【摘要】：目的:研究PE患者WBC、中性粒細(xì)胞計數(shù)、淋巴細(xì)胞計數(shù)、NLR、PLR和血清IL-6水平治療前后的變化規(guī)律,與PAOI及其變化率的相關(guān)性,探討上述指標(biāo)在評估肺栓塞栓子負(fù)荷及近期血栓溶解效果上的臨床意義。方法:前瞻性研究2015年06月至2017年02月3家合作醫(yī)院呼吸內(nèi)科經(jīng)CTPA首次確診的47例PE患者,同時間段37例健康成人作為對照組。比較兩組治療前WBC、中性粒細(xì)胞計數(shù)、淋巴細(xì)胞計數(shù)、NLR、PLR及血清IL-6水平差異及其PE組在治療前后上述指標(biāo)的差異。PE組采用Mastora評分法評估治療前后PAOI,根據(jù)不同PAOI值分為低阻塞組(PAOI30%)31例,中阻塞組(PAOI 30%~50%)12例和高阻塞組(PAOI50%)4例,比較3組間炎癥指標(biāo)水平差異。監(jiān)測PE組治療前和治療后14天內(nèi)炎癥指標(biāo)的變化,描述其變化規(guī)律、與PAOI的相關(guān)性及其與PAOI變化率的關(guān)系。結(jié)果:與健康對照組比較,PE組治療前WBC、中性粒細(xì)胞計數(shù)、NLR、PLR和IL-6水平均明顯升高((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),淋巴細(xì)胞計數(shù)明顯降低((1.55±0.64)×109/L vs(2.20±0.57)×109/L P=0.000)。PE組治療前不同阻塞程度分組的WBC、中性粒細(xì)胞計數(shù)、NLR和IL-6均隨阻塞程度的升高而升高,組間差異均具有統(tǒng)計學(xué)意義(P分別為0.038,0.024,0.049,0.000)。PE組治療后14天內(nèi)WBC、中性粒細(xì)胞計數(shù)和NLR連續(xù)下降;淋巴細(xì)胞計數(shù)于治療后第1~3天上升,第3~7天平穩(wěn),第7~14天上升;PLR于治療后第1~3天下降,第3~7天上升,第7~14天平穩(wěn)。與治療前比較,PE組治療后第14天的WBC、中性粒細(xì)胞計數(shù)、NLR和IL-6水平均明顯降低((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),淋巴細(xì)胞計數(shù)明顯升高((1.55±0.64)×109/L vs(1.90±0.37)×109/L,P=0.000),PLR治療前后無統(tǒng)計學(xué)差異(P=0.421)。PE組治療前WBC、中性粒細(xì)胞計數(shù)、NLR和IL6與PAOI呈正相關(guān)(r分別為0.394、0.430、0.417、0.547,P分別為0.006、0.003、0.004、0.000),NLR與PAOI變化率呈負(fù)相關(guān)(r=-0.352,P=0.015),淋巴細(xì)胞計數(shù)與PAOI變化率呈正相關(guān)(r=0.335,P=0.021)。治療后IL6與PAOI呈正相關(guān)(r=0.498,P=0.000)。結(jié)論:PE治療前WBC、中性粒細(xì)胞計數(shù)、NLR和IL-6水平可反映血栓負(fù)荷程度,NLR越低、淋巴細(xì)胞計數(shù)越高,血栓溶解效果越顯著。PE治療后WBC、中性粒細(xì)胞計數(shù)、NLR和IL-6連續(xù)下降,淋巴細(xì)胞計數(shù)連續(xù)上升,提示PE炎癥反應(yīng)減弱,血栓溶解吸收,可反映PE患者的近期血栓溶解效果。PE患者治療后IL-6水平與PAOI呈正相關(guān),可以反映PE患者的殘余血栓程度。
[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 鹵3.18) 脳 10 ~ 9 / L vs (6.37 鹵2.19) 脳 10 ~ 9 / L P _ (0.000) before treatment. (7.95 鹵3.03) 脳 10 ~ (9) L vs (3.74 鹵2.41) 脳 10 ~ (9) vs ~ (0.000) 鹵3.92 vs 1.71 鹵0.74 vs 0.000165.58 鹵136.73 vs 123.18 鹵51.05 vs 0.01 鹵25.14 鹵25.97 vs 6.45 鹵7.15 P0.000), and (7.95 鹵3.03) 脳 10 ~ (9) / L vs (3.74 鹵2.41) 脳 10 ~ (9) / L). The lymphocyte count was significantly decreased (1.55 鹵0.64) 脳 10 9 / L vs (2.20 鹵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 鹵3.18) 脳 10 ~ 9 / L vs (6.93 鹵2.46) 脳 10 ~ (9) / L P _ (0.000) on the 14th day after treatment. (7.95 鹵3.03) 脳 10 ~ 9 / L vs (4.31 鹵2.08) 脳 10 ~ (9) vs ~ (0.000) 鹵5.43 鹵3.92 vs _ (0.55 鹵1.50) vs _ (0.000) 鹵25.14 鹵25.97 vs ~ (6.25 鹵7.45) vs ~ (0.000). The lymphocyte count was significantly increased (1.55 鹵0.64) 脳 10 9 / L vs (1.90 鹵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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.5

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