血常规及肝肾功能检测在新型冠状病毒肺炎病情预判中的应用

目的探讨血常规和肝肾功能等常规指标对新型冠状病毒肺炎(COVID-19)患者的辅助诊断和病情预测的临床价值。方法回顾性研究,收集2020年1月28日至2月14日中南大学湘雅医院的COVID-19患者30例、其他病毒性肺炎29例、甲型/乙型流感患者35例及往期健康体检者25名,采用SNK-q等方法分析4组人群及COVID-19各亚组间血常规、肝肾功能及其他炎性指标的差异。结果中性粒细胞计数在COVID-19组、甲乙流组和其他类型病毒性肺炎组中逐步递增,且COVID-19组与其他病毒性肺炎组间差异具有统计学意义(H=-19.064,P<0.05);而淋巴细胞计数则在对照组、甲乙流组、其他病毒性肺炎组及COVID-19组中逐步递减,此外DB、UA及GLU在各组间也存在一定差异;亚组分析显示COVID-19患者肺部累及范围+~++者与肺部累及范围+++~++++者组间N(F=9.581,t=-0.152,P<0.05)、N%(F=5.723,t=-0.600,P<0.05)、NLR(F=4.773,t=-1.161,P<0.05)、PCT(F=17.464,t=-1.477,P<0.05)及CRP(F=7.656,t=-1.973,P<0.05)差异具有统计学意义,COVID-19临床分型中轻型、普通型患者与重型、危重型患者组间NLR(F=63.931,t=-2.815,P<0.01)、AST(F=15.704,t=-1.930,P<0.01)、ALT(F=35.551,t=-2.199,P<0.01)、LDH(F=7.715,t=-2.703,P<0.05)及GLU(F=6.306,t=-5.116,P<0.05)差异具有统计学意义;相关分析显示临床分型与影像学分期均与NLR(r=0.406,P=0.026;r=0.397,P=0.030)、ALT(r=0.403,P=0.049;r=0.418,P=0.047)、LDH(r=0.543,P<0.01;r=0.643,P<0.01)及GLU(r=0.750,P<0.01;r=0.471,P=0.042)显著相关;从所有纳入指标中共提取出5个主成分,综合信息提取率为82.86%,其中载荷量较大者有Ur、PCT和CRP(PC1);ALT、AST和GLU(PC2);N%、L%、L和NLR(PC3),表明急性感染指标、肝功能和血常规对疾病监测具有一定的提示作用。ROC曲线分析结果表明,N+TB+Urea的联合检测为区分COVID-19与其他病毒性肺炎的最佳方案;N+L+UA的联合检测则为区分COVID-19与甲乙流患者的最佳方案;在评估病情方面,NLR+LDH+GLU+ALT的联合检测为区分临床分型轻型、普通型患者与重型、危重型患者的最佳方案,其AUC(ROC)可达到0.904,此时cut-off值为0.477,敏感度为75%,特异度为100%。结论除了病原学和影像学检查外,医生还可以通过完善血常规、肝肾功能等实验室常规检测对呼吸道感染患者进行疾病的辅助诊断和病情预估。

The clinical application of blood routine and liver and kidney function test in COVID-19 disease prediction

Objective To explore the clinical application value of routine indicators such as blood routine and liver and kidney function in auxiliary diagnosis and prognosis of COVID-19 patients.Methods SNK-q and other methods were used to retrospectively analyzed the differences of blood routine test,liver and kidney function and other inflammatory indexes of 30 patients with covid-19,29 patients with other viral pneumonia,35 patients with influenza A/B and 25 healthy persons from January 28 to February 14,2020 in Xiangya Hospital of Central South University.Results The neutrophils count increased gradually in COVID-19 group,influenza A/B group and other types of viral pneumonia group,and the difference between COVID-19 group and other viral pneumonia groups was statistically significant(H=-19.064,P<0.05);The lymphocyte count decreased gradually in the control group,influenza A/B group,other viral pneumonia group and COVID-19 group.In addition,DB,UA and GLU were also different among groups.Subgroup analysis showed that there were statistically significant differences in N(F=9.581,t=-0.152,P<0.05),N%(F=5.723,t=-0.600,P<0.05),NLR(F=4.773,t=-1.161,P<0.05),PCT(F=17.464,t=-1.477,P<0.05)and CRP(F=7.656,t=-1.973,P<0.05)between patients with lung involvement+-++and patients with lung involvement+++-++++.There were statistically significant differences in NLR(F=63.931,t=-2.815,P<0.01),AST(F=15.704,t=-1.930,P<0.01),ALT(F=35.551,t=-2.199,P<0.01),LDH(F=7.715,t=-2.703,P<0.05)and GLU(F=6.306,t=-5.116,P<0.05)between the light+common subgroup and the heavy+critical subgroup of COVID-19 clinical classification.Correlation analysis showed that clinical stage and imaging credit period were significantly correlated with NLR(r=0.406,P=0.026;r=0.397,P=0.030),ALT(r=0.403,P=0.049;r=0.418,P=0.047),LDH(r=0.543,P<0.01;r=0.643,P<0.01)and GLU(r=0.750,P<0.01;r=0.471,P=0.042).A total of 5 principal components were extracted from all the included indicators,and the comprehensive information extraction rate was 82.86%.Indicators of a large load included Ur,PCT and CRP in PC1;ALT,AST and GLU in PC2;N%,L%,L and NLR in PC3.It indicated that the indicators of acute infection,liver function and blood routine had certein warning effect on disease surveillance.The results of ROC curve analysis showed that the combined detection of N+TB+Urea was the best practice to distinguish COVID-19 and other viral pneumonia,while the combined detection of N+L+UA was the most effective solution to make a distinction between COVID-19 and influenza A/B patients.In the aspect of disease evaluation,NL+LDH+GLU+ALT combined detection represent the best diagnostic performance to distinguish the clinical stage of light+common type and heavy+critical type,achieving the AUC(ROC)to 0.904,with the sensitivity 75%and the specificity 100%at the cut-off value of 0.477.Conclusion In addition to etiology and imaging examination,doctors can also improve the routine laboratory tests such as blood routine test,liver and kidney function to assist diagnosis and disease prediction of patients with respiratory tract infection.