目的:评估中性粒细胞/淋巴细胞比值(NLR)对脓毒症患者早期病情判断及预后预测的价值。方法:回顾性分析138例成人脓毒症患者的临床资料，记录28 d预后情况。收集患者性别、年龄、基础疾病，入院1 d内血常规、降钙素原(PCT)、肝肾功能、动脉血气分析、原发感染部位、感染病原体种类，计算APACHEⅡ评分和SOFA评分，记录入院2 d和3 d血常规检测结果，计算出院前3 d 的NLR。根据患者28 d生存情况分为存活组和死亡组，比较两组患者中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、NLR的变化水平。采用Logistic回归分析筛选脓毒症患者28 d死亡的高危因素；绘制受试者工作特征(ROC)曲线，评估NLR对脓毒症患者28 d死亡的预测价值；采用Kaplan-Meier生存曲线分析脓毒症患者28 d累积生存情况。结果:共有60例脓毒症患者纳入分析，其中28 d内存活34例，死亡26例。两组患者NEU水平和NLR水平在入院1、2、3 d逐渐降低，LYM水平在入院1、2、3 d逐渐升高；且死亡组NEU水平在3 d显著低于存活组(P＜0.05)，死亡组NLR在入院1、2、3 d均明显高于存活组(均P＜0.05)，死亡组LYM水平在2 d、3 d显著高于存活组(均P＜0.05)。Logistic回归单因素分析显示:入院3 d NEU、2 d LYM、3 d LYM及各时间点NLR与脓毒症患者28 d死亡相关(均P＜0.05)；多因素分析显示:入院1 d NLR、SOFA评分高是脓毒症患者28 d死亡的独立危险因素(均P＜0.05)。ROC曲线分析显示，1 d、2 d和3 d NLR预测脓毒症患者28 d死亡风险的曲线下面积(AUC)分别为0.725、0.671和0.691，具有统计学意义。Kaplan-Meier生存曲线分析显示，1 d NLR ≥17.40时，患者28 d累积生存率明显低于1 d NLR <17.40时(39.3% vs 71.9%；Log-rank χ2=10.745，P=0.001)。结论:入院时NLR升高能够协助脓毒症的早期诊断，升高的NLR对脓毒症患者28 d死亡风险具有良好的预测价值。
Predictive value of neutrophil to lymphocyte ratio in early diagnosis and prognosis of sepsis
JIN Xinmei，HOU Yong-liang，LU Hong-jun
Traditional Chinese Medicine Hospital of Rizhao, Rizhao (276800), China
Abstract:
Objective To evaluate the predictive value of neutrophil / lymphocyte ratio (NLR) in the early diagnosis and prognosis of patients with sepsis. Methods The clinical data of 138 adult patients with sepsis were analyzed retrospectively, and the 28 day prognosis was recorded. Collect the patient' s gender, age, basic diseases, blood routine, procalcitonin (PCT), liver and kidney function, arterial blood gas analysis, primary infection site and type of infection pathogen within 1 day after admission, calculate Apache Ⅱ score and SOFA score, record the blood routine test results on 2 and 3 days after admission, and calculate the NLR in the first 3 days. The patients were divided into survival group and death group according to the 28 day survival. The changes of NEU, LYM and NLR were compared between the two groups. Logistic regression analysis was used to screen the high risk factors of 28 day death in patients with sepsis; The receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of NLR for 28 day death in patients with sepsis; Kaplan-Meier survival curve was used to analyze the 28 day cumulative survival of patients with sepsis. Results A total of 60 patients with sepsis were included in the analysis, of which
