【摘要】 目的评估血中性粒细胞/淋巴细胞比值(NLR)、血嗜酸性粒细胞(EOS)对急性呼吸窘迫综合征(ARDS)患者28 d死亡风险的预测价值,探讨预测ARDS患者预后的方法。方法回顾性分析2017年1月至2019年1月承德医学院附属医院收治的85例ARDS患者的临床资料,依据治疗28 d后的存活状况分为存活组(n=45)和死亡组(n=40)。多因素Logistic回归分析临床资料确定ARDS患者死亡的高危因素。利用受试者工作特征曲线(ROC)评估NLR及EOS对ARDS患者28 d死亡风险的预测价值。结果两组疾病诱因比较差异无统计学意义(P> 0.05)。死亡组急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、Murray肺损伤评分和序贯器官衰竭评分(SOFA)均高于存活组(P<0.05);两组中性粒细胞百分比(GR%)、淋巴细胞计数(LYM)、血小板计数(PLT)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和血乳酸(Lac)比较差异均无统计学意义(P>0.05)。死亡组血白细胞计数(WBC,×10~9/L:21.10±4.29 vs.19.71±5.32)、中性粒细胞计数(NEU,×10~9/L:11.56±6.83 vs.8.15±5.64)、NLR(16.05±6.34 vs.12.29±5.10)和降钙素原(PCT,μg/L:11.78±5.21 vs.7.82±4.56)均高于存活组,血嗜酸性粒细胞计数(EOS,×10~9/L:0.04±0.05 vs.0.05±0.07)和氧合指数(OI,mm Hg:140.47±12.52 vs. 144.53±12.13)均低于存活组(P<0.05)。多因素Logistic回归分析显示,EOS、NLR,、PCT、OI和Murray肺损伤评分是ARDS患者28 d死亡的独立危险因素(P <0.05);NLR对ARDS患者死亡风险的预测价值曲线下面积(AUC)为0.745(95%CI0.618～0.872),当最佳截断值为0.460时,敏感度为78.1%,特异度为67.9%;EOS对ARDS患者死亡风险的预测价值AUC为0.727(95%CI0.599～0.855),当最佳截断值为0.446时,敏感度为62.5%,特异度为82.1%。结论NLR、EOS是ARDS患者28 d死亡的独立危险因素。NLR及EOS对ARDS患者的28 d死亡风险具有良好的预测价值,可作为ARDS预后评估有效而简便的指标。更多还原

【Abstract】 Objective To evaluate the predictive value of neutrophil to lymphocyte ratio(NLR)and eosinophils(EOS) in 28-day mortality of patients with acute respiratory distress syndrome(ARDS),and to explore the ways to improve the prediction of the prognosis of ARDS.Methods The clinical data of 85 patients with ARDS admitted to our hospital from January 2017 to January 2019 were analyzed retrospectively.The patients were divided into the survival group(n=45) and the death group(n=40) according to the survival status after 28-day treatment.Multivariate Logistic regression analysis was used to screen the high risk factors of 28-day mortality in the patients with ARDS.Receiver operating characteristic(ROC) curve were drawn to evaluate the predictive value of NLR and EOS for 28-day mortality risk in ARDS patients.Results There was no significant difference in the causes of diseases between the two groups(P> 0.05).The APACHE II score,Murray lung injury score and SOFA score were all higher in the death group than in the survival group(P <0.05).There were no significant difference in neutrophil percentage,lymphocyte(LYM),platelet(PLT),alanine transaminase(ALT),aspartate transaminase(AST) and blood lactic acid(Lac) between the two groups(P>0.05).WBC(×10~9/L:21.10±4.29 vs.19.71±5.32),NEU(×10~9/L:11.56±6.83 vs.8.15±5.64),NLR(×10~9/L:16.05±6.34 vs.12.29±5.10),PCT(μg/L:11.78±5.21 vs.7.82±4.56) were all in the death group higher in the death group than in the survival group,EOS(x10~9/L:0.04±0.05 vs.0.05±0.07),OI(mm Hg:140.47±12.52 vs.144.53±12.13) were both lower than in the survival group(P <0.05).Multivariate Logistic regression analysis showed that EOS,NLR,PCT,01 and Murray lung injury score were independent risk factors for 28-day death of ARDS patients(P <0.05).The area of ROC under the curve was 0.745(95% CI 0.618-0.872),and the cut-off value was 0.460 for the prediction of mortality by NLR of patients with ARDS,with sensitivity of 78.1% and specificity of 67.9%.The area of ROC under the curve was 0.727(95% CI 0.599-0.855),and the cut-off value was 0.446 for the prediction of mortality by EOS of patients with ARDS,with sensitivity of 62.5% and specificity of 82.1%.Conclusion NLR and EOS were independent risk factors for 28-day death of ARDS patients.NLR and EOS can predict the 28-day mortality of patients with ARDS,and can be used as an effective and simple index to evaluate the prognosis of ARDS.更多还原