肺栓塞患者炎症指标与CT肺动脉阻塞指数的关系

发布时间：2018-11-19 22:29

【摘要】：目的:研究PE患者WBC、中性粒细胞计数、淋巴细胞计数、NLR、PLR和血清IL-6水平治疗前后的变化规律,与PAOI及其变化率的相关性,探讨上述指标在评估肺栓塞栓子负荷及近期血栓溶解效果上的临床意义。方法:前瞻性研究2015年06月至2017年02月3家合作医院呼吸内科经CTPA首次确诊的47例PE患者,同时间段37例健康成人作为对照组。比较两组治疗前WBC、中性粒细胞计数、淋巴细胞计数、NLR、PLR及血清IL-6水平差异及其PE组在治疗前后上述指标的差异。PE组采用Mastora评分法评估治疗前后PAOI,根据不同PAOI值分为低阻塞组(PAOI30%)31例,中阻塞组(PAOI 30%~50%)12例和高阻塞组(PAOI50%)4例,比较3组间炎症指标水平差异。监测PE组治疗前和治疗后14天内炎症指标的变化,描述其变化规律、与PAOI的相关性及其与PAOI变化率的关系。结果:与健康对照组比较,PE组治疗前WBC、中性粒细胞计数、NLR、PLR和IL-6水平均明显升高((10.44±3.18)×109/L vs(6.37±2.19)×109/L P=0.000,(7.95±3.03)×109/L vs(3.74±2.41)×109/L P=0.000,5.43±3.92 vs 1.71±0.74 P=0.000,165.58±136.73 vs 123.18±51.05 P=0.01,25.14±25.97 vs 6.45±7.15 P=0.000),淋巴细胞计数明显降低((1.55±0.64)×109/L vs(2.20±0.57)×109/L P=0.000)。PE组治疗前不同阻塞程度分组的WBC、中性粒细胞计数、NLR和IL-6均随阻塞程度的升高而升高,组间差异均具有统计学意义(P分别为0.038,0.024,0.049,0.000)。PE组治疗后14天内WBC、中性粒细胞计数和NLR连续下降;淋巴细胞计数于治疗后第1~3天上升,第3~7天平稳,第7~14天上升;PLR于治疗后第1~3天下降,第3~7天上升,第7~14天平稳。与治疗前比较,PE组治疗后第14天的WBC、中性粒细胞计数、NLR和IL-6水平均明显降低((10.44±3.18)×109/L vs(6.93±2.46)×109/L P=0.000,(7.95±3.03)×109/L vs(4.31±2.08)×109/L P=0.000,5.43±3.92 vs 2.55±1.50 P=0.000,25.14±25.97 vs 6.25±7.45 P=0.000),淋巴细胞计数明显升高((1.55±0.64)×109/L vs(1.90±0.37)×109/L,P=0.000),PLR治疗前后无统计学差异(P=0.421)。PE组治疗前WBC、中性粒细胞计数、NLR和IL6与PAOI呈正相关(r分别为0.394、0.430、0.417、0.547,P分别为0.006、0.003、0.004、0.000),NLR与PAOI变化率呈负相关(r=-0.352,P=0.015),淋巴细胞计数与PAOI变化率呈正相关(r=0.335,P=0.021)。治疗后IL6与PAOI呈正相关(r=0.498,P=0.000)。结论:PE治疗前WBC、中性粒细胞计数、NLR和IL-6水平可反映血栓负荷程度,NLR越低、淋巴细胞计数越高,血栓溶解效果越显著。PE治疗后WBC、中性粒细胞计数、NLR和IL-6连续下降,淋巴细胞计数连续上升,提示PE炎症反应减弱,血栓溶解吸收,可反映PE患者的近期血栓溶解效果。PE患者治疗后IL-6水平与PAOI呈正相关,可以反映PE患者的残余血栓程度。
[Abstract]:Objective: to study the changes of WBC, neutrophil count, lymphocyte count, NLR,PLR and serum IL-6 levels before and after treatment in patients with PE, and the correlation with PAOI and its change rate. Objective: to evaluate the clinical significance of the above indexes in the evaluation of thrombotic load and thrombolytic effect in the near future. Methods: a prospective study of 47 patients with PE diagnosed by CTPA in respiratory department of 3 cooperative hospitals from June 2015 to February 2017 was carried out, and 37 healthy adults were used as control group in the same period. The WBC, neutrophil count, lymphocyte count, NLR,PLR and serum IL-6 levels were compared between the two groups before and after treatment, and the above indexes in PE group were compared before and after treatment. Mastora score was used to evaluate PAOI, in PE group before and after treatment. According to different PAOI values, there were 31 cases of low occlusion group (PAOI30%), 12 cases of middle occlusion group (PAOI 30%) and 4 cases of high occlusion group (PAOI50%). The changes of inflammatory indexes before treatment and 14 days after treatment in PE group were monitored, and the relationship between the changes of inflammatory indexes and PAOI and the change rate of PAOI were described. Results: compared with the healthy control