中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
18期
1405-1410
,共6页
中性粒细胞/淋巴细胞计数比值%C-反应蛋白%老年人%肺部细菌感染
中性粒細胞/淋巴細胞計數比值%C-反應蛋白%老年人%肺部細菌感染
중성립세포/림파세포계수비치%C-반응단백%노년인%폐부세균감염
Neutrophil/lymphocyte count ratio%C-reactive protein%Elderly%Lung bacterial infections
目的 探讨中性粒细胞/淋巴细胞计数比值(NLCR)在老年人肺部细菌感染诊断中的临床意义.方法 选取60岁以上、临床诊断为肺部感染的老年住院治疗患者261例,其中细菌感染患者140例(细菌组)、肺结核菌感染患者35例(结核组)和非细菌感染患者86例(非细菌组).因其他疾病住院治疗、但无感染的老年患者100例(疾病对照组),门诊体检健康者278例(健康对照组).分别进行全血细胞计数(CBC)、白细胞体积-电导-光散射参数(VCS参数)、C-反应蛋白(CRP)和中性粒细胞CD64指数(CD64指数)检测,NLCR由CBC参数的中性粒细胞百分率(NE)除以淋巴细胞百分率(LY)计算得到.结果 NLCR诊断细菌感染的正确指数(YI指数)为46.1％,仅次于CRP(53.5％).增加病例与病种数后统计分析发现,细菌组、非细菌组、结核组、疾病对照组的CRP分别为31.5(11.3 ～104.8)、3.7(1.5 ～12.7)、41.7(10.5 ～82.4)、2.4(1.2 ～4.0) mg/L,细菌组、非细菌组、结核组、疾病对照组、健康对照组的NLCR分别为6.9(3.2 ～13.8)、2.7(1.8 ～3.6)、4.5(3.0 ～9.0)、2.2(1.7 ～2.9)、1.7(1.4 ～2.0),WBC分别为7.4(5.7 ～ 11.1)×109/L、6.2(5.3 ～7.1)×109/L、6.5(5.2 ～8.5)×109/L、5.7(4.7 ～6.9)×109/L、6.0(5.3～6.8)×109/L,NE分别为79.2(65.7 ～85.0)％、63.3(55.9 ～69.1)％、74.0(65.3 ～82.6)％、62.1 (55.3 ～66.7)％、56.4(51.8 ～60.6)％,差异有统计学意义(x2=162.628、277.763、49.653、218.758,P值均＜0.001);细菌组上述参数水平显著高于非细菌组及对照组(P＜0.001);细菌组与结核组的上述参数差异无统计学意义(P＞0.05);ROC分析显示,NLCR诊断老年人肺部细菌感染的敏感度为77.0％,与CRP相同,优于WBC、NE.与CRP联合应用后敏感度提升至87.1％.仅分析WBC不升高的老年患者,NLCR对肺部细菌感染诊断的敏感度为67.7％,高于NE(43.4％).NLCR水平与细菌感染的种类无相关性,但NLCR升高患者,细菌培养的阳性率(40.2％)远高于NLCR不升高患者(9.1％).细菌组预后差患者NLCR水平为11.2(7.4 ～26.1),明显高于预后好患者组的6.0(2.6 ～10.2),差异有统计学意义(Z=-3.460,P=0.001).结论 NLCR是一项简便、快速、经济的白细胞常规检测参数,有助于老年人,尤其是白细胞计数不升高患者肺部细菌感染的诊断与鉴别诊断,与CRP联合应用可提高诊断的敏感度;NLCR水平高低有助于判断老年患者肺部细菌感染的预后.
