Absolute monocyte and lymphocyte count prognostic score for patients with gastric cancer

AIM:To measure the prognostic significance of absolute monocyte count/absolute lymphocyte count prognostic score(AMLPS) in patients with gastric cancer.METHODS:We retrospectively examined the combination of absolute monocyte count(AMC) and absolute lymphocyte count(ALC) as prognostic variables in a cohort of 299 gastric cancer patients who underwent surgical resection between 2006 and 2013 and were followed at a single institution.Both AMC and ALC were dichotomized into two groups using cut-off points determined by receiving operator characteristic curve analysis.An AMLPS was generated,which stratified patients into three risk groups:low risk(both low AMC and high ALC),intermediate risk(either high AMC or low ALC),and high risk(both high AMC and low ALC).The primary objective of the study was to validate the impact of AMLPS on both disease-free survival(DFS) and overall survival(OS),and the second objective was to assess the AMLPS as an independent prognostic factor for survival in comparison with known prognostic factors.RESULTS:Using data from the entire cohort,the most discriminative cut-off values of AMC and ALC selected on the receiver operating characteristic curve were 672.4/μL and 1734/μL for DFS and OS.AMLPS risk groups included 158(52.8%) patients in the lowrisk,128(42.8%) in the intermediate-risk,and 13(4.3%) in the high-risk group.With a median followup of 37.2 mo(range:1.7-91.4 mo),five-year DFS rates in the low-,intermediate-,and high-risk groups were 83.4%,78.7%,and 19.8%,respectively.And fiveyear OS rates in the low-,intermediate-,and high-risk groups were 89.3%,81.1%,and 14.4%,respectively.On multivariate analysis performed with patient- and tumor-related factors,we identified AMLPS,age,and pathologic tumor-node-metastasis stage as the most valuable prognostic factors impacting DFS and OS.CONCLUSION:AMLPS identified patients with a poor DFS and OS,and it was independent of age,pathologic stage,and various inflammatory markers.

Correlation Analysis on Total Lymphocyte Count and CD4 Count in HIV-infected Patients: A Retrospective Evaluation

CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy （HAART） and monitoring HIV/AIDS disease progression, but it is not widely available in resource-limited settings. This study examined the correlation between total lymphocyte count （TLC） and CD4 count of HIV-infected patients before and after HAART, and assessed the thresholds of TLC for making decisions about the initiation and for monitoring HAART. A retrospective study was performed, and 665 HIV-infected patients with TLC and CD4 count from four counties （Shangcai, Queshan, Shenqiu and Weishi） were included in the study. Pearson correlation and receiver operating characteristic （ROC） were used. TLC and CD4 count after HAART was significantly increased as compared with pre-HAART （P〈0.01）. An overall positive correlation was noted between TLC and CD4 count （pre-HAART, r=0.73, P=0.0001; follow-up HAART, r=0.56, P=0.0001）. The ROC curve between TLC and CD4 count showed that TLC ≤ 1200 cells/mm3 could predict CD4 〈 200 cells/mm3 with a sensitivity of 71.12%, specificity of 66.35% at pre-HAART. After 12-month HAART, the optimum prediction for CD4 count 〈 200 cells/mm3 was a TLC ≤ 1300 cells/mm3, with a sensitivity of 63.27%, and a specificity of 74.84%. Further finding indicated that TLC change was positively correlated to CD4 change （r=0.77, P=0.0001） at the time point of 12-month treatment, and the best prediction point of TLC change for CD4 increasing was 135 cells/mm3. TLC and its change can be used as a surrogate marker for CD4 count and its change of HIV-infected individuals for making decisions about the initiation and for monitoring HAART in resource-limited settings.

Assessing the effect of traditional Chinese medicine on CD4+ lymphocyte count of 807 HIV/AIDS cases

National Free Traditional Chinese Medicine (TCM) HIV/AIDS Treatment Program had been carried out for more than 5 years, treating 9267 cases accumulately by 2009. We report the 3-year outcome on CD4+ lymphocyte count of 807 cases of HIV/AIDS enrolled in the National Free TCM HIV/AIDS Treatment Pro- gram, the CD4+ lymphocyte count were measured every 6 month at 7 time points (0, 6, 12, 18, 24, 30, 36 month). The results showed that the overall CD4+ ly mphocyte count maintained stable at the 6th month and the 12th month, declined significantly at the 18th month, 24th month and 30th month, then elevated to the pre-treatment level at the 36th month. Patients with pre-treatment CD4+ lymphocyte count level 350/mm3 had CD4+ lymphocyte count declined significantly after all visits. In summary, combined treatment of Chinese herbal medicine and conventional therapy on HIV/AIDS suggested promising effect, but more evidences from larger, rigorous designed studies still needed to support the affirmative effect of TCM in the future.

