中性粒细胞与淋巴细胞和血小板比值对急性Stanford A型主动脉夹层患者急性肾损伤的早期预测价值

目的:探讨中性粒细胞与淋巴细胞和血小板比值(NLPR)对急性Stanford A型主动脉夹层(ATAAD)患者急性肾损伤(AKI)早期预测的临床价值。方法:回顾性分析南京医科大学附属南京医院重症医学科收治的211例ATAAD患者的临床资料,根据2012 KDIGO-AKI标准将患者分为急性肾损伤组(AKI组)和非急性肾损伤组(非AKI组),通过logistic回归评估AKI的独立危险因素,并通过ROC曲线和曲线下面积(AUC)评价NLPR等指标对AKI的预测价值。结果:纳入患者中AKI组123例,非AKI组88例,AKI发病率为58.3%;AKI组NLPR显著高于非AKI组,差异有统计学意义(P<0.01)。与非AKI组相比,AKI组术后机械通气时间更长(P<0.05)、住ICU时间均更长(P<0.01),院内病死率增加(P<0.01),需要呋塞米静脉泵入治疗的比例更高(P<0.01),以及肾脏替代治疗的比例更高(P<0.01)。多因素logistic回归分析显示：NLPR(OR=1.118,95%CI:1.055～1.186,P<0.01)是...     

中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值对急性脑梗死患者预后的预测价值研究

目的 比较中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值对急性脑梗死患者预后的预测价值。方法 回顾性选取2019年2月至2022年2月新疆医科大学第一附属医院收治的急性脑梗死患者100例,依据预后情况分为预后良好组(n=60)、预后不良组(n=40)两组。单因素分析、多因素Logistic回归分析急性脑梗死患者预后影响因素,分析急性脑梗死患者溶栓治疗后NIHSS评分、mRS评分与中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)的相关性,统计分析两组不同NLR、PLR患者的病死情况。结果 预后良好组的NIHSS评分≥5分、高血压患者比率明显低于预后不良组,发病至溶栓时间明显短于预后不良组,纤维蛋白原、C反应蛋白、中性粒细胞计数、血小板计数、淋巴细胞计数、NRL、PLR水平均明显低于预后不良组,差异均有统计学意义(P<0.05)。急性脑梗死患者溶栓治疗后NIHSS评分与NLR、PLR均呈显著的正相关(r=0.682、0.654,P<0.05),mRS评分与PLR、PLR均呈显著的负相关(r=-0.511、-0.490,P<0.05)。预后良好组患者的病死...     

探讨五项生物标志物对急性主动脉夹层的诊断价值

目的 探讨五项生物标志物对急性主动脉夹层(AAD)患者的诊断价值。方法 选择2022年6月—2023年2月在厦门大学附属心血管病医院就诊的106例确诊AAD患者作为AAD组,其中A型AAD患者70例,B型AAD患者36例;92例急性心肌梗死(AMI)患者作为AMI组;另外选择同期100例健康体检者作为对照组。收集3组患者的基础资料,检测肝素结合蛋白(HBP)、白细胞介素-6(IL-6)、白细胞计数(WBC)、中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、血小板计数(PLT)、D-二聚体,计算血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR),比较各组上述指标水平差异。绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),评估五项标志物对AAD的诊断价值。结果 (1) AAD组和AMI组的WBC、NEU、NLR、PLR、HBP、IL-6和D-二聚体水平均明显高于对照组[WBC(×10⁹/L):14.20±4.20、12.97±4.98比6.08±1.50,NEU(×10⁹/L):12.35±3.91、10.4...     

血小板/淋巴细胞比值与维持性血液透析患者全因死亡的相关性

目的 探讨血液透析患者血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)对维持性血液透析(maintenance hemodialysis,MHD)患者全因死亡率的影响.方法 回顾性收集在锦州医科大学国药东风总医院血液透析中心规律透析3个月以上、病情平稳的MHD患者的临床资料.根据血常规...     

血小板与淋巴细胞比值与急性脑梗死患者预后的相关性研究

目的 探讨血小板与淋巴细胞比值（PLR）与急性脑梗死（ACI）患者临床预后的相关性。方法 选取我院神经内科收治的80例急性脑梗死住院治疗患者为研究对象,以患者预后4个月为研究终点,治疗结束后按照mRS评分标准将所选的研究对象分为两组,其中mRS>2分的定位预后不良组,mRS≤2分的定为良好组,采用多因素logistic回归分析法比较两组患者的相关化验指标。结果 80例患者4个月预后良好组的患者为32例,预后不良组的患者为48例,其中不良组的白细胞计数及PLR的数据均高于预后良好组,差异具有显著性（P<0.05）;以患者预后4个月作为研究终点,将患者的高血压病史、白细胞计数、糖尿病史以及PLR为因变量进行Logistic多因素分析,结果显示血小板与淋巴细胞比值（PLR）是影响急性脑梗死患者预后的独立危险因素,OR值为1.010(95%CI:1.001～1.147,P<0.05)。结论 血小板与淋巴细胞比值与急性脑梗死患者的病情发展密切相关,对临床预测病情具有一定的价值。     

