| 刘雨萌,黄 燕,唐 礼,庹 俊,董有智,王 雄,甘建和.系统性炎症指标预测脓毒性休克预后的临床价值[J].现代生物医学进展英文版,2023,(20):3899-3902. |
| 系统性炎症指标预测脓毒性休克预后的临床价值 |
| Clinical Value of Systemic Inflammatory Markers in Predicting the Prognosis of Septic Shock |
| Received:March 26, 2023 Revised:April 21, 2023 |
| DOI：10.13241/j.cnki.pmb.2023.20.020 |
| 中文关键词: 脓毒性休克 中性粒细胞淋巴细胞比值 预后评估 |
| 英文关键词: Septic shock Neutrophil-lymphocyte Ratio Prognostic Evaluation |
| 基金项目:国家"十三五"重大科技专项（2017ZX10203201-002-002）；铜仁市科技计划研究专项（2018年） |
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| 中文摘要: |
| 摘要 目的：探讨系统性炎症指标对脓毒性休克预后的临床预测价值。方法：回顾性分析2019年7月至2022年7月贵州省铜仁市石阡人民医院重症医学科救治的脓毒性休克患者46例（治疗组），46例患者随访60 d后根据临床预后分为存活组22例和死亡组24例。收集患者入院后治疗前血常规中白细胞、中性粒细胞、淋巴细胞、单核细胞和血小板计数，计算中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）、血小板与淋巴细胞比值（platelet-to-lymphocyte ratio，PLR）、淋巴细胞与单核细胞比值（lymphocyte-to-monocyte ratio，LMR），同时记录生化中肌酐（Cr）、C反应蛋白（CRP）等指标，比较治疗后存活组和死亡组上述指标的差异，观察NLR、PLR、LMR与Cr水平的相关性。以Shapiro-Wilk检验进行正态性检验；Mann-Whitney U检验非正态分布的两组计数资料；相关性研究采用Spearman相关性分析；影响脓毒性休克预后的独立危险因素采用二分类logistic回归分析，并绘制生存曲线和受试者工作特征曲线（ROC曲线），评估危险因素预测脓毒性休克发生死亡事件的价值。结果：治疗组与正常对照组相比，入院时白细胞、中性粒细胞、淋巴细胞、单核细胞、血小板计数、NLR、PLR、LMR，差异有统计学意义（P＜0.01）。患者入院当天中性粒细胞、淋巴细胞、NLR、CRP在存活组与死亡组之间比较，差异有统计学意义（均P＜0.05），其余指标差异无统计学意义。脓毒性休克患者肌酐水平与NLR呈正相关（P＜0.01）。多因素logistic回归分析，结果显示仅有NLR是影响脓毒性休克患者60d预后的独立危险因素（OR=1.038，P= 0.031）。ROC曲线分析发现曲线下面积为0.705（95% CI: 0.597~0.812，P=0.001）；根据约登指数原则提示NLR预测死亡风险的截断值为16.35（敏感度为66.7%，特异度为72.7%），即NLR＞16.35时脓毒性休克的死亡率较高。Kaplan-Meier法分析治疗后60天生存预后，结果显示NLR≤16.35组中位生存期显著高于NLR＞16.35组，（χ2=5.568，P= 0.018）。结论：ICU初始NLR有助于脓毒性休克的病情判断并对患者生存预后评估有一定的临床价值，是发生死亡事件的独立预测指标。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the clinical value of systemic inflammatory markers in predicting the prognosis of septic shock. Methods: 46 patients with septic shock treated in the Department of severe Medicine, Shiqian people's Hospital, Tongren City, Guizhou Province from July 2019 to July 2022 were retrospectively analyzed. 46 patients were followed up for 60 days and divided into survival group (n=22) and death group (n=24). The counts of leukocytes, neutrophils, lymphocytes, monocytes and platelets were collected before admission, and the ratio of neutrophils to lymphocytes (neutrophil-to-lymphocyte ratio, NLR), the ratio of platelets to lymphocytes (platelet-to-lymphocyte ratio, PLR) and the ratio of lymphocytes to monocytes (lymphocyte-to-monocyte ratio, LMR) were calculated. At the same time, the biochemical indexes such as creatinine (Cr) and C-reactive protein (CRP) were recorded, the differences of these indexes between the survival group and the death group were compared, and the correlation between NLR, PLR, LMR and Cr levels was observed. Shapiro-Wilk test was used for normality test, Mann-Whitney U test was used to compare the count data of the two groups with non-normal distribution, Spearman correlation analysis was used for correlation analysis, binary logistic regression analysis was used to explore the independent risk factors affecting the prognosis of septic shock, and the working characteristic curve (ROC curve) and survival curve were drawn to evaluate the value of risk factors in predicting the death of septic shock. Results: There were significant differences in leukocyte, neutrophil, lymphocyte, monocyte, platelet count, NLR, PLR and LMR between the treatment group and the normal control group. There were significant differences in neutrophils, lymphocytes, NLR and CRP between the survival group and the death group on the day of admission, but there was no significant difference in other indexes. The level of creatinine was positively correlated with NLR in patients with septic shock. Multivariate logistic regression analysis showed that only NLR was an independent risk factor for 60-day prognosis of patients with septic shock (OR=1.038, P= 0.031). ROC curve analysis found that the area under the curve was 0.705 (95% CI: 0.597 ～ 0.812); the cutoff value of NLR to predict the risk of death was 16.35 (sensitivity was 66.7%, specificity was 72.7%) according to the principle of Yoden index, that is, the mortality rate of septic shock was higher when NLR > 16.35. Kaplan-Meier method was used to analyze the survival prognosis at 60 days after treatment. The results showed that the median survival time of NLR ≤ 16.35 group was significantly higher than that of NLR > 16.35 group (P=0.018). Conclusion: The initial NLR of ICU is helpful to judge the condition of septic shock and has certain clinical value in evaluating the survival and prognosis of patients, and it is an independent predictor of death. |
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