目的 探討中性粒細胞/淋巴細胞計數比值(NLCR)在老年人肺部細菌感染診斷中的臨床意義.方法 選取60歲以上、臨床診斷為肺部感染的老年住院治療患者261例,其中細菌感染患者140例(細菌組)、肺結覈菌感染患者35例(結覈組)和非細菌感染患者86例(非細菌組).因其他疾病住院治療、但無感染的老年患者100例(疾病對照組),門診體檢健康者278例(健康對照組).分彆進行全血細胞計數(CBC)、白細胞體積-電導-光散射參數(VCS參數)、C-反應蛋白(CRP)和中性粒細胞CD64指數(CD64指數)檢測,NLCR由CBC參數的中性粒細胞百分率(NE)除以淋巴細胞百分率(LY)計算得到.結果 NLCR診斷細菌感染的正確指數(YI指數)為46.1％,僅次于CRP(53.5％).增加病例與病種數後統計分析髮現,細菌組、非細菌組、結覈組、疾病對照組的CRP分彆為31.5(11.3 ～104.8)、3.7(1.5 ～12.7)、41.7(10.5 ～82.4)、2.4(1.2 ～4.0) mg/L,細菌組、非細菌組、結覈組、疾病對照組、健康對照組的NLCR分彆為6.9(3.2 ～13.8)、2.7(1.8 ～3.6)、4.5(3.0 ～9.0)、2.2(1.7 ～2.9)、1.7(1.4 ～2.0),WBC分彆為7.4(5.7 ～ 11.1)×109/L、6.2(5.3 ～7.1)×109/L、6.5(5.2 ～8.5)×109/L、5.7(4.7 ～6.9)×109/L、6.0(5.3～6.8)×109/L,NE分彆為79.2(65.7 ～85.0)％、63.3(55.9 ～69.1)％、74.0(65.3 ～82.6)％、62.1 (55.3 ～66.7)％、56.4(51.8 ～60.6)％,差異有統計學意義(x2=162.628、277.763、49.653、218.758,P值均＜0.001);細菌組上述參數水平顯著高于非細菌組及對照組(P＜0.001);細菌組與結覈組的上述參數差異無統計學意義(P＞0.05);ROC分析顯示,NLCR診斷老年人肺部細菌感染的敏感度為77.0％,與CRP相同,優于WBC、NE.與CRP聯閤應用後敏感度提升至87.1％.僅分析WBC不升高的老年患者,NLCR對肺部細菌感染診斷的敏感度為67.7％,高于NE(43.4％).NLCR水平與細菌感染的種類無相關性,但NLCR升高患者,細菌培養的暘性率(40.2％)遠高于NLCR不升高患者(9.1％).細菌組預後差患者NLCR水平為11.2(7.4 ～26.1),明顯高于預後好患者組的6.0(2.6 ～10.2),差異有統計學意義(Z=-3.460,P=0.001).結論 NLCR是一項簡便、快速、經濟的白細胞常規檢測參數,有助于老年人,尤其是白細胞計數不升高患者肺部細菌感染的診斷與鑒彆診斷,與CRP聯閤應用可提高診斷的敏感度;NLCR水平高低有助于判斷老年患者肺部細菌感染的預後.
목적 탐토중성립세포/림파세포계수비치(NLCR)재노년인폐부세균감염진단중적림상의의.방법 선취60세이상、림상진단위폐부감염적노년주원치료환자261례,기중세균감염환자140례(세균조)、폐결핵균감염환자35례(결핵조)화비세균감염환자86례(비세균조).인기타질병주원치료、단무감염적노년환자100례(질병대조조),문진체검건강자278례(건강대조조).분별진행전혈세포계수(CBC)、백세포체적-전도-광산사삼수(VCS삼수)、C-반응단백(CRP)화중성립세포CD64지수(CD64지수)검측,NLCR유CBC삼수적중성립세포백분솔(NE)제이림파세포백분솔(LY)계산득도.결과 NLCR진단세균감염적정학지수(YI지수)위46.1％,부차우CRP(53.5％).증가병례여병충수후통계분석발현,세균조、비세균조、결핵조、질병대조조적CRP분별위31.5(11.3 ～104.8)、3.7(1.5 ～12.7)、41.7(10.5 ～82.4)、2.4(1.2 ～4.0) mg/L,세균조、비세균조、결핵조、질병대조조、건강대조조적NLCR분별위6.9(3.2 ～13.8)、2.7(1.8 ～3.6)、4.5(3.0 ～9.0)、2.2(1.7 ～2.9)、1.7(1.4 ～2.0),WBC분별위7.4(5.7 ～ 11.1)×109/L、6.2(5.3 ～7.1)×109/L、6.5(5.2 ～8.5)×109/L、5.7(4.7 ～6.9)×109/L、6.0(5.3～6.8)×109/L,NE분별위79.2(65.7 ～85.0)％、63.3(55.9 ～69.1)％、74.0(65.3 ～82.6)％、62.1 (55.3 ～66.7)％、56.4(51.8 ～60.6)％,차이유통계학의의(x2=162.628、277.763、49.653、218.758,P치균＜0.001);세균조상술삼수수평현저고우비세균조급대조조(P＜0.001);세균조여결핵조적상술삼수차이무통계학의의(P＞0.05);ROC분석현시,NLCR진단노년인폐부세균감염적민감도위77.0％,여CRP상동,우우WBC、NE.여CRP연합응용후민감도제승지87.1％.부분석WBC불승고적노년환자,NLCR대폐부세균감염진단적민감도위67.7％,고우NE(43.4％).NLCR수평여세균감염적충류무상관성,단NLCR승고환자,세균배양적양성솔(40.2％)원고우NLCR불승고환자(9.1％).세균조예후차환자NLCR수평위11.2(7.4 ～26.1),명현고우예후호환자조적6.0(2.6 ～10.2),차이유통계학의의(Z=-3.460,P=0.001).결론 NLCR시일항간편、쾌속、경제적백세포상규검측삼수,유조우노년인,우기시백세포계수불승고환자폐부세균감염적진단여감별진단,여CRP연합응용가제고진단적민감도;NLCR수평고저유조우판단노년환자폐부세균감염적예후.
