通讯作者: 髙崴崴, 13598832393@163.com

DOI：10.12201/bmr.202409.00062

Correlational Analysis of Immune-Inflammatory Markers with the Clinical Outcomes of Severe Pneumonia

• 摘要：【】目的 对比分析不同免疫炎症参数对重症社区获得性肺炎(Community-Acquired Pneumonia ,SCAP)不良结局的预测价值,提出新的指标。方法 回顾性分析2021年5月至2024年4月在郑州大学第二附属医院收治的重症肺炎患者共196例,根据28d住院结局分为好转组与预后不良组,收集实验室指标并计算出中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、NLR与血红蛋白比值(neutrophil-to-lymphocyte ratio/HB,NLR/HB)等炎症指标。利用Logistic回归分析寻找SCAP预后不良的独立危险因素,并构建回归模型。使用受试者工作特征(area under curve,ROC)曲线评价NLR/HB对SCAP发生预后不良的诊断效能。结果 好转组住院期间NLR均高于不良组。好转组HB均高于预后不良组,且入院患者的HB值整体呈下降趋势。好转组住院期间血小板(PLT) 值整体呈升高趋势,不良组则呈下降趋势。提出NLR/HB计算公式为NLR/HB=NLR*100/HB。NLR/HB7d在多模型的多因素Logistic回归分析显著性表现的最为稳定(P＜0.001)。将有差异的指标纳入多因素Logistic回归模型中。结果显示:NLR/HB7d、D-二聚体、有创机械通气是预后不良的危险因素(P＜0. 05),血小板计数7d(P＜0. 05)是预后不良的保护因素。ROC曲线分析结果显示NLR/HB7d、血小板计数7d分别为0.786( 95%CI =0.722~ 0.851,P＜0.001)、0.749( 95%CI =0.681~ 0.816,P＜0.001)。结论 动态监测血常规在临床上是十分必要的,NLR/HB有望成为判断重症肺炎患者预后不良的有效指标。

  关键词： 重症肺炎； 中性粒细胞； 淋巴细胞； 血小板； 血红蛋白；; ; ; ; 

   

  Abstract: 【】 Objective To compare and analyze the predictive value of different immune-inflammatory parameters for adverse outcomes in Severe Community-Acquired Pneumonia (SCAP) and to propose new indicators. Methods The retrospective analysis was conducted on 196 severe pneumonia patients admitted to the Second Affiliated Hospital of Zhengzhou University from May 2021 to April 2024. Patients were divided into an good prognosis group and a poor prognosis group based on the 28-day hospital outcome. Laboratory indicators were collected and inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR) and the ratio of NLR to hemoglobin (NLR/HB) were calculated. Logistic regression analysis was used to identify independent risk factors for poor prognosis in SCAP and to construct a regression model. The diagnostic efficacy of NLR/HB for adverse outcomes in SCAP was evaluated using the receiver operating characteristic (area under curve, AUC) curve. Results Showed that the NLR during hospitalization in the good prognosis group was higher than that in the poor prognosis group. The hemoglobin (HB) in the good prognosis group was higher than that in the poor prognosis group, and the HB value of admitted patients generally showed a downward trend. The platelet (PLT) count in the good prognosis group showed an overall upward trend during hospitalization, while the poor prognosis group showed a downward trend. The calculation formula for NLR/HB is proposed as NLR/HB = NLR * 100 / HB. NLR/HB at day 7 showed the most stable significance in multi-model multi-factor logistic regression analysis (P < 0.001). The indicators with differences were included in the multi-factor logistic regression model. The results showed that NLR/HB at day 7, D-dimer, and invasive mechanical ventilation were risk factors for poor prognosis (P < 0.05), and the platelet count at day 7 was a protective factor for poor prognosis (P < 0.05). The ROC curve analysis showed that NLR/HB at day 7 and platelet count at day 7 were 0.786 (95% CI = 0.722~0.851, P < 0.001) and 0.749 (95% CI = 0.681~0.816, P < 0.001), respectively.? Conclusion Dynamic monitoring of blood routine is very necessary in clinical practice, and NLR/HB is expected to become an effective indicator for judging the poor prognosis of severe pneumonia patients.

  Key words: Severe Pneumonia; Neutrophils; Lymphocytes; Platelets; Hemoglobin

  提交时间：2024-09-27

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  1	2024-09-07	bmr.202409.00062V1	下载

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