急性Stanford A型主动脉夹层术后死亡因素分析

目的 分析探讨急性Stanford A型主动脉夹层患者手术后死亡相关危险因素.方法 回顾性分析2003年1月至2008年6月复旦大学附属中山医院心外科接受手术治疗的急性Stanford A型主动脉夹层患者共185例,其中男性144例(77.8%),女性41例(22.2%);年龄(49.46±11.04)岁.对该组患者术后转归进行单因素和多因素Logistic回归分析.结果 术后30 d内总死亡率9.1%,单因素分析或多因素Logistic回归分析结果:术前神经系统表现阳性(单因素OR=5.084,CI=1.792～14.426,P=0.002;多因素OR=5.538,CI=1.834～16.721,P=0.002),低血压(单因素OR=6.986,CI=1.510～32.323,P=0.013;多因素OR=1.998,CI=0.315～12.679,P=0.463),肾功能不全(单因素OR=3.594,CI=1.237～10.438,P=0.019;多因素OR=3.254,CI=1.034～10.242,P=0.044).结论 术前神经系统表现阳性、肾功能不全是急性Stanford A型主动脉夹层患者手术后死亡的独立危险因素.     

急性Stanford A型主动脉夹层术后死亡因素分析

Objective To assess the risk factors of the in-hospital mortality of acute type A aortic dissection after operation. Method From January 2003 to June 2008,185 patients, 144 males and 41 females, with acute type A aortic dissection operated on were enrolled. The average age of patients was (49.46 ± 11.04 ) years old.The patients' demographics, history, clinical features, and some laboratory examinations were reviewed. Univariate and multivariate analysis followed by logistic regression analysis were carried out to identify the predictors of inhospital mortality. Results The in-hospital mortality rate was 9.1%. The results of univariate and multivariate analyses as follows: pre-operation positive neurological symptom (Univariate OR = 5.084,95%CI:1.792 -14.426, P = 0.002; Multivariate OR = 5.538,95%CI: 1.834 - 16.721, P = 0.002, respectively), hypotension (Univariate OR = 6.986,95%CI:1.510- 32.323,P =0.013; multivariate OR = 1.998,95%CI:0.315-12.679,P = 0.463, respectively) and renal failure (Univariate OR = 3.594,95%CI:1.237 - 10.438,P =0.019; Multivariate OR = 3.254,95%CI:1.034- 10.242, P= 0.044, respectively). Conclusions There are two predictors, pre-operation positive neurological symptom and renal failure, of pre-hospital mortality found in current analyses. Our results may improve the regimen made by cardiac surgeons and emergency doctors so as to help patients and their relatives to make correct decision.     

A型主动脉夹层术后急性肾损伤危险因素与预测价值分析

目的 探讨A型主动脉夹层术后急性肾损伤(AKI)的危险因素及其对术后发生AKI的预测价值。方法 选取2015年1月至2021年12月在该院确诊并行A型主动脉夹层手术的111例患者作为研究对象,按照术后是否发生AKI分为AKI组(69例)和无AKI组(42例),比较两组临床资料,通过多因素Logistic回归分析术后发生AKI的危险因素,并绘制受试者工作特征(ROC)曲线评估相关危险因素对术后发生AKI的预测价值。结果 AKI组与无AKI组术前白细胞计数、降钙素原(PCT)、血清肌酐,术中急诊手术占比、体外循环总时间、主动脉阻断时间、深低温停循环时间,以及术后重症监护病房滞留时间比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前白细胞计数升高(OR=1.204,95%CI:1.023～1.416,P=0.025)、术前PCT水平升高(OR=1.080,95%CI:1.014～1.447,P=0.004)、术中深低温停循环时间增加(OR=1.134,95%CI:1.044～1.232,P=0.003)是A型主动脉夹层术后发生AKI的独立危险因素。R...     

