外周血NLR CD64指数PCT对呼吸机相关性肺炎的诊断价值

目的 探讨外周血中性粒细胞与淋巴细胞比值（NLR）、CD64指数、降钙素原（PCT）对呼吸机相关性肺炎（VAP）的诊断价值。方法 选取2019年1月至2020年6月安徽省蚌埠市第一人民医院重症医学科接受机械通气48 h的患者124例，以患者是否发生VAP分为VAP组（76例）及非VAP组（48例），另选取健康体检者60例为对照组。检测并对比3组入组时及VAP组治疗第3、7天时的外周血NLR、CD64指数和PCT水平，采用受试者工作特征曲线（ROC）分析入组时NLR、CD64指数和PCT单独诊断VAP的价值。结果 入组时VAP组NLR、CD64指数和PCT明显高于非VAP组和对照组，且非VAP组明显高于对照组（P<0.05）；VAP组治疗后第3、7 天的NLR、CD64指数和PCT明显低于入组时，且治疗后第7 天明显低于治疗后第3天（P<0.05）。ROC结果显示，NLR、CD64指数和PCT单独诊断VAP的曲线下面积（AUC）分别为0.709、0.888和0.864，最佳截断值为7.33、4.69和0.72 ng/mL。结论 VAP患者外周血NLR、CD64指数和PCT均明显升高，对早期VAP的诊断具有积极意义，其中CD64指数诊断价值最高。

The diagnostic value of peripheral blood NLR, CD64 index and PCT in ventilator-associated pneumonia

Objective To investigate the diagnostic value of peripheral blood neutrophil to lymphocyte ratio (NLR), neutrophil CD64 index and procalcitonin (PCT) in ventilator-associated pneumonia (VAP). Methods From January 2018 to June 2019, 124 patients who received mechanical ventilation for 48 hours in the Department of Critical Medicine, the First People''s Hospital of Bengbu City, Anhui Province were selectedand divided into VAP group (76 cases) and non VAP group (48 cases), and another 60 healthy people were selected as healthy control group. The levels of NLR, CD64 index and PCT in peripheral blood were detected and compared among the three groups at the time of admission and on the 3 d and 7 d of treatment in VAP group. The value of NLR, CD64 index and PCT in the diagnosis of VAP was analyzed by ROC curve. Results NLR, CD64 index and PCT in VAP group were significantly higher than those in non VAP group and healthy control group, and those in non VAP group were significantly higher than those in healthy control group (P<0.05); NLR, CD64 index and PCT of VAP group were significantly lower than those at 3 d and 7 d after treatment, and those of 7 d after treatment were significantly lower than those of 3 d after treatment (P<0.05). ROC results showed that the area under the curve (AUC) of NLR, CD64 index and PCT diagnosis of VAP was 0.709, 0.888 and 0.864 respectively, and the best cut-off values were 7.33, 4.69 and 0.72 ng/mL. Conclusions Peripheral blood NLR, CD64 index and PCT significantly increased in VAP patients, which have positive significance for the early diagnosis of VAP, and CD64 index has the highest diagnostic value.