NLR和血清IL-6水平与重症肺炎患者病情严重程度及预后的关系

Correlation of neutrophil-to-lymphocyte ratio and serum interleukin-6 level with severity and prognosis of severe pneumonia in patients

目的探讨中性粒细胞/淋巴细胞比值(NLR)和血清白细胞介素6(IL-6)水平与重症肺炎患者病情严重程度及预后的关系。方法选取丽水市第二人民医院重症监护病房(ICU)2021年1月至2023年6月收治的重症肺炎患者158例的临床资料进行回顾性分析,设为病例组,依据入院时急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分将病例组分为低危组(n=67)、中危组(n=52)、高危组(n=39),再根据患者28 d生存情况分为生存组(n=125)和死亡组(n=33),选取该院同期健康体检者51例设为对照组,对比NLR和血清IL-6水平;采用Pearson分析NLR、IL-6与APACHEⅡ评分的相关性;采用多因素Cox风险回归分析NLR、IL-6对重症肺炎患者预后的影响;采用logistic回归模型建立NLR、IL-6两项联合预测重症肺炎患者预后模型;绘制受试者工作特征(ROC)曲线分析NLR、IL-6及两项联合预测重症肺炎患者预后的曲线下面积(AUC)、灵敏度、特异度。结果病例组NLR、IL-6分别为(8.38±5.16)、(116.08±45.95)ng/L,均高于对照组的(1.06±0.35)、(41.25±10.05)ng/L(t=10.11、11.52,均P<0.001)。高危组NLR、IL-6、APACHEⅡ评分分别为(15.52±4.69)、(159.74±58.63)ng/L、(26.88±5.47)分,均高于低危组的(4.62±1.08)、(86.45±14.47)ng/L、(7.58±1.45)分和中危组的(7.86±2.47)、(121.52±32.05)ng/L、(16.85±3.14)分(t_(高危组与低危组)=16.22、8.68、24.37,t_(高危组与中危组)=10.07、3.98、11.03,均P<0.05)。Pearson相关性分析显示,NLR、IL-6与APACHEⅡ评分均呈正相关(r=0.827、0.873,均P<0.05)。死亡组NLR、IL-6分别为(11.83±6.39)、(144.68±64.62)ng/L,均高于生存组的(7.46±4.37)、(108.53±36.34)ng/L(t=4.60、4.23,均P<0.05)。多因素Cox风险回归分析显示,NLR、IL-6水平升高均是影响重症肺炎患者预后的风险因素(均P<0.05)。ROC曲线分析显示,NLR、IL-6及两项联合预测重症肺炎患者预后的AUC分别为0.702、0.664、0.881,两项联合的AUC均大于NLR、IL-6单独检测(Z=2.77、3.15,均P<0.05)。结论重症肺炎患者NLR和IL-6水平呈异常升高趋势,其水平会随病情严重程度而改变,同时会对患者预后产生影响。

Objective To correlate neutrophil/lymphocyte ratio(NLR)and serum interleukin-6(IL-6)level with severity and prognosis of severe pneumonia in patients.MethodsThe clinical data of 158 patients with severe pneumonia who received treatment in the Intensive Care Unit of The Second People's Hospital of Lishui from January 2021 to June 2023 were retrospectively analyzed.These 158 patients constituted the case group.Based on their Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores at admission,the patients were categorized into low-risk(n=67),medium-risk(n=52),and high-risk(n=39)groups.Additionally,they were further divided into a survival group(n=125)and a death group(n=33)according to their survival status at 28 days post-admission.Fifty-one healthy individuals who underwent physical examinations at the same hospital during the same period were included in the control group.The NLR and IL-6 levels were compared among the groups.Pearson correlation analysis was conducted to analyze the correlation of NLR and IL-6 levels with the APACHEⅡscore.Multivariate Cox regression analysis was performed to evaluate the effects of NLR and IL-6 levels on the prognosis of severe pneumonia.A logistic regression model was developed to create a prediction model for the prognosis of these patients based on NLR and IL-6 levels.Receiver operating characteristic curves were generated to assess the area under the curve(AUC),sensitivity,and specificity of NLR,IL-6,and their combination in predicting the prognosis of patients with severe pneumonia.Results In the case group,the NLR and IL-6 levels were(8.38±5.16)and(116.08±45.95)ng/L,respectively,both of which were significantly higher than those in the control group[(1.06±0.35),(41.25±10.05)ng/L,t=10.11,11.52,both P<0.001].In the high-risk group,the NLR,IL-6,and APACHEⅡscores were(15.52±4.69),(159.74±58.63)ng/L,and(26.88±5.47)points,respectively,all of which were significantly higher than those in the low-risk group[(4.62±1.08),(86.45±14.47)ng/L,(7.58±1.45)points,t_(high-risk group vs.low-risk group)=16.22,8.68,24.37,all P<0.05]and medium-risk group[(7.86±2.47),(121.52±32.05)ng/L,(16.85±3.14)points,t_(high-risk group vs.medium-risk group)=10.07,3.98,11.03,all P<0.05].Pearson correlation analysis indicated that both NLR and IL-6 were positively correlated with the APACHEⅡscore(r=0.827,0.873,both P<0.05).In the death group,the NLR and IL-6 levels were(11.83±6.39)and(144.68±64.62)ng/L,respectively,which were significantly higher than those in the survival group[(7.46±4.37),(108.53±36.34)ng/L,t=4.60,4.23,both P<0.05].Multivariate Cox regression analysis demonstrated that elevated levels of NLR and IL-6 were significant risk factors affecting the prognosis of patients with severe pneumonia(both P<0.05).Receiver operating characteristic curve analysis revealed that the AUC for NLR,IL-6,and their combination in predicting the prognosis of severe pneumonia patients were 0.702,0.664,and 0.881,respectively.The AUC for the combination was significantly greater than that for NLR or IL-6 alone(Z=2.77,3.15,both P<0.05).Conclusion NLR and IL-6 levels are abnormally elevated in patients with severe pneumonia,and their levels change with the severity of the disease and affect the prognosis of patients.