Detection of microbial antigenic components of circulating immune complexes in HIV patients:Involvement in CD4^+ T lymphocyte count depletion

Objective:To investigate the prevalence of microbial antigenic components of circulating immune complexes amongst grades of CD4 T lymphocyte counts in HIV sero positive and seronegative participants.Methods:Polyethelene glycol(PEG-600) and buffering methods of precipitation and dissociation of immune complexes was used to generate immune solution from sera of 100 HIV sero-positive and 100 HIV sero-negative participants.These were categorized into 3 grades based on CD4 count:】 500 cell/mm,200-499 cell/mm3 and 【200 cell/mm3.The immune solutions were assayed using membrane based immunoassay and antibody titration, along side its unprocessed serum for detection of various microbial antigens and or antibodies. CD4 T cell counts were estimated using Patec Cyflow SL-3 Germany.Results:Antigenic component of immune complexes of various infectious agents was detected in 99 and 70 HIV seropositive and HIV sero-negative participants,respectively.In group A,there were 10 HIV positive participants,including 4(40.0%) had circulating immune complexes(CICs) due to Salmonella species only:1(10.0%) due to Salmonella-Plasmodium falciparum(P.falciparum),SalmonellaP. falciparum-HCV and P.falciparum antigens,respectively.In group B,45(45.4%) HIV seropositive participants with CICs had CD4 T lymphocyte count between 200-499 cells/mm^3.Out of these,20(44.4%) had CICs due to Salmonella species only:9(20%) due to Salmonella-P. falciparum.In group C,there were 44(44.4%) HIV sero-positive participants,including 3(6.8%) due to Salmonella species only:24(54.4%) due to Salmonella-P.falciparum:2(4.5%) due to P. falciparum only.Conclusions:In HIV sero-positive participants,presence of heterogeneity of Salmonella species-P.falciparum antigens was highly incriminated in CD4 count depletion but not homogeneity of malaria parasites antigens.Malaria parasites antigens only were incriminated in CD4^+ count depletion amongst HIV sero-negative participants.Before taking any decision on the management of HIV-1-positive individuals,their malaria and Salmonella paratyphi status should be assessed,but not malaria status alone.

CD4 T-Lymphocytes Count in HIV-<i>Toxoplasma gondii</i>Co-Infected Pregnant Women Undergoing a Prevention of Mother-to-Child Transmission Program

Toxoplasma gondii (T. gondii) is a parasite responsible of toxoplasmosis, a disease often asymptomatic but with serious consequences in pregnant women and immunocompromised subjects. Objective: This study aimed to investigate the impact of T. gondii infection on CD4+ T lymphocytes count in HIV-infected pregnant women. Methods: This was a cross-sectional study of pregnant women co-infected by HIV and T. gondii. The study was conducted from January to July 2016 at the Prevention of Mother-to-Child Transmission of HIV (PMTCT) sites in the Health District of Lacs in Togo. Diagnosis of HIV was performed by immuno-chromatographic methods with Determine TM HIV-1/2 and immuno-filtration with Tri-Dot HIV-1 and 2 kits. Presence of anti-toxoplasmic IgG and IgM antibodies was established via enzyme immunoassay using ELISA-BIOREX&reg;kit. Flow cytometry was used to count CD4+ T lymphocytes. Results: Our study found that of the 4599 pregnant women, 111 (2.41%) were HIV-positive. Among them, 109 (98.20%) were infected by HIV-1 and 2 (1.98%) by HIV-2. Antibodies against T. gondii were detected in 5.36% (IgM), 25% (IgG) and 3.57% (both IgM and IgG) of HIV 56 infected women. There was no significant difference between CD4 cell count in HIV (+)/T. gondii IgM (-)/IgG (-) infected pregnant women (378.8 ± 222.8 cell//μl) compared to HIV (+)/T. gondii/IgM (+) (457.3 ± 183.3 cell//μl), HIV (+)/T. gondii IgG (+) (419.4 ± 287.3 cell//μl) and HIV (+)/T. gondii IgM/IgG (+) (480.5 ± 252.4 cell/μl). Conclusion: This study showed that intracellular parasite T. gondii did not alter CD4+ T lymphocytes count in HIV/T. gondii co-infected pregnant women.

