摘要
目的分析中性粒细胞/淋巴细胞比值(NLR)和D-二聚体对预测新型冠状病毒肺炎(COVID-19)患者进展至重症的诊断价值。方法选取2022年12月18日至2023年1月16日我院收治的194例COVID-19患者作为研究对象,根据患者病情分为重症组(n=42)和非重症组(n=152)。比较两组患者的相关临床特征及实验室检查指标,并分析NLR和D-二聚体与患者入院时急性生理和慢性健康状况Ⅱ(APACHE-II)评分的相关性。通过二元Logistic回归分析,建立个体化预警模型,并验证模型的诊断价值。结果重症组患者的年龄、APACHE-II评分、白细胞计数(WBC)、中性粒细胞计数(NEU)、NLR、D-二聚体水平及合并有冠心病患者的比例明显高于非重症组,淋巴细胞计数(LYM)明显低于非重症组,差异均有统计学意义(均P<0.05)。相关性分析显示,COVID-19患者NLR和D-二聚体水平与APACHE-II评分呈正相关(NLR:r=0.587,P<0.001;D-二聚体:r=0.655,P<0.001)。二元Logistic回归分析显示,NLR水平升高是COVID-19患者重症化的独立危险因素(OR=1.522,95%CI:1.141~2.031),D-二聚体水平升高是独立危险因素(OR=1.084,95%CI:1.016~1.156)。ROC曲线分析显示,该模型预测重症肺炎的AUC为0.929,敏感度和特异度分别为95.2%和84.2%。结论COVID-19患者NLR或D-二聚体水平升高与重症肺炎的发生密切相关,基于这两种指标建立的个体化预警模型对预测重症COVID-19具有较高的诊断价值。
Objective To analyze the diagnostic value of neutrophil to lymphocyte ratio(NLR)and D-dimer in predicting the progression of novel coronavirus disease 2019(COVID-19)pneumonia to severe disease.Methods 194 COVID-19 pneumonia patients admitted to our hospital from December 18,2022 to January 16,2023 were selected as the study subjects.According to whether the patient has severe pneumonia,they are divided into a severe group(42 cases)and a non-severe group(152 cases).Compare the clinical characteristics and laboratory test indicators of two groups of patients and analyze the correlation between NLR and D-Dimer with acute physiology and chronic health(APACHE II)scores at admission.Establish an individualized early warning model through binary logistic regression and verify the diagnostic value of the model.Results The age,APACHE II score,serum WBC,NEU,NLR,D-Dimer levels,and the proportion of patients with concomitant coronary heart disease in the severe group were significantly higher than those in the non-severe group,while LYM was significantly lower than that in the non-severe group(P<0.05).Among them,NLR was positively correlated with APACHE II score(r=0.587,P<0.05),while D-Dimer was negatively correlated with APACHE II score(r=0.673,P<0.05).Binary logistic regression analysis suggests that an increase in NLR levels is an independent risk factor for the exacerbation of COVID-19 pneumonia in patients(OR=1.522,95%CI:1.141-2.031),while a increase in D-Dimer levels is an independent risk factor(OR=1.084,95%CI:1.016-1.156).The ROC curve analysis shows that the AUC of the model for predicting severe pneumonia is 0.929,with sensitivity and specificity of 95.2%and 84.2%,respectively,significantly improved compared to a single indicator.Conclusion The increase in NLR levels or the decrease in D-Dimer levels in COVID-19 pneumonia patients are closely related to the occurrence of severe pneumonia.The personalized early warning model established based on these two indicators has high diagnostic value for predicting severe pn
作者
吴宝川
董翠莲
张珍珠
WU Baochuan;DONG Cuilian;ZHANG Zhenzhu(Department of Laboratory,910 th Hospital of the Joint Logistics Force of the Chinese People's Liberation Army,Quanzhou City,Fujian Province,362000,China)
出处
《蛇志》
2024年第3期315-320,共6页
Journal of Snake
