文章摘要
李一凡,王可欣,王 晨,叶思楠,王 晶,李思颉,王长远.中性粒细胞与淋巴细胞比值在急诊老年社区获得性肺炎中的应用价值[J].,2021,(3):455-458
中性粒细胞与淋巴细胞比值在急诊老年社区获得性肺炎中的应用价值
Application Value of Neutrophil to Lymphocyte Ratio for the Elderly Patients with Community Acquired Pneumonia in Emergency Department
投稿时间:2020-04-23  修订日期:2020-05-18
DOI:10.13241/j.cnki.pmb.2021.03.010
中文关键词: 中性粒细胞与淋巴细胞比值  降钙素原  APACHE II评分  社区获得性肺炎  老年
英文关键词: Neutrophil to lymphocyte ratio  Procalcitonin  APACHE II scores  CAP  Elderly
基金项目:国家自然科学基金项目(81801313);首都医科大学本科生创新项目(XSKY2019138)
作者单位E-mail
李一凡 首都医科大学宣武医院急诊科 北京 100053 jinse102500@163.com 
王可欣 首都医科大学第一临床医学院 北京 100053  
王 晨 首都医科大学第一临床医学院 北京 100053  
叶思楠 首都医科大学第一临床医学院 北京 100053  
王 晶 首都医科大学宣武医院急诊科 北京 100053  
李思颉 首都医科大学宣武医院急诊科 北京 100053  
王长远 首都医科大学宣武医院急诊科 北京 100053  
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中文摘要:
      摘要 目的:探讨中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte rate,NLR)在急诊老年社区获得性肺炎(community acquired pneumonia,CAP)患者中的应用价值。方法:选择2018年10月到2019年10月首都医科大学宣武医院急诊观察室收治的130例老年CAP患者,检测其入院后血常规,血清C反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT)水平,血气分析,生化全项,胸部X线,并给予痰细菌学检查等辅助检查,进行急性生理及慢性健康状况评分(Acute Physiology and Chronic Health Evaluation,APACHE Ⅱ)。入院72h后,再次给予血常规、PCT等检查,比较2组NLR和PCT的差异。随访28天后,根据老年CAP患者的临床转归分成死亡组和生存组,比较2组白细胞(WBC)、NLR、CRP、APACHE Ⅱ评分和PCT及NLR、PCT、APACHE Ⅱ预测老年CAP患者死亡的ROC曲线下面积(AUC)。结果:死亡组CAP患者血清CRP、PCT水平、NLR和APACHE Ⅱ评分均显著高于生存组(P<0.05),2组患者WBC比较差异无明显统计学意义(P=0.341)。APACHE II评分预测老年CAP患者死亡的AUC为0.741(95%CI:0.647~0.836),PCT预测老年CAP患者死亡的AUC为0.723(95%CI:0.610~0.835),NLR预测老年CAP患者死亡的AUC为 0.709 (95%CI:0.602~0.815),NLR预测老年CAP患者死亡的AUC与PCT和APACHE II评分比较无统计学差异(P=0.848,0.662);入院72h死亡组NLR和PCT入院时无明显变化(P>0.05),而生存组NLR和PCT较入院时比较显著降低(P<0.01)。结论:NLR对急诊老年CAP患者的预后预测价值与PCT及APACHE II评分相当,NLR持续高水平状态提示急诊老年CAP患者的预后不良。
英文摘要:
      ABSTRACT Objective: To study the value of Neutrophil to lymphocyte rate (NLR) in elderly patients with community acquired pneumonia (CAP) in emergency department. Methods: 130 elderly patients with CAP were selected in the emergency observation room of Xuanwu Hospital of Capital Medical University from October 2018 to october 2019. After admission,they were given blood routine examination, C reactive protein (CRP), Procalcitonin (PCT), blood gas analysis, biochemical test, chest x-ray and sputum culture, Acute Physiology and Chronic Health Evaluation (APACHE II) was performed.72 hours after admission, blood routine examination and PCT were performed again, the differences of NLR and PCT between the two groups were compared.28 days follow-up, the patients were divided into death group and survival group according to the clinical outcome of the elderly patients with CAP. WBC, NLR, CRP, PCT and APACHE II scores were compared between the two groups, and the area under ROC curve (AUC) to predict death of NLR, PCT and APACHE II were compared. Results: The levels of serum CRP, NLR, PCT and APACHE II scores in the death group were significantly higher than those in the survival group (P<0.05). There was no significant difference in WBC between the two groups (P=0.341). The AUC of APACHE II predicting the death of elderly CAP patients was 0.741(95%CI : 0.647~0.836), the AUC of PCT predicting the death of elderly CAP patients was 0.723(95% CI: 0.610~0.835), the AUC of NLR predicting the death of elderly CAP patients was 0.709(95%CI: 0.602~0.815). The AUC of predicting the death was no significant difference between NLR and PCT or APACHE II (P=0.848,0.662); There was no significant change in NLR and PCT in the death group 72 hours after admission (P>0.05), while NLR and PCT in the survival group were significantly lower than those in the admission (P<0.01). Conclusion: The predictive value of NLR in evaluating the prognosis of elderly patients with CAP is similar to that of PCT and APACHE II scores in emergency department. The continuous high NLR level indicates that the prognosis of elderly patients with CAP is poor.
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