Diagnostic value of biomarkers for sepsis in adult patients in the emergency department: Don't forget the neutrophil-lymphocyte count ratio

Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding.

Protocol of Determining the Effect of Selenium Supplementation on CD4 + T Lymphocyte Count in HIV/AIDS Patients: A Randomized Double Blind Placebo Controlled Trial

Background: Acquired immune deficiency syndrome (AIDS) is believed to be both among major epidemics and a critical global health issue. The administration of antiretroviral therapy is recently proposed for all patients with CD4 + T cell count of ≤ 350/μlit in different studies The accessibility of combination therapy has been restricted due to high costs of drugs, particularly in low and middle income countries. In Iran, according to WHO, drugs were distributed among only 6% of adults and 4% - 14% of children in 2009. Moreover, new strains are created and therefore, resistance to the current medication along with a considerable risk of ART-related toxic adverse effects points out the need for more affordable, effective and safer treatments. The use of antioxidants such as Selenium (Se) has been indicated to be beneficial in these patients. Method: In a double-blind randomized placebo control trial, 100 HIV positive, HAART-receiving patients will be selected from more than 2000 individuals covered under IRCHA (Iranian Referral HIV/AIDS Research Centre). They are then randomized to receive daily Se supplement of 200 μgr elemental Se and placebo for 6 months. The baseline assessment of the patients who meet the inclusion and exclusion criteria includes doing some lab tests to determine the absolute count of CD4 + T lymphocyte and the plasma levels of Se. The incidence of opportunistic infection will be assessed during the monthly visits in the first six months of the follow-up and the one performed at the end of the 9th month. For evaluating the trend of CD4 + T cells changes, the absolute count of CD4 + T lymphocyte will be measured every 3 months in the 5th, 8th, and 9th, visits. The plasma levels of Se will be measured in the final follow-up session and compared with the baseline value.

Lymphocyte count predicts the severity of COVID-19:Evidence from a meta-analysis

BACKGROUND In December 2019,coronavirus disease 2019(COVID-19)was reported firstly in Wuhan,China.COVID-19 is currently a global pandemic.AIM To assess the suitability of lymphocyte count as a biomarker of COVID-19 severity.METHODS Five literature databases(PubMed/MEDLINE,Web of Science,Google Scholar,Embase,and Scopus)were searched to identify eligible articles.A meta-analysis was performed to calculate the standard mean difference(SMD)and 95%confidence interval(CI)of lymphocyte counts in coronaviral pneumonia cases.RESULTS Eight studies,including 1057 patients,were integrated in the meta-analysis.Lymphocyte counts were associated with severe coronavirus(CoV)infection(SMD=1.35,95%CI:1.97 to 0.37,P<0.001,I2=92.6%).In the subgroup analysis stratified by prognosis,lymphocytes were associated with CoV infection mortality(n=2,SMD=0.42,95%CI:0.66 to 0.19,P<0.001,I2=0.0%),severity(n=2,SMD=0.93,95%CI:1.20 to 0.67,P<0.001,I2=0.0%),and diagnostic rate(n=4,SMD=2.32,95%CI:3.60 to 1.04,P<0.001,I2=91.2%).CONCLUSION Lymphocyte count may represent a simple,rapid,and commonly available laboratory index with which to diagnosis infection and predict the severity of CoV infections,including COVID-19.

