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学科主题临床检验诊断学
中性粒细胞/淋巴细胞计数比值在老年人肺部细菌感染诊断中的临床应用
其他题名Clinical application of neutrophil/lymphocyte count ratio in the diagnosis of lung bacterial infections in the elderly
李秀锋; 朱梦捷; 王建中
关键词中性粒细胞/淋巴细胞计数比值 C-反应蛋白 老年人 肺部细菌感染 Neutrophil/lymphocyte Count Ratio C-reactive Protein Elderly Lung Bacterial Infections
刊名中华医学杂志
2015
DOI10.3760/cma.j.issn.0376-2491.2015.18.011
95期:18页:1405-1410
收录类别中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型Journal Article
摘要目的 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. 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.
语种中文
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文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/43610
专题北京大学第一临床医学院_检验科
作者单位100034,北京大学第一医院检验科
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李秀锋,朱梦捷,王建中. 中性粒细胞/淋巴细胞计数比值在老年人肺部细菌感染诊断中的临床应用[J]. 中华医学杂志,2015,95(18):1405-1410.
APA 李秀锋,朱梦捷,&王建中.(2015).中性粒细胞/淋巴细胞计数比值在老年人肺部细菌感染诊断中的临床应用.中华医学杂志,95(18),1405-1410.
MLA 李秀锋,et al."中性粒细胞/淋巴细胞计数比值在老年人肺部细菌感染诊断中的临床应用".中华医学杂志 95.18(2015):1405-1410.
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