group, the neutrophil count, NLR,PLR and IL-6 levels of WBC, in PE group were significantly increased (10.44 卤3.18) 脳 10 ~ 9 / L vs (6.37 卤2.19) 脳 10 ~ 9 / L P _ (0.000) before treatment. (7.95 卤3.03) 脳 10 ~ (9) L vs (3.74 卤2.41) 脳 10 ~ (9) vs ~ (0.000) 卤3.92 vs 1.71 卤0.74 vs 0.000165.58 卤136.73 vs 123.18 卤51.05 vs 0.01 卤25.14 卤25.97 vs 6.45 卤7.15 P0.000), and (7.95 卤3.03) 脳 10 ~ (9) / L vs (3.74 卤2.41) 脳 10 ~ (9) / L). The lymphocyte count was significantly decreased (1.55 卤0.64) 脳 10 9 / L vs (2.20 卤0.57) 脳 10 9 / L WBC, neutrophil count in groups with different degrees of obstruction before treatment. Both NLR and IL-6 increased with the increase of the degree of occlusion, and the difference between the two groups was statistically significant (P = 0.038, 0.024, 0.049 and 0.000). PE, respectively). Within 14 days after treatment, WBC, neutrophil count and NLR decreased continuously. The lymphocyte count increased on the 1st day after treatment, stabilized on the 7th day, and increased on the 7th day, while PLR decreased on the 1st day, increased on the 3rd day, and stabilized on the 7th day after treatment. Compared with pre-treatment, WBC, neutrophil count, NLR and IL-6 levels in PE group were significantly decreased (10.44 卤3.18) 脳 10 ~ 9 / L vs (6.93 卤2.46) 脳 10 ~ (9) / L P _ (0.000) on the 14th day after treatment. (7.95 卤3.03) 脳 10 ~ 9 / L vs (4.31 卤2.08) 脳 10 ~ (9) vs ~ (0.000) 卤5.43 卤3.92 vs _ (0.55 卤1.50) vs _ (0.000) 卤25.14 卤25.97 vs ~ (6.25 卤7.45) vs ~ (0.000). The lymphocyte count was significantly increased (1.55 卤0.64) 脳 10 9 / L vs (1.90 卤0.37) 脳 10 9 / L before and after treatment. There was no significant difference in the number of WBC, neutrophils before and after treatment in the P0. 421). PE group. There was a positive correlation between NLR and IL6 and PAOI (r = 0.394) (r = 0.430) and 0.417 ~ (0.54) (P = 0.006), respectively. There was a negative correlation between), NLR and PAOI (r = 0.352P ~ (0. 015), and there was a negative correlation between), NLR and PAOI (r = 0. 394). The lymphocyte count was positively correlated with the change rate of PAOI (r = 0.335, P < 0.021). There was a positive correlation between IL6 and PAOI after treatment (r = 0. 498, P < 0. 000). Conclusion: before PE treatment, WBC, neutrophils count, NLR and IL-6 levels can reflect the degree of thrombus load, the lower the NLR, the higher the lymphocyte count, the more significant the thrombolytic effect is. The WBC, neutrophils count after PE treatment. The decrease of NLR and IL-6 and the continuous increase of lymphocyte count indicated that PE inflammation was weakened and thrombolytic absorption could reflect the short-term thrombolytic effect in PE patients. The IL-6 level in PE patients was positively correlated with PAOI after treatment. It can reflect the degree of residual thrombus in PE patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.5

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