摘要
目的探讨血清中性粒细胞与淋巴细胞计数比值(NLR)对呼吸机相关性肺炎(VAP)的诊断价值。方法选取2018年12月—2019年12月新疆医科大学第五附属医院重症医学科收治有创机械通气治疗患者77例,根据7 d内是否发生VAP分为VAP组24例和非VAP组53例;根据抗感染治疗1周后不同效果将VAP组分为改善亚组(n=17)和恶化亚组(n=7),获取不同时间点NLR、PCT及临床肺部感染评分(CPIS),并通过绘制受试者工作特征曲线(ROC)判断三者对VAP的诊断价值。结果 2组机械通气前NLR、PCT、CPIS比较,差异均无统计学意义(P均>0.05),VAP组在机械通气第4 d时NLR、PCT、CPIS均显著高于机械通气开始时(t/P=2.140/0.038、4.975/<0.001、9.952/<0.001),而非VAP组机械通气开始时与第4 d时比较差异均无统计学意义(P均>0.05)。机械通气第4 d VAP组NLR、PCT、CPIS水平显著高于非VAP组(t/P=7.126/<0.001、6.380/<0.001、6.364/<0.001)。抗感染治疗1周后,VAP患者改善亚组上述指标均显著低于确诊VAP时(t/P=2.077/0.046、2.297/0.023、5.130/<0.001),而恶化亚组均显著高于确诊VAP时(t/P=2.243/0.045、2.371/0.035、2.428/0.032),且改善亚组3项指标均显著低于恶化亚组(t/P=7.281/<0.001、14.930/<0.001、10.710/<0.001)。VAP患者NLR、PCT与CPIS均呈正相关(r=0.847、0.836,P均<0.001),NLR诊断VAP的AUC为0.845,截断值为8.765时,其敏感度及特异度分别为83.33%、75.47%,约登指数为0.588。三者联合检测诊断VAP的AUC为0.901,敏感度、特异度分别为87.50%、75.47%,约登指数为0.630。结论 NLR在VAP诊断中有较高敏感度及特异度,监测其动态变化可能有助于早期诊断VAP和进行预后评估。
Objective To investigate the diagnostic value of serum neutrophil to lymphocyte ratio(NLR)in ventilator-associated pneumonia(VAP).Methods From December 2018 to December 2019,77 patients with invasive mechanical ventilation were treated in the intensive care department of the Fifth Affiliated Hospital of Xinjiang Medical University.According to the condition,they were divided into VAP group(n=24)and non VAP group(n=53).According to the effect of anti infection treatment after one week,VAP group was divided into improvement subgroup and deterioration subgroup.NLR,PCT and CPIS at different time points were obtained,and the diagnostic value of three indicators was analyzed The receiver operating characteristic(ROC)curve was drawn to judge its diagnostic value for VAP.Results There was no significant difference in NLR,PCT and CPIS between VAP group and non VAP group before mechanical ventilation(all P>0.05).NLR,PCT and CPIS of VAP group on the 4th day of mechanical ventilation were significantly higher than those at the beginning of mechanical ventilation(t/P=2.140/0.038,4.975/<0.001,9.952/<0.001).There was no significant difference in NLR,PCT and CPIS between non VAP group and the 4th day of mechanical ventilation(all P>0.05)05),the NLR,PCT levels and CPIS of VAP group were significantly higher than those of non VAP group on the fourth day of mechanical ventilation(t/P=7.126/<0.001,6.380/<0.001,6.364/<0.001).After one week of anti infection treatment,the above three indexes of improvement subgroup were significantly lower than those of deterioration subgroup(t/P=7.281/<0.001,14.930/<0.001,10.710/<0.001),and the above indexes of improvement subgroup were significantly lower than those of diagnosis of VAP(t/P=2.077/0.046,2.297/0.023,5.130/<0.001),while deterioration subgroup were significantly higher than those of diagnosis of VAP(t/P=2.243/0.045,2.371/0.035,2.428/0.032).When VAP was diagnosed,NLR,PCT and CPIS were positively correlated(r=0.847,0.836,P<0.001).The AUC of NLR in the diagnosis of VAP was 0.845.When the critical value was 8.765,the sensitivity and specificity were 83.33%and 75.47%respectively,Youden`s index was 0.588,when combined the 3 factors,the sensitivity,specificity and Youden index was 87.50%,75.47%and 0.630.Conclusion NLR has high sensitivity and specificity in the diagnosis of VAP.Monitoring its dynamic changes may be helpful for early diagnosis and prognosis evaluation of VAP.
作者
罗彬
林爽
杨健
方喆琦
马骏麒
Luo Bin;Lin Shuang;Yang Jian;Fang Zheqi;Ma Junqi(Department of ICU.Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;不详)
出处
《疑难病杂志》
CAS
2021年第4期373-377,共5页
Chinese Journal of Difficult and Complicated Cases
基金
新疆维吾尔自治区自然科学基金资助项目(2019D01C166)。
作者简介
通信作者:马骏麒,E-mail:1477582405@qq.com。
