【摘要】：[目的]探討血細胞參數(shù)中性粒細胞淋巴細胞計數(shù)比值(neutrophil lymphocyte ratio,NLR)、血小板-淋巴細胞比率(platelet-lymphocyteratio,PLR)、血小板分布寬度(platelet distribution width,PDW)、紅細胞分布寬度(Red Cell Distribution Width,RDW)等在入院時血流動力學穩(wěn)定的急性肺栓塞患者預后中的應用價值,明確其是否具有相關性及優(yōu)越性,是否可作為預測急性肺栓塞患者的預后指標。[方法]共計207例初入院時血流動力學穩(wěn)定的急性肺栓塞患者完成本次研究。第一階段通過對在昆明醫(yī)科大學第二附屬醫(yī)院2015年4月1日——2016年6月30日確診肺栓塞的符合納入排除標準的135例患者進行回顧性調(diào)查,探討未發(fā)生臨床不良事件組(n=111例)和發(fā)生臨床不良事件組(n=24例)不同組間的相關血細胞是否存在統(tǒng)計學差異;第二階段通過對2016年7月1日——2017年3月1日期間確診肺栓塞的符合納入排除標準的72例患者進行30天隨訪調(diào)查,根據(jù)第一階段所得指標最佳臨界值進行分組,驗證前述相關血細胞參數(shù)預測臨床不良事件發(fā)生的價值及優(yōu)越性。[結(jié)果]1.第一階段共計135例肺栓塞患者中,發(fā)生臨床不良事件組與未發(fā)生臨床不良事件組的血細胞參數(shù)WBC、N、NLR、PLR具有明顯統(tǒng)計學差異,而PDW、RDW無統(tǒng)計學意義。經(jīng)ROC曲線進一步分析,WBC、N、NLR、PLR曲線下面積分別為 0.78、0.81、0.87、0.60,WBC、N、NLR 的 P 值均小于 0.01、PLR的P值為0.11。WBC、N、NLR、Pro-BNP、cTNT-hs預測臨床不良事件發(fā)生的敏感度、特異度、陽性預測值、陰性預測值分別為: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預測臨床不良事件發(fā)生的最佳臨界值為4.87。2.第二階段共計72例肺栓塞患者中,NLR≥4.87組肺栓塞患者(n=22例)與NLR4.87組肺栓塞患者(n=50例)血細胞參數(shù)WBC、N、NLR具有明顯統(tǒng)計學差異,NLR最優(yōu),余血細胞參數(shù)無明顯統(tǒng)計學意義。NLR≥4.87組肺栓塞患者的臨床不良事件發(fā)生率是NLR4.87肺栓塞患者的22.73倍。經(jīng)ROC曲線進一步分析,NLR、cTNT-hs、Pro-BNP 的 AUC 分別 0.852、0.781、0.821,P值均小于0.05,預測臨床不良事件發(fā)生的敏感度、特異度、陽性預測值、陰性預測值、RR 值分別為 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 聯(lián)合預測臨床不良事件發(fā)生的ROC曲線下面積為0.879:敏感度、特異度、陽性預測值、陰性預測值分別為 100%、97%、85.7%、100%,P 值為 0.00。[結(jié)論]1.NLR、Pro-BNP、cTNT-hs對急性肺栓塞患者臨床不良事件發(fā)生的預測評估都有一定的價值。2.NLR可作為急性肺栓塞患者臨床不良事件發(fā)生的獨立預測因子,可被用于肺栓塞臨床風險分類。3.NLR聯(lián)合Pro-BNP預測價值更為顯著。
[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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