Red cell distribution width-to-albumin ratio is a simple promising prognostic marker in acute cholangitis requiring biliary drainage

Background: It is crucial to assess the severity of acute cholangitis(AC). There are currently several prognostic markers. However, the accuracies of these markers are not satisfied. The present study aimed to investigate the predictive value of the red cell distribution width(RDW)-to-albumin ratio(RAR) for the prognosis of AC. Methods: We retrospectively evaluated consecutive patients diagnosed with AC between May 2019 and March 2022. RAR was calculated, and its predictive ability for in-hospital mortality, intensive care unit(ICU) admission, bacteremia, and the length of hospitalization were analyzed. Results: Out of 438 patients, 34(7.8%) died. Multivariate analysis showed that malignant etiology [odds ratio(OR) = 4.816, 95% confidence interval(CI): 1.936-11.980], creatinine(OR = 1.649, 95% CI: 1.095-2.484), and RAR(OR = 2.064, 95% CI: 1.494-2.851) were independent risk factors for mortality. When adjusted for relevant covariates, including age, sex, malignant etiology, Tokyo severity grading(TSG), Charlson comorbidity index, and creatinine, RAR significantly predicted mortality(adjusted OR = 1.833, 95% CI: 1.280-2.624). When the cut-off of RAR was set to 3.8, its sensitivity and specificity for mortality were 94.1% and 56.7%, respectively. Patients with an RAR of > 3.8 had a 20.9-fold(OR = 20.9, 95% CI: 4.9-88.6) greater risk of mortality than the remaining patients. The area under the curve value of RAR for mortality was 0.835(95% CI: 0.770-0.901), which was significantly higher than that of TSG and the other prognostic markers, such as C-reactive protein-to-albumin ratio, and procalcitonin-to-albumin ratio. Lastly, RAR was not inferior to TSG in predicting ICU admission, bacteremia, and the length of hospitalization. Conclusions: RAR successfully predicted the in-hospital mortality, ICU admission, bacteremia, and the length of hospitalization of patients with AC, especially in-hospital mortality. RAR is a promising marker that is more convenient than TSG and other prognostic markers for predicting the prognosis of patients with AC.

Red cell distribution width/platelet ratio estimates the 3-year risk of decompensation in Metabolic Dysfunction-Associated Steatotic Liver Disease-induced cirrhosis

BACKGROUND For compensated advanced chronic liver disease(cACLD)patients,the first decompensation represents a dramatically worsening prognostic event.Based on the first decompensation event(DE),the transition to decompensated advanced chronic liver disease(dACLD)can occur through two modalities referred to as acute decompensation(AD)and non-AD(NAD),respectively.Clinically Significant Portal Hypertension(CSPH)is considered the strongest predictor of decompensation in these patients.However,due to its invasiveness and costs,CSPH is almost never evaluated in clinical practice.Therefore,recognizing noninvasively predicting tools still have more appeal across healthcare systems.The red cell distribution width to platelet ratio(RPR)has been reported to be an indicator of hepatic fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease(MASLD).However,its predictive role for the decompensation has never been explored.AIM In this observational study,we investigated the clinical usage of RPR in predicting DEs in MASLD-related cACLD patients.METHODS Fourty controls and 150 MASLD-cACLD patients were consecutively enrolled and followed up(FUP)semiannually for 3 years.At baseline,biochemical,clinical,and Liver Stiffness Measurement(LSM),Child-Pugh(CP),Model for End-Stage Liver Disease(MELD),aspartate aminotransferase/platelet count ratio index(APRI),Fibrosis-4(FIB-4),Albumin-Bilirubin(ALBI),ALBI-FIB-4,and RPR were collected.During FUP,DEs(timing and modaities)were recorded.CSPH was assessed at the baseline and on DE occurrence according to the available Clinical Practice Guidelines.RESULTS Of 150 MASLD-related cACLD patients,43(28.6%)progressed to dACLD at a median time of 28.9 months(29 NAD and 14 AD).Baseline RPR values were significantly higher in cACLD in comparison to controls,as well as MELD,CP,APRI,FIB-4,ALBI,ALBI-FIB-4,and LSM in dACLD-progressing compared to cACLD individuals[all P<0.0001,except for FIB-4(P:0.007)and ALBI(P:0.011)].Receiving operator curve analysis revealed RPR>0.472 and>0.894 as the best cut-offs in the prediction respectively of 3-year first DE,as well as its superiority compared to the other non-invasive tools examined.RPR(P:0.02)and the presence of baseline-CSPH(P:0.04)were significantly and independently associated with the DE.Patients presenting baseline-CSPH and RPR>0.472 showed higher risk of decompensation(P:0.0023).CONCLUSION Altogether these findings suggest the RPR as a valid and potentially applicable non-invasive tool in the prediction of timing and modalities of decompensation in MASLD-related cACLD patients.

