肺部超声评分联合Lac、NLR对重症肺部感染患者治疗效果及预后的评估价值

Evaluation the treatment effect and prognosis value of lung ultrasound score combined with Lac and NLR in patients with severe lung infection

目的分析肺部超声评分(LUS)联合外周血乳酸(Lac)、中性粒细胞/淋巴细胞比值(NLR)对重症肺部感染患者治疗效果及预后的评估价值。方法选择2021年6月至2023年6月在邵阳学院附属第二医院重症医学科接受诊断与治疗的重症肺部感染患者143例,其中男性79例,女性64例;年龄60~76岁,平均年龄64.26岁;细菌性肺部感染98例,病毒性肺部感染42例。将所有患者按照治疗效果分为研究组(有效)97例与对照组(无效)46例。分析两组患者在治疗前与治疗后3 d、7 d时LUS、Lac、NLR变化情况;对上述临床指标同肺部感染评分间的数据关联,通过Pearson相关性分析进行探索;通过Logistic回归方程分析对治疗效果产生影响的相关因素;通过受试者工作特性(ROC)曲线和曲线下面积(AUC)对上述3项单个指标、3项联合对治疗效果的预测情况进行分析。结果研究组治疗后3 d、7 d的LUS、Lac、NLR评分均显著低于对照组[LUS:(12.15±0.16)分vs(14.33±0.25)分、(9.35±0.13)分vs(15.15±0.27)分;Lac:(3.75±1.01)mg/L vs(4.60±1.20)mg/L、(2.15±0.93)mg/L vs(5.62±1.36)mg/L;NLR:(3.20±0.17)%vs(5.03±0.25)%、(2.09±0.16)%vs(6.33±0.32)%。P<0.05];治疗3 d、7 d,LUS单项指标同肺部感染评分相关性最强(r=0.235、0.425),Lac相关性相较最弱(r=0.173、0.306);LUS、Lac、NLR均与患者治疗效果相关(P<0.05);上述3项单个指标和联合指标在治疗后3 d时AUC小于7 d时AUC;在治疗7 d后,AUC从大到小依次为联合指标、LUS、NLR、Lac,其中3项联合的AUC数值最大,为0.910。结论LUS联合Lac与NLR指标对重症肺部感染患者治疗效果与预后的评估结果更加准确,值得推广。

Objective To analyze the treatment effect and prognosis value of lung ultrasound score(LUS)combined with peripheral blood lactic acid(Lac)and neutrophil/lymphocyte ratio(NLR)in patients with severe lung infection.Methods From June 2021 to June 2023,a total of 143 patients diagnosed with severe lung infection and performed treatment were enrolled,which included 79 males and 64 female,aged 60-76 years old with mean age of 64.26 years old.There were 98 cases of bacterial lung infection and 42 of viral lung infection.All of them were divided into study group(effective,n=97)and control group(ineffective,n=46)according to treatment effect.The changes of LUS,Lac andNLRbefore treatment and 3-day,7-day post treatment of 2 groups were analyzed.The correlation between the above clinical parameters and lung infection score data was explored by Pearson correlation analysis.Logistic regression equation was used to analyze the related factors affecting therapeutic effect.The receiver operating characteristic(ROC)curve and area under curve(AUC)were used to analyze the prediction of treatment effect by LUS,Lac andNLR individual and combined.Results The scores of LUS,Lac and NLR at 3-day and 7-day after treatment in study group were significantly lower than those in control group[LUS:(12.15±0.16)scores vs(14.33±0.25)scores,(9.35±0.13)scores vs(15.15±0.27)scores;Lac:(3.75±1.01)mg/L vs(4.60±1.20)mg/L,(2.15±0.93)mg/L vs(5.62±1.36)mg/L;NLR:(3.20±0.17)%vs(5.03±0.25)%,(2.09±0.16)%vs(6.33±0.32)%.P<0.05].On the 3rd and 7th day of treatment,LUS showed the strongest correlation with lung infection score(r=0.235,0.425),and Lac showed the weakest correlation(r=0.173,0.306);LUS,Lac and NLR were all related to the therapeutic effect of patients(P<0.05).The AUC of LUS,Lac and NLR individual and combined at 3-day post treatment was less than that at 7-day.At 7-day after treatment,the AUC value was combined,LUS,NLR,and Lac in descending order,and combined AUC value was the largest(0.910).Conclusion It is demonstrated that LUS combined with Lac and NLR indicators are more accurate in evaluating treatment effect and prognosis of patients with severe lung infection,which is worthy of promotion.