血小板/淋巴细胞计数比值对急性心肌梗死后发生心力衰竭的预测价值

目的探讨血小板/淋巴细胞计数比值(PLR)对急性心肌梗死(AMI)后发生心力衰竭的预测价值。方法回顾性分析2015年1月1日至2017年12月30日于神木市医院住院并行冠状动脉造影检查的232例AMI患者的临床资料。根据是否合并心力衰竭,分为心力衰竭组(n=164)和非心力衰竭组(n=68);同时,根据入院时血常规检测得到PLR值,再通过受试者工作特征曲线(ROC曲线)确定PLR的cut-off值,将其分为高PLR组(n=179)和低PLR组(n=53)。比较心力衰竭组和非心力衰竭组患者的一般资料、实验室检查结果、冠状动脉造影资料;比较高PLR组和低PLR组不良心血管事件发生情况。对AMI患者发生心力衰竭的影响因素进行分析。结果 ROC曲线分析显示,PLR预测AMI患者发生心力衰竭的cut-off值为169.7,灵敏度和特异度分别为52.1%和89.9%。单因素分析发现,淋巴细胞计数、中性粒细胞计数/淋巴细胞计数比值(NLR)、PLR、N端脑利钠肽是AMI患者发生心力衰竭的危险因素(P0.05)。多因素Logistic回归分析发现,PLR(OR:1.037,95%CI:1.021～1.054,P0.001)、N端脑利钠肽(OR:1.001,95%CI:1.001～1.002,P0.001)是AMI患者发生心力衰竭的危险因素。结论 PLR与AMI后心力衰竭相关,PLR越高,AMI后心力衰竭发生率越高,且PLR与N端脑利钠肽是AMI患者发生心力衰竭的独立预测因子。     

术前血小板/淋巴细胞比值和淋巴细胞/单核细胞比值对胃癌患者预后的影响分析

目的探讨术前血小板与淋巴细胞比值(PLR)和淋巴细胞与单核细胞比值(LMR)对胃癌患者预后的评估价值。方法收集该院2013年1月至2014年7月入院行胃癌根治术治疗的458例患者的临床病理资料及随访信息,根据受试者工作特征曲线和约登指数确定的术前PLR、LMR的最佳临界值将患者分为高PLR组(PLR126)、低PLR组(PLR≤126)及高LMR组(4.59)、低LMR组(≤4.59),比较不同组间患者临床病理资料和生存率,采用Cox回归模型分析胃癌患者预后的影响因素。结果术前高PLR组1年、3年生存率分别为66.6%、38.0%,低于低PLR组的73.5%、55.5%(P 0.05);高LMR组1年、3年生存率分别为73.9%、54.8%,高于低LMR组的66.0%、37.8%(P0.05)。单因素分析提示,年龄、肿瘤位置、肿瘤最大径、淋巴结转移、T分期、N分期、TNM分期、脉管浸润、神经浸润、PLR和LMR均为胃癌预后的影响因素(P 0.05);多因素分析显示,年龄55岁[HR=1.331(95%CI:1.043～1.699)]、有淋巴结转移[HR=1.582(95%CI:1.047～2.390)]、N分期为N2～N3期[HR=1.395(95%CI:1.005～1.936)]、有脉管浸润[HR=1.539(95%CI:1.059～2.238)]和LMR≤4.59[HR=1.645(95%CI:1.294～2.091)]是影响胃癌患者预后的独立危险因素(P0.05)。结论术前PLR和LMR均与胃癌预后相关,低LMR是胃癌预后的独立预测因子。     

Platelet to lymphocyte ratio in acute aortic dissection

Background

Inflammation plays an important role in the initiation and progression of acute aortic dissection (AAD). New inflammatory indices derived from full cell blood count and its differential may be associated with increased risk. We evaluated platelet‐lymphocyte (PLR), red cell distribution width (RDW) and RDW/PLT's (platelets) (RPR) in AAD.

Methods

We studied 120 consecutive patients with AAD type I admitted for emergency surgery (group I), 121 consecutive patients with aortic aneurysms of the ascending aorta prior to elective repair (group II) and 121 controls (group III), age and sex matched.

Results

PLR was significantly higher in group I vs both groups II and III (P < .001). There was an excellent correlation of PLR with neutrophil/lymphocyte ratio (NLR) in all three groups (P < .001 for all). After adjustment for hemoglobin, RDW did not differ but RPR remained significantly higher in group I compared to groups II and III (P < .001). The best cutoff value of PLR to predict dissection was 159 with 53% sensitivity and 86% specificity. No association between PLR, RDW, and RPR and mortality in group I was found.

Conclusions

Indices derived from full cell blood count may provide diagnostic information in patients with AAD; whether these indices may contribute to prognosis assessment should be further investigated.