Monocyte-to-lymphocyte ratio as a prognostic factor in peripheral whole blood samples of colorectal cancer patients

BACKGROUND Colorectal cancer is the third most common malignancy worldwide.Therefore,it is critically important to identify new useful markers that can be easily obtained in routine practice.Inflammation is a crucial issue in the pathogenesis and development of cancer.AIM To evaluate the prognostic value of absolute monocyte count,monocyte to lymphocyte ratio(MLR),the combination of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio(NLR-PLR),and combined platelet and neutrophilto-lymphocyte ratio(PLT-NLR)in peripheral blood samples of patients with colorectal cancer undergoing surgery.METHODS We conducted a retrospective study of 160 patients with colorectal cancer who underwent surgery,and 42 healthy controls.The status of absolute monocyte count,MLR,NLR-PLR and PLT-NLR was calculated on the basis of blood samples obtained before and after surgery.Haematologic factors were examined in correlation with the type of tumour growth,tumour size,histological type,percentage of mucinous component,grade of malignancy,Tumour-Node-Metastasis stage,venous,lymphatic and perineural invasion of cancer cells,status of lymph node invasion and the presence of cancer cell deposits.The Kaplan-Meier method and the long-rank test were used to compare survival curves.To determine independent prognostic factors,univariate and multivariate Cox proportional hazards regression models were applied.RESULTS The PLT-NLR status was correlated with tumour size and the presence of perineural invasion(P=0.015;P=-0.174,P=0.037).Moreover,high NLR-PLR and PLR-NLR ratios in the blood samples obtained after surgery were positively associated with histological type of cancer and percentage of the mucinous component(NLR-PLR:P=0.002;P=0.009;PLR-NLR status:P=0.002;P=0.007).The analysis of 5-year disease-free survival showed that the MLR of whole blood obtained after surgery[HR=2.903,95%CI:(1.368-6.158),P=0.005]and the status of lymph node metastasis[HR=0.813,95%CI:(0.653-1.013),P=0.050]were independent prognostic factors in colorectal cancer patients.CONCLUSION The postoperative MLR in whole blood samples can be used as an independent prognostic factor in patients diagnosed with colorectal cancer.

Elevated peripheral blood lymphocyte- to-monocyte ratio predicts a favorable prognosis in the patients with metastatic nasopharyngeal carcinoma

Introduction:Patients with metastatic nasopharyngeal carcinoma(NPC)have variable survival outcomes.We have previously shown that an elevated peripheral blood lymphocyte-to-monocyte ratio(LMR)is associated with an increased metastatic risk in patients with primary NPC.The present study aimed to investigate the prognostic value of pretreatment LMR in a large cohort of metastatic NPC patients.Methods:Clinical data of 672 patients with metastatic NPC diagnosed between January 2003 and December2009 were analyzed.The peripheral lymphocyte and monocyte counts were retrieved,and LMR was calculated.Receiver operating characteristic(ROC)curve analysis and univariate and multivariate COX proportional hazards analyses were performed to evaluate the association of LMR with overall survival(OS).Results:Univariate analysis revealed that an elevated absolute lymphocyte count(≥1.390×109/L)and LMR(≥2.475)as well as a decreased monocyte count(<0.665×109/L)were significantly associated with prolonged OS.Multivariate Cox proportional hazard analysis showed that LMR(hazard ratio[HR]=0.50,95%confidence interval[CI]=0.41–0.60,P<0.001),absolute lymphocyte count(HR=0.77,95%CI=0.64–0.93,P=0.007),and monocyte count(HR=1.98,95%CI=1.63–2.41,P<0.001)were independent prognostic factors.By stratification analyses,only LMR remained a significant predictor of prognosis.Conclusion:We identified pretreatment LMR as an independent prognostic factor for patients with metastatic NPC.Independent validation of our findings is needed.

Lymphocyte recovery is an independent predictor of relapse in allogeneic hematopoietic cell transplantation recipients for acute leukemia

AIM To examine the optimal absolute lymphocyte count(ALC) cut-off utilizing receiver operator characteristics(ROC) in addition to graft characteristics associated with early ALC recovery.METHODS Patients who received T-cell replete peripheral hematopoietic cell transplantation(HCT) for acute leukemia were identified. ALC cut-off was established using ROC analysis and subsequently the cohort was stratified. Time to endpoint analysis and cox regression modelling was computed to analyze outcomes. RESULTS A total of 72 patients met the inclusion criteria andwere analyzed. Optimal ALC cut-off was established to be on day 14(D14) with ALC > 0.3 × 10~9/L. At 2 years, cumulative incidence of relapse was 16.9% vs 46.9%(P = 0.025) for early and delayed lymphocyte recovery cohorts, respectively. Chronic graft vs host disease was more prevalent in the early lymphocyte recovery(ELR) group at 70% vs 27%, respectively(P = 0.0006). On multivariable analysis for relapse, ELR retained its prognostic significance with HR = 0.27(0.05-0.94, P = 0.038).CONCLUSION ELR is an independent predictor for relapse in patients receiving allogeneic HCT for acute leukemia. ELR was influenced by graft characteristics particularly CD34 count.