Application of neutrophil-lymphocyte ratio and red blood cell distribution width in diabetes mellitus complicated with heart failure

BACKGROUND Accumulating clinical evidence has shown that diabetes mellitus(DM)is a serious risk factor for cardiovascular disorders and an important factor for adverse cardiovascular events.AIM To explore the value of the combined determination of the neutrophil-lymphocyte ratio(NLR)and red blood cell distribution width(RDW)in the early diagnosis and prognosis evaluation of DM complicated with heart failure(HF).METHODS We retrospectively analyzed clinical data on 65 patients with type 2 DM(T2DM)complicated with HF(research group,Res)and 60 concurrent patients with uncomplicated T2DM(control group,Con)diagnosed at Zhejiang Provincial People’s Hospital between January 2019 and December 2021.The NLR and RDW values were determined and comparatively analyzed,and their levels in T2DM+HF patients with different cardiac function grades were recorded.The receiver operating characteristic(ROC)curves were plotted to determine the NLR and RDW values(alone and in combination)for the early diagnosis of HF.The correlation between NLR and RDW with the presence or absence of cardiac events was also investigated.RESULTS Higher NLR and RDW levels were identified in the Res vs the Con groups(P<0.05).The NLR and RDW increased gradually and synchronously with the deterioration of cardiac function in the Res group,with marked differences in their levels among patients with grade II,III,and IV HF(P<0.05).ROC curve analysis revealed that NLR combined with RDW detection had an area under the curve of 0.915,a sensitivity of 76.9%,and a specificity of 100%for the early diagnosis of HF.Furthermore,HF patients with cardiac events showed higher NLR and RDW values compared with HF patients without cardiac events.CONCLUSION NLR and RDW were useful laboratory indicators for the early diagnosis of DM complicated with HF,and their joint detection was beneficial for improving diagnostic efficiency.Additionally,NLR and RDW values were directly proportional to patient outcomes.

Dyeing PET Textile with C.I.Disperse Red 60 and C.I. Disperse Orange 25 in Supercritical CO_2

For a better understanding of the feasibility of supercritieal fluid dyeing （SFD） and more available information for the process development, the experiments of dyeing PET textile with C.I. disperse red 60 （anthraquinone type） and C. I. disperse orange 25 （azo type） in supercritieal CO2 were carried out with a high-pressure dyeing apparatus at temperatures from 80 to 130℃ and pressure up to 31 MPa. The effect of operating conditions on color yield （K/S） was investigated in SFD experiment, and the optimum operating conditions for the above two disperse dyes were obtained as follows： the temperature 120℃, the pressure 25 MPa and the dyeing time 100 min. As compared with SFD, the conventional water dyeing （CWD） was carried out with the same dyes and textile. The results show that the better fastness, levelness and apparent color can be achieved in SFD and the SFD process has many significant advantages over the CWD process.

Red cell distribution width to platelet ratio: New and promising prognostic marker in acute pancreatitis

AIM: To evaluate the accuracy of red cell distribution width (RDW) to platelet ratio (RPR) to predict in-hospital mortality in acute pancreatitis (AP).

