实用医学杂志 ›› 2021, Vol. 37 ›› Issue (7): 903-908.doi: 10.3969/j.issn.1006⁃5725.2021.07.015

• 临床研究 • 上一篇    下一篇

中性粒细胞/淋巴细胞比值、C-反应蛋白/白蛋白及低钙在重症颅脑损伤并早期呼吸机相关性肺炎的价值分析

黄琪惠, 张琳   

  1. 安徽医科大学第三附属医院重症医学科(合肥 230000)

  • 出版日期:2021-04-10 发布日期:2021-04-10
  • 通讯作者: 张琳 E⁃mail:2005202zhl@sina.com
  • 基金资助:

    合肥市重点学科建设资助项目(编号:合卫科教 【2019】160 号);合肥市名医工作室资助项目(编号:合人才【2019】1号)

     

Clinical value of NLR,CRP/Alb and Ca2+ in severe craniocerbral injury complicated with early⁃onset ven⁃ tilator pneumonia

HUANG Qihui,ZHANG Lin
  

  1. Department of Intensive Care Medicine,the Third Affiliated Hos⁃ pital of Anhui Medical University,Hefei 230000,China

  • Online:2021-04-10 Published:2021-04-10
  • Contact: ZHANG Lin E⁃mail:2005202zhl@sina.com

摘要:

目的 评价中性粒细胞/淋巴细胞比值(NLR)、C⁃反应蛋白/白蛋白比值(CRP/Alb)及血清钙离子(Ca2+)水平在重型颅脑损伤患者(sTBI)并早发型呼吸机性肺炎(EOVAP)的价值。方法 选取安徽医 科大学第三附属医院 ICU 2018 1 月至 2020 1 月符合标准的 sTBI 患者 112 例,根据是否并发肺炎分为 EOVAP 组(40 例)和非 EOVAP 组(72 例),比较两组间 NLR、CRP/Alb Ca2+ 水平差异,采用 logistic 回归分析 及受试者工作特征曲线分析其诊断价值,采用 Cox 比例风险模型评估以 28 天时间截点后患者的预后价值。结果 根据多因素 logistic 回归分析显示,外周血 NLR、CRP/Alb 的显著升高,Alb Ca2+ 水平不同程度 的降低均为 sTBI 患者发生 EOVAP 的独立危险因素(P < 0.05)。ROC 曲线显示 NLR、CRP/Alb 诊断 sTBI EOVAP AUC 0.814 0.798,明显优于 Alb Ca2+。同时 Cox 比例风险回归模型评估分析表明:NLR (OR = 1.126,95%CI:1.072 ~ 1.181,P < 0.01)和 CRP/Alb(OR = 2.652,95%CI:1.203 ~ 15.846,P < 0.01)是患 28 d 预后的危险因素。结论 NLR、CRP/Alb 以及低钙血症对预测 sTBI 患者并发 EOVAP 有较高的临床 诊断价值,同时NLR 和CRP/Alb 与患者28 d预后密切相关。

关键词:

Abstract: Objective To evaluate the value of neutrophil to lymphocyte ratio(NLR),C⁃reactive protein to albumin ratio(CRP/Alb),and serum calcium ion(Ca2 +)levels in patients with severe craniocerebral injury (TBI)and early ventilator pneumonia(EOVAP). Methods 112 sTBI patients who met the standard in the Third Affiliated Hospital of Anhui Medical University from January 2018 to January 2020 were selected and divided into EOVAP group(40 cases)and non ⁃ EOVAP group(72 cases)according to whether they were complicated with pneumonia. Differences in NLR,CRP/Alb,and Ca2+ levels between the two groups were compared. Logistic regres⁃ sion analysis and subject work characteristic curve were used to analyze the diagnostic value. The Cox proportional hazards model assesses the prognosis of patients after the 28⁃day cutoff. Results According to multivariate Logistic regression analysis,significant increases in peripheral blood NLR,CRP/Alb,and decreases in Alb and Ca2+ levels were independent risk factors for EOVAP(< 0.05). The ROC curve showed that the AUC of NLR and CRP/Alb in diagnosing sTBI combined with EOVAP was 0.814 and 0.798,significantly better than Alb and Ca2+ . Cox propor⁃ tional hazard regression model evaluation analysis showed that:NLR(OR = 1.126,95% CI:1.072~1.181,< 0.01)and CRP/Alb(OR = 2.652,95%CI:1.203 ~ 15.846,< 0.01)is a risk factor for the prognosis of patients at 28 days. Conclusion NLR,CRP/Alb,and hypocalcemia have high clinical diagnostic value in predicting EOVAP complication in sTBI patients,and NLR and CRP/Alb are closely related to the prognosis of patients at 28 days,which are worthy of extensive clinical attention.

Key words:

neutrophil to lymphocyte ratio, C?reactive protein, albumin, serum calcium, severe traumatic brain injury, ventilator?associated pneumonia