The Lower Peripheral Blood Lymphocyte to Monocyte Ratio Following Completion of First Line Chemotherapy Is a Risk Factor for Predicting Relapse in Patients with Diffuse Large B-Cell Lymphoma

Background and objective: During routine follow up, there is no specific predictor to ascertain relapse after standard first line chemotherapy in diffuse large cell lymphoma. Therefore, this study was designed to assess the prognostic significance of the ratio between absolute lymphocyte and monocyte counts (LMR) in the peripheral blood to verify relapse in diffuse large B cell lymphoma. Patients and methods: A total of 139 patients with newly diagnosed diffuse large B cell lymphoma (DLBCL) were evaluated and treated with CHOP or R-CHOP between the years 2009 and 2016. Three months following completion of first line therapy, Lymphocyte/monocyte ratio (LMR) was calculated from the routine automated complete blood cell count (CBC) attained a plateau after the bone marrow recovery after first line chemotherapy. The absolute lymphocyte count/absolute monocyte count ratio (LMR) was calculated by dividing the ALC by the AMC. Results: ROC curve analysis of 139 patients established 2.8 as cutoff point of LMR for relapse with AUC of 0.97 (95% CI 0.93 - 0.99, P ≤ 0.001). Cox regression analysis was performed to identify factors predicting relapse. In univariate regression analysis, ALC (95% CI 0.003 - 0.03, p ≤ 0.001), AMC (95% CI 15.4 - 128.8, p ≤ 0.001), LMR (95% CI 0.001 - 0.01, p ≤ 0.001), and LDH (95% CI 0.1 - 0.5, p ≤ 0.001) following completion of therapy are significant factors for relapse. Other significant factors for relapse are Ann Arbor stage (95% CI 1.1 - 6.9, P = 0.03), extranodal sites (95% CI 1.2 - 6.1, P = 0.01), age (95% CI 1.3 - 6.5, P = 0.01) and treatment of CHOP protocol (95% CI 0.05 - 0.6, P = 0.007). In a multivariate analysis LMR following completion of therapy was predictive for relapse (95% CI 0.001 - 0.2, P = 0.005). ALC was also significant in multivariate analysis (95% CI 0.01 - 0.8, P = 0.03). LDH following completion of therapy (95% CI 0.2 - 14.9, P = 0.5), AMC following completion of therapy (95% CI 0.3 - 43.1, P = 0.3), age (95% CI 0.9 - 205.4, P = 0.06), extra-nodal sites (95% CI 0.04 - 9.8, P = 0.8), Ann Arbor stage (95% CI 0.3 - 28.7, P = 0.3), and Treatment of CHOP protocol (95% CI 0.01 - 2.4, P = 0.2) were not statistically significant. Conclusion: This study observed that LMR assessed after first line chemotherapy during routine follow up is an independent predictor of relapse and clinical outcome in DLBCL patients. LMR at follow up can be used a simple inexpensive biomarker to alert clinicians for relapse during follow up after standard first line chemotherapy in DLBCL patients.

Community Normal Reference Values for CD3+, CD4+, CD8+T Lymphocytes and Leucocytes among Immunocompetent Adults in Coastal Kenya

