外周血NLR和CRP/ALB值对获得性败血症预后评估的临床价值-现代医学

外周血NLR和CRP/ALB值对获得性败血症预后评估的临床价值

单位：安徽省宣城市人民医院感染科, 安徽宣城 242000

分类号：R515.3

出版年·卷·期（页码）：2020·39·第六期（699-704）

摘要：

目的： 检测计算获得性败血症患者的外周血中性粒细胞/淋巴细胞值（NLR）及C反应蛋白（CRP）/白蛋白（ALB）值，探讨二者对获得性败血症预后评估的临床价值。方法： 选取2017年1月至2019年10月本院收治的获得性败血症患者85例，根据30 d后是否治愈分为预后良好组（53例）和预后不良组（32例），选取局部感染患者88例、健康体检者90例作为对照。分别采集3组外周血，利用免疫荧光干式定量法检测CRP水平，溴甲酚绿法检测ALB水平，酶联免疫吸附法（ELISA）检测白细胞介素-6（IL-6）水平，电化学发光法检测降钙素原（PCT）水平、并计算CRP/ALB值，使用全自动血细胞分析仪记录中性粒细胞、淋巴细胞个数并计算NLR，采用多因素Logistic回归分析影响获得性败血症患者预后的因素，采用受试者工作特征（ROC）曲线分析NLR、CRP/ALB值对获得性败血症的预后价值。结果： 与对照组相比，局部感染组、败血症组患者外周血NLR、CRP/ALB值、IL-6和PCT水平明显升高（P<0.05）；与局部感染组相比，败血症组患者外周血NLR、CRP/ALB值、IL-6和PCT明显升高（P<0.05）；与预后良好组相比，预后不良组患者外周血NLR、CRP/ALB值、IL-6和PCT水平明显升高（P<0.05）；NLR、CRP/ALB值与IL-6和PCT均明显正相关（均P<0.05）；NLR、CRP/ALB值、IL-6、PCT水平均为影响获得性败血症患者预后的危险因素；NLR、CRP/ALB值联合预测ROC曲线下面积为0.930（95%CI为0.857~1.000），敏感度为87.8%，特异性为94.3%。结论： 获得性败血症患者外周血NLR、CRP/ALB值均明显升高，且与炎症因子指标关系密切，是影响获得性败血症预后的危险因素，对获得性败血症预后具有一定的预测价值。

Objective: To detect the ratios of neutrophil to lymphocyte(NLR) and C-reactive protein to albumin (CRP/ALB) in peripheral blood of patients with acquired septicemia, and to explore their clinical values in evaluating the prognosis of patients with acquired septicemia.Methods: 85 patients with acquired septicemia admitted to our hospital from January 2017 to October 2019 were divided into good outcome group(53 cases) and poor outcome group(32 cases) according to whether they cured after 30 days. Another 88 patients with local infection and 90 healthy people were selected as controls. Three groups of peripheral blood were collected, the levels of C-reactive protein(CRP) were detected by immunofluorescence dry quantitative analysis method, the levels of albumin(ALB) were detected by bromocresol green method, the levels of interleukin-6(IL-6) were detected by enzyme-linked immunosorbent assay(ELISA), the levels of procalcitonin(PCT) were detected by electro-chemiluminescence, and the CRP/ALB was calculated. The numbers of neutrophils and lymphocytes were recorded by automatic blood cell analyzer and the ratio of NLR was calculated, the prognostic factors affecting the prognosis of patients with acquired septicemia were analyzed by multivariate logistic regression, and the prognostic values of NLR and CRP/ALB for acquired septicemia were analyzed by receiver operating characteristic(ROC) curve.Results: Compared with the control group, the levels of NLR, CRP/ALB, IL-6 and PCT in peripheral blood of the local infection group and the septicemia group increased significantly(P<0.05); compared with the local infection group, the levels of NLR, CRP/ALB, IL-6 and PCT in peripheral blood of the septicemia group increased significantly(P<0.05); compared with the good outcome group, the levels of NLR, CRP/ALB, IL-6 and PCT in peripheral blood of the poor outcome group increased significantly(P<0.05); NLR, CRP/ALB were positively correlated with IL-6 and PCT(all P<0.05); NLR, CRP/ALB, IL-6 and PCT levels were all risk factors affecting the prognosis in patients with acquired septicemia; the area under ROC curve of NLR, CRP/ALB joint prediction was 0.930(95% CI:0.857-1.000), the sensitivity was 87.8%, and the specificity was 94.3%. Conclusions: The NLR and CRP/ALB in peripheral blood of patients with acquired septicemia are significantly increased, which are closely related to inflammatory factors and are risk factors for the prognosis of patients with acquired septicemia. They have certain predictive values for patients with acquired septicemia and can be used as prognostic markers for patients with acquired septicemia.

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