Objective To investigate the clinical application of neutrophil/lymphocyte count ratio in the diagnosis of lung bacterial infections in the elderly.Methods Complete blood count(CBC),white blood cell volume-conductivity-scatter (VCS) parameters,C-reactive protein (CRP) and neutrophil CD64 index (CD64 index) of patients older than or equal to 60 years with pulmonary bacterial infections (n =140),tuberculosis (n =35),non-lung bacterial infections (n =86),no infections or controls (n =100) and healthy people (n =278) were detected.Neutrophil/lymphocyte count ratio (NLCR)is calculated through the percentage of neutrophils (NE) divided by the percentage of lymphocytes (LY).Results Youden Index of NLCR(46.1％) was greater than that of WBC,NE and CD64,and second only to CRP(53.5％) by means of comparison of multiple parameters for diagnosis of bacterial infections in part of cases.After the increase in the number of cases and types of the disease,the CRP levels of pulmonary bacterial infections,tuberculosis,non-lung bacterial infections,no infections or controls were 31.5(11.3-104.8),3.7(1.5-12.7),41.7 (10.5-82.4),2.4 (1.2-4.0) mg/L,respectively.NLCR levels of them were 6.9 (3.2-13.8),2.7 (1.8-3.6),4.5 (3.0-9.0),2.2 (1.7-2.9),1.7 (1.4-2.0);WBC levels of those groups were 7.4(5.7-11.1) × 109/L,6.2(5.3-7.1) × 109/L,6.5(5.2-8.5) × 109/L,5.7(4.7-6.9) ×109/L,6.0(5.3-6.8) × 109/L;NE levels of those groups were 79.2 (65.7-85.0)％,63.3 (55.9-69.1)％,74.0(65.3-82.6)％,62.1 (55.3-66.7)％,56.4(51.8-60.6)％,respectively.Thedifferences were statistically significant (Chi-square value =162.628,277.763,49.653,218.758,P ＜0.001);CRP,NLCR,WBC,NE of patients with pulmonary bacterial infections were significantly higher than non-lung bacterial infections and the controls (P ＜ 0.001).There was no difference in CRP,WBC,NE and NLCR levels between lung bacterial infections and tuberculosis (P ＞ 0.05).The sensitivity of NLCR for diagnosis of pulmonary bacterial infections was 77.0％,which is equal to CRP,and higher than that of WBC,NE.There was a high sensitivity (87.1％) for diagnosing pulmonary bacterial infections in the elderly by combination of NLCR and CRP.The sensitivity of NLCR for diagnosis of pulmonary bacterial infections was 67.7％,which was higher than that of NE (43.4％) in patients with lung bacterial infections had a normal WBC.Although the correlation between NLCR and types of bacterial infections had not been found,the positive rate of bacterial culture of patients with increased NLCR (40.2％) was much higher than that with normal ones(9.1％).NLCR levels of patients with poor prognosis was 11.2 (7.4-26.1),which is significantly higher than that of patients with good prognosis in cases with pulmonary bacterial infections (Z =-3.460,P =0.001).Conclusions NLCR is a simple,rapid and economic parameter of blood leukocyte,which is helpful in diagnosis and differentiation of elderly patients with lung bacterial infections,especially the cases without increasing WBC.NLCR,combined CRP can improve the diagnostic sensitivity for lung bacterial infections,and that be used for the prognostic evaluation of patients with pulmonary bacterial infections in the elderly.