Background: Studies on the reference values of CD4 and CD3 T cells in healthy individuals have continued to gain significance because of the importance of these immunological markers in the initiation of antiretroviral therapy and prophylactic drugs for opportunistic infections. These ranges tend to vary across populations. The CD4:CD8 ratio is used to measure of how balanced immune function is. Therefore, this study aimed at determining normal reference values for CD4+ and CD3+T-lymphocytes and leucocytes in healthy adults in Coastal Kenya. Methods: A cross-sectional study was carried between May 2015 and February 2016 in Coast General Referral hospital, Tudor, Port-Reitz, Mlaleo, Likoni and Sub-County hospitals. Participants were recruited from voluntary HIV counselling and testing clinics. Patients were counselled for HIV test and those who consented were tested for HIV. They were screened for diseases that potentially cause lymphocyte homeostasis perturbation. CD4+, CD3+ CD8+cells/μl were analyzed using a BD FACSCount flow cytometer (Becton-Dickson, NJ). Results: We enrolled 500 participants, two hundred and forty (48.0%) were males and two hundred and sixty (52.0) females. The mean CD4 cell count was 1054.9 ± 95% CI 1041.2 - 1068.6 cells/mm3, absolute CD8 was 688.4 ± 95% CI 679.1 - 697.7 cells/mm3, absolute CD3 cell count was 1945.1 ± 95% CI 1907.4 - 1982.2 cells/mm3 absolute leukocyte count 5.19 ± 95% CI 5.12 - 5.19, absolute lymphocyte count 1.85 ± 95% CI1.83 - 1.88 and haemoglobin level 12.76 ± 95% CI 12.65 - 12.87. Females had significantly higher mean CD4 and CD8 T cell counts than males (p < 0.05). The mean values of white blood cells 4.7 (3.0 - 7.9) × 109/l, platelets 239 (77 - 353) × 109/l and erythrocytes 4.65 (3.51 - 5.40) × 109 were significantly higher in males than females (p Conclusion: Immunohaematological markers found in this study were different from the standard values for the western countries. Females had significantly higher mean CD4+T and CD3+T cell counts but lower mean haemoglobin level, erythrocytes, white blood cells and platelets than males. Our findings provide new insight in the CD4 and CD3 T cell reference values of Kenyans.

红细胞分布宽度与血小板分布宽度可以辅助预测流感合并下呼吸道感染患者预后

目的探讨血细胞计数及相关参数是否可以预测流感合并下呼吸道感染患者的预后。方法回顾性研究2013年至2023年首都医科大学附属北京朝阳医院经急诊医学科、发热门诊或呼吸科收治入院或留观的流感合并下呼吸道感染患者,以28天死亡为研究终点,分为生存组和死亡组,比较分析两组间血细胞计数及相关参数的差异,回归分析死亡的独立预测因素,建模并对模型进行评价。结果此项研究最终纳入417例患者,28天生存组361例(86.6%),死亡组56例(13.4%)。死亡组淋巴细胞计数和血小板计数显著低于生存组,红细胞分布宽度、血小板分布宽度、血小板平均体积及大血小板比率显著高于生存组(P<0.05)。多变量Logistic回归分析筛选独立相关变量,当淋巴细胞计数≤0.68×10^(9)/L,或血小板计数≤147×10^(9)/L,或红细胞分布宽度>12.7%,或血小板分布宽度>13.9 fL时,患者28天死亡风险增加,四个指标建立预测模型的AUC为0.734(95%CI 0.664~0.804),敏感度58.9%,特异度80.4%,阳性预测值32.0%,阴性预测值92.7%,阳性似然比3.01,阴性似然比0.51。模型的一致性指数为0.735,拟合优度Hosmer-Lemeshow检验显示拟合效果较好(P=0.406)。结论淋巴细胞计数、血小板计数、红细胞分布宽度、血小板分布宽度可作为早期预测流感合并下呼吸道感染患者28天死亡风险的指标,以这些指标构建的列线图模型可计算临床实测值所对应的死亡风险概率。

细菌性肺炎患者血清LTB4、NLCR及CRP/PA变化及其与肺损伤程度的关系

目的探讨细菌性肺炎患者血清白三烯B4(LTB4)、中性粒细胞/淋巴细胞计数比值(NLCR)及C-反应蛋白与前白蛋白(CRP/PA)比值变化及其与肺损伤程度的关系。方法回顾性选取172例细菌性肺炎患者(观察组)和同期140例健康体检者(对照组)的临床资料,根据肺损伤程度,将患者分为轻中度组和重度组。比较各组LTB4、NLCR及CRP/PA水平,分析LTB4、NLCR及CRP/PA联合评估患者肺损伤程度的价值。结果与对照组比较,观察组LTB4、NLCR及CRP/PA水平更高(P<0.05);与轻中度组比较,重度组LTB4、NLCR及CRP/PA水平更高(P<0.05);ROC结果显示,LTB4、NLCR和CRP/PA评估患者肺损伤程度的AUC为0.793、0.717、0.758,三者联合评估患者肺损伤程度的AUC为0.933,高于单项评估(P<0.05)。结论LTB4、NLCR及CRP/PA在细菌性肺炎患者中表达水平均会升高,且其均与肺损伤程度有关,其联合评估肺损伤程度的价值较高。