Influence of the concentration ratio of nitrogen to phosphorus on the growth and interspecies competition of two red tide algae

The growth and interspecies competition of two red tide algal species Thalassiosira pseudonana Hasle et Heimdal and Gymnodinium sp. were studied under different concentration ratios of nitrogen to phosphorus, and the algal hatch culture experiments were conducted. The physiological and biochemical indexes were measured periodically, including the maximum comparing growth rate, relative growth rate, average double time and chlorophyll a concentration. The results showed that when the concentration ratio of nitrogen to phosphorus was 16： 1, the maximum comparing growth rate, relative growth rate and chlorophyll a concentration of Thalassiosira pseudonana all reached the highest,and average double time was the shortest. This implied that the optimal concentration ratio of nitrogen to phosphorus of Thalassiosira pseudonana is 16： 1. When the concentration ratio of nitrogen to phosphorus was 6：1, the maximum comparing growth rate, relative growth rate and the chlorophyll a concentration of Gymnodinium sp. reached the highest, and average double time was the shortest, so the optimal concentration ratio of nitrogen to phosphorus of Gymnodinium sp. is 6： 1. From the growth curves as indicated both in the cell density and the chlorophyll a concentration, it is suggested that the influence of concentration ratio of nitrogen to phosphorus on the chlorophyll a concentration and the cell density are almost the same. Different concentration ratios of nitrogen to phosphorus had weak influence on community succession and the competition between the two algae. Gymnodinium sp. may use the phosphorus in vivo for growth, so it is important to pay attention to the concealment of phosphorus, in order to avoid the outbreak of red tide. On the basis of the importance of nitrogen and phosphorus and the ratio of their concentration, the possible outbreak mechanism of red tide of the two algae was also discussed.

Study on the packed volume and the void ratio of idealized human red blood cells using a ?nite-discrete element method

Numerical simulations are performed to examine the packing behavior of human red blood cells(RBCs). A combined ?nite-discrete element method(FDEM) is utilized, in which the RBCs are modeled as no-friction and no-adhesion solid bodies. The packed volume and the void ratio of a large number of randomly packed RBCs are clari?ed,and the effects of the RBC shape, the mesh size, the cell number, and the container size are investigated. The results show that the packed human RBCs with normal shape have a void ratio of 28.45%, which is slightly higher than that of the ?at or thick cells used in this study. Such information is bene?cial to the further understanding on the geometric features of human RBCs and the research on RBC simulations.

R/S ratio in lead Ⅱ, and the prognostic significance of red cell distribution width in acute coronary syndrome

BACKGROUND In spite of developing medical technologies to discover the etiopathogenesis of diseases and developments in the treatment of coronary artery disease, acute coronary syndromes(ACS) continue to be the main cause of mortality and morbidity worldwide. New cardiac biomarkers and techniques are needed to help provide rapid diagnosis in order to evaluate risk in coronary artery patients.AIM To evaluate the effects of R to S ratio(RSR) in the electrocardiograph of patients with ACS, from the point of the arising complication after myocardial infarction(MI), to three-vessel disease(TVD) and mortality.METHODS The data of 1,296 patients with ACS, who presented to the emergency department of our hospital with chest pain between January 2014 and December2018 and were admitted to the cardiology clinic, were retrospectively included in this cross-sectional cohort study. Patients with an RSR value less than I were assigned to group Ⅰ, while those with an RSR value greater than Ⅰ were assigned to group Ⅱ.RESULTS In our study, 466(35.9%) of the 1,296 patients, 357(38.3%) in group 1 and 109(29.9%) in group 2, were female, with a mean age of 61.56 ± 9.42. ST-elevation MI 573(44.2%), unstable angina(UA) 502(38.7%) and non ST-elevation MI 220(17%)were more prevalent in group Ⅰ. Acute anterior MI 263(20.3) in group Ⅰ, and acute inferior MI 184(14.2) in group Ⅱ was higher. Ischemic heart failure was the most common complication. In group Ⅱ, the red cell distribution width(RDW) was 15.42 ± 1.82, the gensini score was 48.39 ± 36.44, the left ventricular ejection fraction was 41.17 ± 10.41, the TVD was 111(8.5), and the mortality rate was 72(5.6), which was significantly higher than group Ⅰ RDW; in MI with ST and nonST-elevation, in TVD, mortality and complications were high and low in UA. In single and multivariate regression analyses, the variables were associated with ACS risk.CONCLUSION RSR levels may be an auxiliary predictive value in ACS in terms of complications developing after MI, TVD, and mortality.

