 d治疗,预后不良亚组NLR、CRP及sCPIS评分[(6.14±1.18)、(16.83±5.10)mg/L,(8.38±0.91)分]均显著高于预后良好亚组[(3.81±0.75),(5.97±2.29)mg/L、(3.38±1.35)分],差异均有统计学意义(t=-6.651、-5.842、-9.680,均P<0.05),NLR、CRP均与sCPIS评分均呈正相关(r=0.768、0.739,均P<0.05)。结论 机械通气72 h时,外周血NLR、CRP联合sCPIS评分诊断早产儿VAP的效能较高。动态监测NLR、CRP及sCPIS评分对预后的评估价值较大,值得临床推广应用。

Objective To analyze the value of combined detection of neutrophil to lymphocyte ratio(NLR) and C-reactive protein(CRP) in peripheral blood in early diagnosis and prognostic evaluation of ventilator-associated pneumonia(VAP) in preterm infants.Methods From January 2019 to June 2022,115 neonates with mechanical ventilation admitted to Affiliated Hospital of Xuzhou Medical University and the Fourth Affiliated Hospital of Nanjing Medical University were consecutively selected.According to the occurrence of VAP,the cases were divided into VAP group(33 cases) and non-VAP group(82 cases).NLR,CRP,and simple clinical pulmonary infection score(sCPIS) were compared between the two groups at the beginning and 72 hours of mechanical ventilation.Receiver operating characteristic(ROC) curve was used to analyze the diagnostic efficacies of the above indicators for neonatal VAP.The levels of NLR,CRP,and sCPIS score were compared between poor prognosis subgroup and improved prognosis subgroup at 7 days after treatment in VAP group.Results After 72 hours of mechanical ventilation,the levels of NLR,CRP,and sCPIS score in VAP group [(4.46±0.86),(10.13±4.79) mg/L,and(5.68±1.29) points] were higher than those in non-VAP group [(3.04±0.95),(5.23±2.41) mg/L,and(3.32±1.20) points],the differences were statistically significant(t=7.444,5.672,9.368,all P<0.05).The area under ROC curve of the combined diagnosis of neonatal VAP by NLR,CRP,and sCPIS score was 0.970,95%CI was 0.945-0.995,the sensitivity was 0.971,and the specificity was 0.889.After 7 days of treatment,the levels of NLR,CRP,and sCPIS score in poor prognosis subgroup [(6.14±1.18),(16.83±5.10) mg/L,and(8.38±0.91) points] were significantly higher than those in improved prognosis subgroup [(3.81±0.75),(5.97±2.29) mg/L,and(3.38±1.35)points],the differences were statistically significant(t=-6.651,-5.842,-9.680,all P<0.05).NLR and CRP were positively correlated with sCPIS score(r=0.768,0.739,both P<0.05).Conclusion The combined detection of peripheral blood NLR,CRP,combined with sCPIS score at 72 hours of mechanical ventilation has high efficacy in diagnosis of VAP in preterm infants,dynamic monitoring of NLR,CRP,and sCPIS score has great prognostic value,which is worthy of clinical application.