外周血细胞计数比值及淋巴细胞亚群在类风湿关节炎病情评估中的价值

目的探讨外周血细胞计数比值及淋巴细胞亚群在类风湿关节炎(RA)及合并间质性肺病(ILD)病情评估中的价值。方法回顾性分析2020年6—12月50例住院RA患者的一般资料、外周血细胞计数比值及淋巴细胞亚群检测结果。按28个关节疾病活动度评分(DAS 28)分为高疾病活动度组(DAS 28>5.1分)及中低疾病活动度组(DAS 28≤5.1分)。另根据是否合并ILD,分为未合并ILD(RA-non-ILD)与合并ILD(RA-ILD)组。对比不同分组外周血细胞计数比值及淋巴细胞亚群的差异,并使用受试者工作特征(ROC)曲线评估外周血细胞计数比值及淋巴细胞亚群对RA的诊断评估价值。结果与中低疾病活动度组相比,RA高疾病活动度组的血小板-淋巴细胞比值(PLR)较高,淋巴细胞-单核细胞比值、总T淋巴细胞比率、总T淋巴细胞绝对计数、CD8^(+)T细胞及CD4^(+)T细胞绝对计数低于中低疾病活动度组(P<0.05)。PLR评估RA病情活动度的ROC曲线下面积(AUC)为0.722,95%CI为0.579~0.865。RA-non-ILD组与RA-ILD组外周血细胞计数比值及淋巴细胞亚群差异无统计学意义(P>0.05),各指标ROC曲线的AUC也均低于0.7。结论PLR对于RA疾病活动度的区分可能具有一定价值,其他各指标无论对于区分RA疾病活动度还是区分是否合并ILD都没有表现出明显潜力。

治疗前血液检测指标对复发髓母细胞瘤患儿生存的预测价值及其危险因素分析

目的 探讨复发后再次治疗前髓母细胞瘤(MB)患儿外周血血小板淋巴细胞比值、预后营养指数与预后的关系。方法 对2015年9月—2022年9月收治的82例MB患儿进行回顾性研究,比较高/低NLR组、高/低PLR组、高/低SII组、高/低PNI组之间的复发后OS率,分析预后相关因素。结果 中性粒细胞-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)、系统性炎症指数(SII)、预后营养指数(PNI)的临界值分别为3.10、311.70、763.70、49.00,单因素分析提示高NLR、高PLR、高SII、低PNI均与更短的OS率有关,组间差异有统计学意义;COX回归模型分析提示PLR为复发后OS相关的独立危险因素,PNI为复发后OS相关的保护因素,高PLR组死亡风险为低PLR组的3.889倍,高PNI组的死亡风险为低PNI组的0.484倍。结论 复发是影响儿童MB预后的重要因素,高PLR为复发MB患儿预后不良的危险因素,高PNI为复发MB患儿的保护因素。

