血细胞参数在急性肺栓塞患者预后中的应用价值探讨

发布时间：2018-09-02 08:16

【摘要】：[目的]探讨血细胞参数中性粒细胞淋巴细胞计数比值(neutrophil lymphocyte ratio,NLR)、血小板-淋巴细胞比率(platelet-lymphocyteratio,PLR)、血小板分布宽度(platelet distribution width,PDW)、红细胞分布宽度(Red Cell Distribution Width,RDW)等在入院时血流动力学稳定的急性肺栓塞患者预后中的应用价值,明确其是否具有相关性及优越性,是否可作为预测急性肺栓塞患者的预后指标。[方法]共计207例初入院时血流动力学稳定的急性肺栓塞患者完成本次研究。第一阶段通过对在昆明医科大学第二附属医院2015年4月1日——2016年6月30日确诊肺栓塞的符合纳入排除标准的135例患者进行回顾性调查,探讨未发生临床不良事件组(n=111例)和发生临床不良事件组(n=24例)不同组间的相关血细胞是否存在统计学差异;第二阶段通过对2016年7月1日——2017年3月1日期间确诊肺栓塞的符合纳入排除标准的72例患者进行30天随访调查,根据第一阶段所得指标最佳临界值进行分组,验证前述相关血细胞参数预测临床不良事件发生的价值及优越性。[结果]1.第一阶段共计135例肺栓塞患者中,发生临床不良事件组与未发生临床不良事件组的血细胞参数WBC、N、NLR、PLR具有明显统计学差异,而PDW、RDW无统计学意义。经ROC曲线进一步分析,WBC、N、NLR、PLR曲线下面积分别为 0.78、0.81、0.87、0.60,WBC、N、NLR 的 P 值均小于 0.01、PLR的P值为0.11。WBC、N、NLR、Pro-BNP、cTNT-hs预测临床不良事件发生的敏感度、特异度、阳性预测值、阴性预测值分别为:83.3%、75.7%、42.5%、95.5%;83.3%、80.2%、47.6%、95.7%;95.8%、73%、43.4%、98.8%;75%、55%、21.8%、90.8%;70.8%、62.2%、28.8%、90.8%。NLR预测临床不良事件发生的最佳临界值为4.87。2.第二阶段共计72例肺栓塞患者中,NLR≥4.87组肺栓塞患者(n=22例)与NLR4.87组肺栓塞患者(n=50例)血细胞参数WBC、N、NLR具有明显统计学差异,NLR最优,余血细胞参数无明显统计学意义。NLR≥4.87组肺栓塞患者的临床不良事件发生率是NLR4.87肺栓塞患者的22.73倍。经ROC曲线进一步分析,NLR、cTNT-hs、Pro-BNP 的 AUC 分别 0.852、0.781、0.821,P值均小于0.05,预测临床不良事件发生的敏感度、特异度、阳性预测值、阴性预测值、RR 值分别为 90.9%、80.3%、45.5%、98%、22.73;72.7%、74%、30%、90.4%、3.12;82%、87%、40.9%、96%、25.00。NLR、Pro-BNP 联合预测临床不良事件发生的ROC曲线下面积为0.879:敏感度、特异度、阳性预测值、阴性预测值分别为 100%、97%、85.7%、100%,P 值为 0.00。[结论]1.NLR、Pro-BNP、cTNT-hs对急性肺栓塞患者临床不良事件发生的预测评估都有一定的价值。2.NLR可作为急性肺栓塞患者临床不良事件发生的独立预测因子,可被用于肺栓塞临床风险分类。3.NLR联合Pro-BNP预测价值更为显著。
[Abstract]:[objective] to investigate the hemodynamic stability of neutrophil lymphocyte count ratio (neutrophil lymphocyte ratio,NLR), platelet-lymphocyte ratio (platelet-lymphocyteratio,PLR), platelet distribution width (platelet distribution width,PDW) and erythrocyte distribution width (Red Cell Distribution Width,RDW) on admission. Clinical value in prognosis of patients with acute pulmonary embolism. To determine whether it has relevance and superiority, whether it can be used as a prognostic index in patients with acute pulmonary embolism. Methods A total of 207 patients with acute pulmonary embolism with stable hemodynamics at first admission completed the study. In the first stage, 135 patients with pulmonary embolism diagnosed at the second affiliated Hospital of Kunming Medical University from April 1, 2015 to June 30, 2016, who met the exclusion criteria, were retrospectively investigated. To investigate whether there were statistical differences in the related blood cells between the group without clinical adverse events (n = 111) and the group with clinical adverse events (n = 24). In the second phase, 72 patients with pulmonary embolism diagnosed during the period from 1 July 2016 to 1 March 2017 who met the exclusion criteria were followed up for 30 days and grouped according to the best critical value of the indicators obtained in the first phase, To verify the value and superiority of the above-mentioned blood cell parameters in predicting the occurrence of clinical adverse events. [result] 1. In the first stage, there were significant differences in blood cell parameters (WBC,N,NLR,PLR) between the patients with clinical adverse events and those without clinical adverse events, but there was no significant difference in PDW,RDW between the patients with clinical adverse events and those with pulmonary embolism. Further analysis was made on the area under the ROC curve of NLRR of WBCCU (0.788 / 0.81 / 0.60). The P value of NLRR of WBCCU was less than 0.01P = 0.11.The sensitivity, specificity and positive predictive value of NLRV Pro-BNPcTNT-hs in predicting clinical adverse events were all lower than that of P value of 0.11% WBCCU NLRU Pro-BNPcTNT-hs. The negative predictive value was: 83.33.3um, 43.35.75.75, 83.30.2and 47.60.2respectively. The negative predictive value was 47.60.75, 75.75.75.75.75.75.75.75.75.75.75.75.75.75.75.75 and 75.75.75.75.75.75.75.75.75.75.75.75.75.75.75.75.75.75 and 43.33.3um, 43.33.3um and 43.32.52.555.55.50.52, respectively. The best critical value for predicting the occurrence of clinical adverse events was 4.87.2.NLR was 4.87.2. In the 72 patients with pulmonary embolism in the second stage, there were significant differences in blood cell parameters (WBC,N,NLR) between NLR 鈮，

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