化橘红提取物在早期糖尿病肾病大鼠中多靶点防治作用的研究

目的探究化橘红提取物在糖尿病肾病(diabetic nephropathy,DN)中的多靶点防治作用。方法对大鼠腹腔注射STZ试剂制备DN模型。将90只Wistar实验大鼠分为为正常对照组、模型空白组、贝那普利对照组、化橘红提取物预防组、化橘红提取物低剂量组和化橘红提取物高剂量组。检测各组FBG、HbA1C、U-mA1b、β_(2)-MG、SCr、BUN水平,同时检测SGLT2、AGES、RAGES、TGF-β1的mRNA及蛋白表达水平。结果模型空白组FBG、HbA1C、U-mA1b、β_(2)-MG、BUN水平均较正常对照组升高,SGLT2、AGES、RAGES、TGF-β1的mRNA和蛋白表达水平均较正常对照组升高,中西药物干预后上述指标均较模型空白组降低(P<0.05);其中,中药预防组干预效果最佳。结论化橘红提取物的作用机制可能是通过调节葡萄糖转运蛋白的异常表达、减少糖基化作用而减少TGF-β1表达水平,发挥防治DN、保护肾脏损伤的作用。

急性脑梗死静脉溶栓患者的CRP、NLR和LER动态变化及其对预后的预测价值

目的探讨急性脑梗死(ACI)静脉溶栓患者的C反应蛋白(CRP)、中性粒细胞和淋巴细胞比值(NLR)及白细胞和红细胞计数比值(LER)的动态变化及其对患者预后的预测价值。方法选择商丘市第一人民医院2020年2月至2023年2月急诊就诊的ACI且在院进行静脉溶栓治疗的126例患者。根据发病后90 d改良Rankin量表评分(mRS)将所有患者分为预后良好组(94例)及预后不良组(32例)。比较两组溶栓前、溶栓后1 d、溶栓后7 d的CRP、NLR、LER的变化情况及发病90 d的mRS评分。采用Cox回归分析影响ACI静脉溶栓患者预后的相关因素。采用Spearman相关性分析CRP、NLR、LER水平与ACI静脉溶栓患者mRS评分的相关性。采用受试者工作特征(ROC)曲线分析溶栓后1 d及7 d的CRP、NLR、LER的变化情况对ACI静脉溶栓患者预后的预测价值。结果重复测量方差分析显示,两组CRP、NLR、LER在时间效应、组间效应及交互效应均有统计学意义(P<0.05);简单效应分析,预后良好组患者溶栓后1 d及7 d的CRP、NLR、LER水平低于预后不良组(P<0.05)。预后良好组发病90 d的mRS评分分布优于预后不良组(P<0.05)。Cox回归分析结果显示溶栓后1 d及7 d的CRP、NLR、LER水平均是ACI静脉溶栓患者预后的相关影响因素。Spearman相关性分析示,溶栓后1 d及7 d的CRP、NLR、LER水平与ACI静脉溶栓患者发病90 d的mRS评分呈正相关(r=0.405、0.481、0.518、0.680、0.530、0.504,P<0.05)。ROC曲线结果显示溶栓后7 d的CRP、NLR、LER及三者联合的曲线下面积(AUC)均大于溶栓后1 d的各项对应指标及联合指标的AUC,溶栓后7 d各项指标联合预测ACI静脉溶栓患者预后的AUC最大,为0.856。结论ACI静脉溶栓患者的CRP、NLR、LER随患者病情改善呈逐渐下降趋势,且与患者的预后相关,3种指标联合检测对ACI静脉溶栓患者预后的预测价值更高。