中性粒细胞与淋巴细胞比率、血小板计数联合D-二聚体对重症肺炎合并脓毒症患儿预后的预测价值

目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房(emergency intensive care unit,EICU)2018年1月~2023年1月收治的310例重症肺炎合并脓毒症患儿的临床资料,对所有患儿治疗出院后进行门诊复查或电话随访并根据相关标准对患儿预后进行评估,根据预后情况分为预后良好组(n=198)和预后不良组(n=112)。利用医院电子病历系统,收集全部患儿年龄、性别等基本临床资料,记录入院时患儿早期预警评分[慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)],并收集诊断患儿入院24 h内的实验室指标。采用Logistic回归分析肺炎合并脓毒症患儿发生预后不良的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、PLT计数、D-D预测重症肺炎合并脓毒症患儿预后的灵敏度、特异度、准确度。结果两组患儿年龄、性别差异无统计学意义(P>0.05)。预后不良组APACHEⅡ、SOFA评分显著高于预后良好组(P<0.05)。预后良好组NLR、D-D水平均低于预后不良组,PLT计数水平高于预后不良组(P<0.05)。将单因素分析的结果中P≤0.05的变量纳入多因素Logistic回归确定影响预后的独立危险因素。调整年龄、性别、APACHEⅡ评分等混杂因素,连续变量原值收入,结果表明,NLR、D-D水平是预后的保护因素(OR<1,P<0.05),PLT计数水平是预后的危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,三项指标联合预测的曲线下面积(area under the curve,AUC)为0.949,灵敏度为94.95%,特异度为82.14%,准确度为90.32%,三者联合预测效能价值高。结论重症肺炎合并脓毒症患儿的外周血NLR、PLT计数、D-D水平显著升高,三项联合检测在预测患儿28 d后的预后中具有重要的价值。

AMI患者PLT、PDW、PLR水平及其与疾病严重程度的相关性研究

目的探讨急性心肌梗死(AMI)患者血小板计数(PLT)、血小板分布宽度(PDW)、血小板/淋巴细胞比值(PLR)水平及其与疾病严重程度的相关性。方法选取2017年1月至2020年12月苏州市相城区中医医院收治的200例AMI患者作为观察组,另选取同期150例常规体检健康者作为对照组。根据AMI患者随访结果又分为预后不良组和预后良好组。比较观察组和对照组,以及预后良好组和预后不良组PLT、PDW、PLR水平。采用多因素Logistic回归分析AMI患者预后的危险因素。采用Spearman相关分析Killip心功能分级与PLT、PDW、PLR水平的相关性;采用Pearson相关分析PLT、PDW、PLR水平的相关性。结果观察组PLT[(166.32±28.44)×10^(9)/L]高于对照组[(158.77±30.52)×10^(9)/L],PDW[(16.59±4.95)%]高于对照组[(15.54±3.01)%],PLR(162.40±78.85)高于对照组(114.74±12.34),差异均有统计学意义(P<0.05)。预后不良组和预后良好组性别、年龄、体质量指数、吸烟史、糖尿病、高血压、高血脂比较,差异均无统计学意义(P>0.05);预后不良组和预后良好组Killip心功能分级,PLT、PDW、PLR水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,PLT、PDW、PLR水平升高是AMI患者预后不良的独立危险因素(P<0.05)。Spearman相关分析结果显示,Killip心功能分级与PLT、PDW、PLR水平均呈正相关(r=0.702、0.664、0.302,P<0.05);Pearson相关分析结果显示,PLT水平与PDW、PLR水平均呈正相关(r=0.361、0.507,P<0.05),PDW水平与PLR水平呈正相关(r=0.596,P<0.05)。结论AMI患者PLT、PDW、PLR水平均升高,并且与AMI患者的Killip心功能分级均呈正相关,PLT、PDW、PLR可作为预测AMI患者预后的良好指标,对预防和治疗AMI有重要临床意义。

淋巴细胞与肺癌患者重度免疫检查点抑制剂相关肺炎的相关性研究

目的本研究旨在探讨外周血淋巴细胞绝对计数(ALC)及其他检测指标与肺癌患者重度免疫检查点抑制剂相关肺炎(CIP)的危险因素及CIP患者预后的关系。方法回顾性分析昆明医科大学第二、三附属医院2019年1月1日至2022年6月1日符合纳入标准的40例轻度CIP患者和24例重度CIP患者。通过Logistic回归模型分析探究重度CIP的影响因素;采用Kaplan-Meier法绘制不同指标与CIP患者预后的相关函数;使用Cox比例风险模型分析影响CIP患者预后的因素。结果多因素Logistic回归分析结果提示低水平ALC是重度CIP发生的独立危险因素(P<0.05);Kaplan-Meier分析结果提示低水平ALC的患者较高水平ALC患者预后不佳,多因素Cox风险比例模型分析结果提示CIP发生时重度CIP患者预后不佳(P<0.05)。结论CIP发生时,低水平ALC是重度CIP发生的高危因素,低水平ALC患者预后较差,重度CIP是CIP患者预后不佳的高危因素。