血浆相关指标及联合检测在病毒性肺炎早期诊断中的临床价值

Clinical value of plasma related indicators alone and joint detection in early diagnosis of viral pneumonia

目的 探究血浆相关指标:中性粒细胞/血小板与淋巴细胞比值(NLR、PLR)、淋巴细胞与单核细胞比值(LMR)及联合检测在病毒性肺炎早期诊断中的临床价值。方法 选取2020年4月至2023年4月首都医科大学大兴教学医院收治的病毒性肺炎、细菌性肺炎患者各55例作为研究对象,分别纳入病毒性肺炎组与细菌性肺炎组,对照组选取同期体检健康者(n=110),比较三组NLR、PLR、LMR,并统计肺炎组患者临床指标,分析上述指标与病毒性肺炎的关系并对三者及联合在病毒性肺炎中的早期诊断价值进行探究。结果 三组NLR、PLR比较结果:细菌性肺炎组>病毒性肺炎组>对照组,LMR比较结果细菌性肺炎组<病毒性肺炎组<对照组,差异有统计学意义(F=54.911、69.849、685.249,P<0.05);病毒性肺炎组C反应蛋白(CRP)、中性粒细胞计数(N)、单核细胞计数(M)均低于细菌性肺炎组,差异有统计学意义(t=8.808、1.426、10.401,P<0.05);两组血压、呼吸频率、脉搏、血氧饱和度、白细胞计数(WBC)、淋巴细胞计数(L)、血小板(PLT)、尿素氮比较,差异无统计学意义(P>0.05);回归分析结果显示:NLR、PLR、LMR与病毒性肺炎有关;NLR、PLR、LMR诊断病毒性肺炎时,以LMR的曲线下面积值(AUC)值最高,为0.968,敏感度、特异度分别为87.27%与96.36%,NLR、PLR的AUC分别为0.809、0.754,联合后的AUC为0.691,敏感度提升为100.00%,特异度为38.18%。结论 病毒性肺炎患者NLR、PLR异常升高、LMR异常降低,三者及联合均可作为病毒性肺炎的诊断指标,其中LMR效能最佳,联合诊断提升敏感度,值得临床推广。

Objective To investigate the clinical value of plasma related indicators(neutrophil to lymphocyte ratio,NLR;platelet to lymphocyte ratio,PLR;lymphocyte to monocyte ratio,LMR)alone and joint detection in early diagnosis of viral pneumonia.Methods 55 patients with viral pneumonia and 55 pa-tients with bacterial pneumonia who were admitted to Daxing Teaching Hospital,Capital Medical University from April 2020 to April 2023 were selected as the research subjects.Meanwhile,110 healthy individuals were selected as the control group.NLR,PLR and LMR in the three groups were comparatively analyzed.Clinical indicators in patients with pneumonia were analyzed.The relationship between above-mentioned indicators and viral pneumonia,and the value of the three alone and their combination in early diagnosis of viral pneumonia were discussed.Results NLR,PLR and LMR in the three groups were significantly different.NLR and PLR decreased in sequence,and LMR increased in sequence from the bacterial pneumonia group,the viral pneumo-nia group to the control group(F=54.911,69.849,685.249,P<0.05).CRP(C-reactive protein),N(neutro-phil)and M(monocyte)were lower in the viral pneumonia group when compared with those in the bacterial pneumonia group,with statistically significant differences(t=8.808,1.426,10.401,P<0.05).Blood pres-sure,respiratory rate,pulse,oxygen saturation,WBC(white blood cell count),L(lymphocyte),PLT(platelet)and urea nitrogen showed no statistically significant difference between the two groups(P>0.05).Regression analysis found that NLR,PLR and LMR were associated with viral pneumonia.For single diagno-sis of viral pneumonia,the AUC value of LMR was the highest(0.968).Its diagnostic sensitivity and specific-ity were 87.27%and 96.36%.The AUC values of NLR and PLR were 0.809 and 0.754.The AUC,sensitivity and specificity of combination of the three were 0.691,100.00%and 38.18%.Conclusion Patients with viral pneumonia have abnormally increased NLR and PLR,and abnormally decreased LMR.The three and their combination can be used for diagnosing viral pneumonia,and LMR has the best diagnostic performance.Com-bined diagnosis with the three indicators can improve the sensitivity.