静脉双功超声联合红细胞分布宽度、血小板/淋巴细胞预测烧伤患者静脉血栓栓塞症的价值研究

目的 探讨静脉双功超声(DUS)联合红细胞分布宽度(RDW)、血小板与淋巴细胞比值(PLR)对烧伤患者静脉血栓栓塞症(VTE)发生风险的预测价值。方法 回顾性分析2020年4月至2023年4月金华市中心医院收治的烧伤患者126例,治疗后常规随访6个月,以静脉血管造影为金标准分为VTE组25例和无VTE组101例。治疗前采用DUS检测下肢深静脉的管腔直径和峰值流速,由经验丰富的超声科医师进行血栓定性诊断;检测患者血生化指标包括RBC、RDW、PLT、PLR以及凝血功能指标。比较两组患者的临床资料、治疗前的超声参数和血生化指标;分析患者下肢深静脉峰值流速与RDW、D-二聚体、Fib、PLR及血栓风险评估表(Caprini评分)的相关性;以静脉血管造影结果为金标准,分析DUS血栓定性诊断的价值;分析下肢深静脉峰值流速、RDW和PLR对VTE的诊断效能。结果 与无VTE组比较,VTE组患者年龄和烧伤面积占体表总面积百分比增加,管腔直径、RDW、D-二聚体和Fib水平均增加(均P<0.05),而峰值流速和PLR降低(均P<0.05)。峰值流速与RDW、D-二聚体和Fib水平均呈负相关(均P<0.05),与PLR呈正相关(P<0.05)。DUS血栓定性诊断的准确度为0.889,灵敏度为0.800,特异度为0.911,阳性预测值为0.690,阴性预测值为0.948。ROC曲线分析显示,峰值流速、RDW和PLR诊断VTE的AUC分别为0.723、0.698和0.623,峰值流速联合RDW诊断VTE的AUC为0.797,高于单一指标(均P<0.05)。结论 DUS或可作为临床筛查和诊断VTE的首选无创工具,峰值流速联合RDW能够提供更多VTE的血流信息,能够更好地预测烧伤患者VTE的发生风险。

配方施肥对铁心杉幼苗生长和生理生化指标的影响

【目的】旨在寻找最适合铁心杉幼苗生长的肥料配比。【方法】采用“3414”试验设计方案,设置14组肥料配比,以每组50盆的1年生铁心杉实生苗为材料,探究不同肥料配比对幼苗生长和生理生化指标的影响。【结果】与不施肥相比,合理施肥的铁心杉幼苗叶片的叶绿素含量最高提高了42.01%,可溶性糖含量最高提高了11.64%,可溶性蛋白含量最高提高了13.81%,游离脯氨酸含量最高提高了211.25%;在N_(2)P_(2)K_(1)的肥料配方下,铁心杉幼苗的苗高、根直径、地上生物量、地下生物量、总生物量及苗木质量指数达到最大值,地径、根表面积和总根长也处于中上水平。【结论】N_(2)P_(2)K_(1)(每盆施1.0 g N、1.0 g P、0.5 g K)是铁心杉幼苗最佳的施肥配方。

碱激发矿渣-赤泥新型低碳透水混凝土性能研究

以粒化高炉矿渣与拜耳法赤泥两种工业固废作为胶凝材料,硅酸钠溶液作为碱激发剂,石灰岩碎石作为粗骨料,制备透水混凝土,研究了设计孔隙率、水胶比与骨料粒径对透水混凝土强度与透水性能的影响。结果表明:随设计孔隙率增大,试样的强度逐渐减小,但透水性能逐渐增强。最优水胶比受设计孔隙率和骨料粒径的影响,当透水混凝土设计孔隙率为15%、骨料粒径为4.75~9.50 mm时,最优水胶比为0.36,其强度较高且具有良好的透水性能。碱矿渣-赤泥透水混凝土的力学与透水性能均优于水泥透水混凝土,符合低碳绿色的发展理念。

