摘要
目的:探讨外周血中性粒细胞/淋巴细胞比值(NLR)对脓毒性休克患者预后的评估价值。方法:回顾性分析2013年10月-2017年10月承德医学院附属医院重症医学科收治的满足纳入标准的151例脓毒性休克患者临床资料。根据28d生存情况分为存活组(77例)和死亡组(74例),比较组间NLR(ICU初始)、APACHEⅡ(急性生理和慢性健康评分)、SOFA(序贯器官衰竭评分)等变量差异;二元Logistic回归分析找出影响疾病预后的独立危险因素;绘制受试者工作特征(ROC)曲线及生存曲线,评价危险因素对预后的预测价值。结果:(1)死亡组NLR、APACHEⅡ、SOFA、年龄均显著高于存活组,淋巴细胞计数(LYM)显著小于存活组,差异有统计学意义(P<0.01)。(2)二元Logistic回归分析表明NLR是脓毒性休克患者28d预后的独立危险因素(OR=1.110,95%CI=1.040~1.185,P=0.002)。(3)ROC曲线提示NLR曲线下面积(AUC)为0.830,以NLR>17.01作为预测28d死亡风险的临界值,敏感度为75.7%,特异度为81.8%。(4)生存曲线分析显示NLR>17.01组与NLR≤17.01组相比,28d生存率明显下降(P<0.01)。结论:ICU初始的NLR可以作为评估脓毒性休克患者预后的指标。
Objective：To explore the evaluation value of the neutrophil/lymphocyte ratio（NLR）in peripheral blood for the prognosis of patients with septic shock.Methods：A retrospective study was conducted.A total of 151 patients with septic shock who admitted ICU of the affiliated hospital of Chengde Medical College from October 2013 to October2017 and met inclusion criteria were included.According to the 28-day survival,the patients were divided into survival group（n=77）and death group（n=71）.The difference of NLR（ICU admission）,APACHEⅡ（Acute physiology and chronic health evaluation）,SOFA（Sequential organ failure assessment）and other variables between two groups were compared.Binary Logistic regression analysis was used to find the risk factors of prognosis.Receiver-operating characteristic（ROC）curve and survival curve were plotted for assessing the value of risk factors on the 28-day prognosis.Results：（1）NLR,APACHEⅡ,SOFA and age in the death group were significantly higher than those in the survival group,lymphocyte count（LYM）was significantly lower than those of the survival group（P〈0.01）.（2）It was shown by binary logistic regression analysis that NLR was the independent risk factors for 28-day of prognosis（OR=1.110,95%CI=1.040-1.185,P=0.002）.（3）It was shown by ROC curve that area under the ROC curve（AUC）of NLR was 0.830.Based on NLR〉17.01 as a predictor of cut-off value of death in 28-day,the sensitivity was 75.7%,specificity 81.8%.（4）Survival analysis shown that the 28-day survival rate in the patients with NLR≤17.01 was significantly higher than that in those NLR〉17.01（P〈0.01）.Conclusion：The initial NLR of ICU can be used as an indicator for evaluating the prognosis of patients with septic shock.
作者
崔久庆
刘秀娟
滑立伟
CUI Jiuqing,LIU Xiujuan,HUA Liwei(Chengde Medical College,Chengde City,Hebei Province 06700)
出处
《医学理论与实践》
2018年第9期1267-1270,共4页
The Journal of Medical Theory and Practice
