红细胞体积分布宽度、总淋巴细胞计数对社区获得性肺炎并发脓毒症预后评估的价值分析-现代医学

红细胞体积分布宽度、总淋巴细胞计数对社区获得性肺炎并发脓毒症预后评估的价值分析

单位：1. 沧州市人民医院呼吸内科, 河北沧州 061000;
2. 任丘市第二人民医院综合内科, 河北沧州 062550

分类号：R563.1

出版年·卷·期（页码）：2022·50·第三期（279-284）

摘要：

目的：分析红细胞体积分布宽度(RDW)、总淋巴细胞计数(TLC)对社区获得性肺炎(CAP)并发脓毒症预后评估的价值。方法：选取2015年7月至2019年9月沧州市人民医院呼吸内科收治的CAP患者671例作为研究对象，根据是否并发脓毒症分为CAP组(598例)和CAP合并脓毒症组(73例)。另选取同期在该院进行体检的健康人90例作为对照组。收集受试者一般资料，血气分析仪器检测动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)水平；采用魏氏法检测血沉；全自动生化分析仪检测受试者血清白细胞计数、RDW、TLC；酶联免疫吸附法(ELISA)测定受试者血清白介素(IL)-6、IL-8水平；比较CAP并发脓毒症患者不同生存状态血清中RDW、TLC；多因素Logistic回归分析CAP患者并发脓毒症的影响因素；受试者工作特征(ROC)曲线分析RDW、TLC对CAP并发脓毒症患者预后的预测价值。结果：与对照组相比，CAP组、CAP合并脓毒症组PaO₂、TLC依次降低(P<0.05)，PaCO₂、白细胞计数、血沉、IL-6、IL-8、RDW依次升高(P<0.05)。生存组血清RDW低于死亡组(P<0.05)，TLC高于死亡组(P<0.05)。多因素Logistic回归分析，结果显示，RDW偏高及TLC偏低是CAP患者并发脓毒症的独立危险因素(P<0.05)。ROC曲线分析显示，RDW、TLC预测CAP并发脓毒症患者预后的曲线下面积(AUC)分别为0.821(95%CI 0.675~0.967)、0.851(95%CI 0.741~0.961)，敏感度为88.9%、94.4%，特异度为72.0%、70.0%；联合检测预测CAP并发脓毒症患者预后的AUC为0.935(95%CI 0.914~0.975)，敏感度为97.1%，特异度为68.5%。结论：CAP患者血清中RDW升高，TLC降低，两者是CAP并发脓毒症的独立危险因素，可能作为CAP并发脓毒症预后的诊断标志物。

Objective: To analyze the value of red blood cell volume distribution width(RDW) and total lymphocyte count(TLC) in prognosis evaluation of community-acquired pneumonia(CAP) complicated with sepsis. Methods: From July 2015 to September 2019, 671 patients with CAP admitted to respiratory department of Cangzhou People's Hospital were selected and divided into CAP group(598 Cases) and CAP combined with sepsis group(73 cases) according to whether sepsis occurred. Another 90 healthy people who had physical examination in Cangzhou People's Hospital during the same period were selected as the control group. The general data of the subjects were collected, the arterial partial pressure of oxygen(PaO₂) and arterial partial pressure of carbon dioxide(PaCO₂) were detected by blood gas analyzer; erythrocyte sedimentation rate(ESR) was detected by Widmann method; the levels of white blood cell count, RDW and TLC were detected by automatic biochemical analyzer; the levels of interleukin(IL)-6 and IL-8 were measured by enzyme-linked immunosorbent assay(ELISA); the levels of serum RDW and TLC in CAP patients with sepsis were compared; multivariate Logistic regression analysis was used to analyze the influencing factors of sepsis in CAP patients. ROC curve was used to analyze the prognostic value of RDW and TLC in CAP patients with sepsis. Results: Compared with those in the control group, the levels of PaO₂ and TLC in CAP group and CAP combined with sepsis group decreased in turn(P<0.05), while PaCO₂, WBC count, ESR, IL-6, IL-8 and RDW increased in turn(P<0.05). The level of RDW in the survival group was lower than that in the death group(P<0.05), and the level of TLC in the survival group was higher than that in the death group(P<0.05). Multivariate Logistic regression analysis showed that high level of RDW and low level of TLC were independent risk factors of sepsis in CAP patients(P<0.05). ROC curve analysis showed that the area under the curve(AUC) of RDW and TLC levels in predicting the prognosis of CAP patients with sepsis was 0.821(95%CI 0.675-0.967) and 0.851(95%CI 0.741-0.961), the sensitivity was 88.9%, 94.4%, the specificity was 72.0%, 70.0%, respectively; the AUC of combined diagnosis was 0.935(95%CI 0.914-0.975), the sensitivity was 97.1%, and the specificity was 68.5%. Conclusion: The level of serum RDW in CAP patients is increased, and the level of TLC is decreased. Both of them are independent risk factors of CAP complicated with sepsis, and may be used as diagnostic markers for prognosis of CAP complicated with sepsis.

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