聚乙烯亚胺修饰的聚氨酯泡沫对甲基橙和茜素红的吸附性能研究

制备了聚乙烯亚胺修饰的聚氨酯泡沫(PEI-PUF),考察了合成条件对制备吸附剂性能的影响,研究了PEI-PUF对水溶液中甲基橙和茜素红的吸附性能。研究结果表明:平衡时间为60 min,准一级动力学模型能更好地描述PEI-PUF-30对甲基橙和茜素红的吸附动力学过程;在酸性条件下PEI-PUF-30对甲基橙和茜素红的吸附量较大,吸附量随着pH值的增加而降低,PEI-PUF-30对甲基橙在较宽的pH值范围内(pH<9.8)存在较高的吸附量;Freundlich模型对实验数据的拟合结果较好,PEI-PUF-30对甲基橙和茜素红的最大吸附量分别为128.28和98.76 mg·g^(-1),相比之下对甲基橙有更高的吸附亲和性;随着温度的升高,PEI-PUF-30对甲基橙和茜素红的吸附量增大,表明该过程为吸热反应。

两种冷榨工艺红橘精油挥发性成分对比分析

本文采用气相色谱-四极杆飞行时间质谱联用仪(GC-Q/TOF)对两种冷榨工艺(杯榨法和石灰法)提取的红橘精油中的挥发性成分进行了分析鉴定。共有93种成分得到鉴定,两种红橘精油分别鉴定出89种和84种成分。93种成分中包括萜烯类29种、醇类20种、醛类20种、酯类5种、酮类2种、烃类12种和其他化合物5种,两种精油共有的化合物有80种。杯榨法红橘精油的挥发性成分总含量显著高于石灰法红橘精油。构成精油的化合物中萜烯类含量最高,含量占比超过80%,含量较高的化合物依次为D-柠檬烯、γ-松油烯、β-月桂烯、芳樟醇和α-蒎烯。经主成分分析(PCA),两种红橘精油的挥发性成分存在显著差异。相对气味活度值(ROAV)法表明,芳樟醇是两种红橘精油中香气贡献最大的化合物,杯榨法红橘精油的柑橘香气属性明显强于石灰法红橘精油,并提炼出芳樟醇、百里香酚、β-月桂烯、D-柠檬烯、香茅醛和γ-松油烯为两种红橘精油的关键香气成分。

红黏土动剪切模量比与阻尼比概率分布特征研究

为探讨红黏土的动力学参数特征,揭示动剪切模量比与阻尼比在典型剪应变条件下的概率分布规律,本文以广西红黏土为研究对象,通过收集整理321组动力特性试验基础数据,给出了广西红黏土在典型剪应变条件下动剪切模量比与阻尼比随剪应变的试验推荐关系曲线,分析了不同概率水准条件下动剪切模量比和阻尼比的不确定性分布形态,并利用Boltzmann曲线给出了不同概率水准下动剪切模量比与阻尼比的上下限值及拟合公式。通过与前人给出的常规土类研究结果进行对比,初步揭示了红黏土动力特性与深度和剪应变的关系规律。研究表明:红黏土动剪切模量比、阻尼比在八组典型剪应变条件的上下限值随超越概率的变化呈现一定的规律,在数学形式上均满足Boltzmann方程。当剪应变在1×10^(-4)~1×10^(-3)时,动剪切模量比与阻尼比离散程度均达到最大。在同一剪应变条件下,随着超越概率的增大,红黏土动剪切模量比与阻尼比上下限之间的差距显著增大。

红细胞分布宽度和纤维蛋白原与白蛋白比值对冠状动脉疾病严重程度的预测价值分析

目的 评估冠心病(CHD)患者红细胞分布宽度/白蛋白比值(RAR)和纤维蛋白原/白蛋白比值(FAR)与冠状动脉疾病(CAD)严重程度的关系,并进一步探讨不同糖代谢状态下RAR和FAR与CAD严重程度的关系。方法选取2021年1月至2022年12月于天津市人民医院心脏内科行冠状动脉造影术的CHD患者577例,其中CAD多支病变组412例,CAD单支病变组165例。收集患者基线资料和实验室相关检查并计算RAR和FAR;分别以RAR和FAR为自变量进行单因素和多因素logistic回归分析;采用受试者工作曲线(ROC)分析RAR和FAR对CHD患者CAD严重程度的预测价值;Spearman相关性分析患者的主要不良心血管事件(MACE)发生情况。结果Logistic回归分析显示,RAR和FAR是CAD严重程度的独立危险因素(OR=1.974,95%CI:1.348~2.593,P=0.000;OR=1.737,95%CI:1.486~2.377,P=0.000)。在不同糖代谢状态下,RAR是糖尿病患者CAD严重程度的最高危险因素(OR=2.828,95%CI:1.157~7.145),而FAR在糖尿病患者CAD发生风险预测中处于相对较低影响(OR=2.217,95%CI:1.533~5.570)。ROC曲线分析显示,RAR(AUC=0.776,95%CI:0.731~0.821,P=0.000)和FAR(AUC=0.725,95%CI:0.676~0.774,P=0.000)对CHD患者CAD严重程度具有预测价值。Spearman相关性分析显示,CHD患者血清RAR和FAR水平与MACE呈正相关(P<0.001)。结论 RAR和FAR是CHD患者CAD严重程度的独立危险因素;RAR对CHD合并糖代谢异常患者CAD严重程度更具有预测价值。

中性粒细胞与淋巴细胞比值联合红细胞分布宽度在急诊老年脓毒症病人中的应用价值

目的 探讨中性粒细胞与淋巴细胞比值(NLR)结合红细胞分布宽度(RDW)对急诊老年脓毒症病人疾病严重程度和预后的评估意义。方法 收集2019年1月到2022年2月在首都医科大学宣武医院急诊科就诊及住院治疗的老年脓毒症病人169例。病人入急诊后给予生化全项、血气分析、全血细胞计数、降钙素原(PCT)、胸部计算机体层摄影(CT)、病原学检查等。依据以上检查结果进行急性生理与慢性健康状况评估(APACHEⅡ)。根据病人入急诊时合并脓毒性休克情况分为脓毒症组114例和脓毒性休克组55例。随访28 d,依据病人死亡情况分成生存组125例和死亡组44例。分别比较脓毒性休克组和脓毒症组、生存组和死亡组病人NLR、白细胞计数(WBC)、PCT、RDW和APACHEⅡ评分的区别,进行NLR、RDW与PCT及APACHEⅡ评分的相关性分析;分析RDW、NLR及2个指标相互结合评估老年脓毒症病人死亡风险的受试者工作特征曲线下面积(AUC)和PCT曲线下面积的区别。结果 脓毒症休克组病人PCT、NLR、RDW和APACHEⅡ评分分别为(1.86±1.04)μg/L、9.63±3.92、(14.95±3.49)%和(16.75±3.53)分,均明显高于脓毒症组的(1.38±1.06)μg/L、7.87±3.94、(12.74±3.83)%、(14.61±2.87)分(P<0.01);WBC在脓毒症死亡组与生存组比较差异无统计学意义(P=0.361),死亡组APACHEⅡ评分、NLR、PCT和RDW分别为(18.52±2.41)分、(10.64±3.74)、(2.55±1.14)μg/L和(15.98±3.69)%,均大于生存组的(14.17±2.71)分、7.67±3.82、(1.19±0.81)μg/L、(12.57±3.43)%(P<0.01),RDW和NLR均与APACHEⅡ评分和PCT具有相关性(均P<0.01);PCT的AUC 95%CI为0.86(0.80,0.92),APACHEⅡ评分的AUC 95%CI为0.88(0.83,0.93),RDW的AUC 95%CI为0.75(0.66,0.83),NLR的AUC95%CI为0.73(0.64,0.81),RDW和NLR的AUC均小于PCT(P=0.048,0.024),但RDW与NLR联合的AUC为0.80,与PCT比较差异无统计学意义(P=0.363)。结论 NLR及RDW两个指标都能够在急诊老年脓毒症病人的病情和预后评估中有较好的应用价值,二者联合的应用价值与PCT相近。

PLR-HRR评分在胃癌术后患者预后中的应用价值

目的探究血小板/淋巴细胞比值(PLR)与血红蛋白/红细胞分布宽度比值(HRR)联合构成的PLR-HRR评分对胃癌完整切除(R0)术后患者生存的预测价值。方法回顾性收集2019年1月1日至2020年6月30日在宁夏医科大学总医院行胃癌R0术后辅助化疗的146例胃癌患者的临床病理资料,应用ROC曲线确定PLR和HRR最佳截断值进行分组并建立PLR-HRR评分,分析不同PLR-HRR评分与胃癌患者临床病理特征的关系,采用Kaplan-Meier生存曲线和COX风险回归分析评估PLR-HRR评分在胃癌R0术后患者预后中的应用价值。建立基于PLR-HRR评分的生存率预后模型,计算模型C指数;绘制ROC曲线评估模型区分度;绘制决策分析曲线(DCA)和临床影响曲线(CIC)评估列线图模型的临床疗效。结果PLR、HRR预测胃癌患者生存率的最佳截断值分别为186.09和9.85。将患者分为3组,PLR-HRR 0分组40例(PLR<186.09且HRR≥9.85);PLR-HRR 1分组73例(PLR≥186.09且HRR≥9.85、PLR<186.09且HRR<9.85);PLR-HRR 2分组33例(PLR≥186.09且HRR<9.85)。不同PLR-HRR评分组肿瘤最大径、TNM分期、PLR、HRR差异均有统计学意义(P均<0.05)。Kaplan-Meier生存曲线结果显示,PLR-HRR评分0分、1分、2分组3年生存率分别为84.0%、61.5%、14.6%,差异有统计学意义(P<0.001)。多因素COX回归分析显示,有腹腔积液、肿瘤最大径≥5 cm、TNM分期为Ⅳ期、PLR-HRR评分为2分是影响胃癌R0术后患者生存的影响因素(P均<0.05)。基于PLR-HRR及其他影响因素构建的列线图C指数为0.767(95%CI:0.711~0.823),ROC曲线显示预测模型区分度良好,DCA和CIC曲线显示预测模型在大部分阈值概率范围内提供了显著的净收益。结论PLR-HRR评分可作为评估胃癌R0术后患者预后的可靠指标,评分越高提示患者预后越差。基于PLR-HRR及其他影响因素构建的列线图具有良好的预测能力。

RDW、HCT、NLR水平与急性心力衰竭患者病情严重程度的相关性

目的:分析红细胞体积分布宽度(RDW)、血细胞比容(HCT)、中性粒细胞/淋巴细胞比值(NLR)水平与急性心力衰竭患者病情严重程度的相关性。方法:选取2021年8月至2023年3月该院收治的128例急性心力衰竭患者为研究组,另选取同期本院128名健康体检者为对照组。比较两组、不同美国纽约心脏病协会心功能分级患者RDW、HCT、NLR水平,采用Spearman相关性分析RDW、HCT、NLR水平与急性心力衰竭患者病情严重程度的相关性。结果:研究组RDW、NLR水平均高于对照组,HCT水平低于对照组,差异有统计学意义(P<0.05);心功能分级Ⅳ级患者RDW、NLR水平均高于Ⅲ级、Ⅱ级患者,且Ⅲ级患者高于Ⅱ级患者,心功能分级Ⅳ级患者HCT水平均低于Ⅲ级、Ⅱ级患者,且Ⅲ级患者低于Ⅱ级患者,差异有统计学意义(P<0.05);Spearman相关性分析结果显示,RDW、NLR水平与急性心力衰竭患者病情严重程度均呈正相关(r>0,P<0.05),HCT水平与急性心力衰竭患者病情严重程度呈负相关(r<0,P<0.05)。结论:RDW、NLR水平与急性心力衰竭患者病情严重程度均呈正相关,HCT水平与急性心力衰竭患者病情严重程度呈负相关。