     

白细胞介素-6对急性主动脉夹层患者预后的预测价值

目的探讨白细胞介素-6(IL-6)对急性主动脉夹层患者的预后的预测价值。方法连续入选新疆医科大学第一附属医院心脏中心,2012年1月至2014年2月完全符合诊断标准的主动脉夹层患者87例,用酶联免疫吸附试验(ELISA)检测入院时血浆IL-6。以死亡作为随访终点,随访1年。采用ROC曲线和Cox生存回归分析IL-6对急性主动脉夹层患者死亡的预测价值。结果死亡组患者入院时IL-6高于存活组患者[(17.92±4.61)pg/ml vs.(12.59±2.53)pg/ml,P<0.001],且具有统计学意义。ROC曲线分析提示,IL-6对急性主动脉夹层患者死亡具有预测价值(曲线下面积为0.862,95%置信区间=0.81~0.92,P<0.001),最佳临床分界点为18.36 pg/ml,敏感度为87.4%,特异度为70.8%。根据IL-6判断夹层患者死亡的最佳临床分界点(18.36 pg/ml),将患者分为IL-6降低组和IL-6升高组。Cox生存回归分析显示,IL-6和急性主动脉夹层患者死亡密切相关[IL-6分组:HR(95%CI)=3.68(1.16~5.42),P<0.001;IL-6连续变量:HR(95%CI)=1.33(1.14~1.61),P=0.016],IL-6升高组和IL-6降低组的死亡率具有明显统计学差异(79.1%vs.24.5%,P<0.001)。结论 IL-6对急性主动脉夹层患者预后具有一定预测价值,并且能够识别高危患者。     

NLR联合MLR在非ST段抬高型心肌梗死危险分层中的预测价值

目的探讨中性粒细胞/淋巴细胞比率(NLR)联合单核细胞/淋巴细胞比率(MLR)在非ST段抬高型心肌梗死(NSTEMI)危险分层中的价值。方法纳入2013年6月至2014年12月于第三军医大学附属新桥医院行冠状动脉照影的患者288例,分为对照组(110例),稳定性心绞痛(SAP)组(66例)和NSTEMI组(112例),对NSTEMI组患者计算GRACE评分,并根据GRACE评分分为低危组和中高危组。收集所有受试者的血常规指标并计算NLR、MLR。结果 NSTEMI组的NLR、MLR明显高于对照组和SAP组(P0.01)。Spearman相关分析表明NLR、MLR与GRACE评分呈正相关(r=0.342,P0.01;r=0.398,P0.01);中高危组比低危组的NLR(P0.01)、MLR(P0.01)高。通过受试者工作曲线(ROC)分析,预测NSTEMI危险分层的ROC曲线下面积(AUC)分别是NLR的AUC为0.747(95%CI:0.656~0.837,P0.01);MLR的AUC为0.765(95%CI:0.677~0.852,P0.01);NLR联合MLR的AUC为0.778(95%CI:0.693~0.863,P0.01)。结论NLR、MLR与GRACE评分呈正相关,NLR联合MLR对NSTEMI患者的危险分层有一定的预测价值。     

The potential value of the neutrophil to lymphocyte ratio for early differential diagnosis and prognosis assessment in patients with aortic dissection

ObjectivesThe aim of the study was to assess the diagnostic performance and clinical utility of the neutrophil to lymphocyte ratio (NLR) in patients with suspected aortic dissection (AD) and investigate its role in predicting in-hospital mortality in AD.MethodsNLR values were calculated and compared in 467 consecutive patients with initially suspected AD. A receiver operating characteristic (ROC) curve analysis with the area under the curve (AUC) was used to evaluate the discriminative accuracy and predictive capability of the NLR for AD. Clinical utility was determined by decision curve analysis (DCA). The association between NLR and in-hospital mortality was investigated by logistic regression analyses in patients diagnosed with AD.ResultsThe NLR was significantly elevated in patients with AD, and the optimal cut-off point for the NLR to distinguish AD from other acute chest pain diseases was 5.67 [AUC (95% CI): 0.877 (0.844–0.905)]. We recommended an NLR of 2.43 as the appropriate cut-off point with 96.9% sensitivity and a negative likelihood ratio (LR) of 0.09 to satisfy clinical requirements for diagnosis. DCA showed that the use of NLR had a positive net benefit. The deceased patients with AD had a higher NLR than the discharged patients. Moreover, the NLR was an independent predictor of in-hospital mortality for AD [adjusted odds ratio (OR): 1.084 (1.029–1.142)], and patients with higher NLR values tended to have a higher risk of in-hospital mortality. The optimal cut-off point for the NLR to predict in-hospital mortality was 9.20 [AUC (95% CI): 0.695 (0.619–0.765)].ConclusionsAs an easily available and inexpensive parameter, the NLR could serve as a valuable clinical biomarker for early differential diagnosis and prognosis assessment of AD.     

血浆D-二聚体及血小板/淋巴细胞比值对急性缺血性脑卒中青年患者预后的预测作用

目的 探讨血浆D-二聚体(D-D)及血小板/淋巴细胞比值(PLR)对急性缺血性脑卒中(AIS)青年患者预后的预测作用.方法 选取接受静脉注射重组组织纤溶酶原激活剂治疗的动脉硬化性AIS患者90例,根据术后3个月的改良Rankin量表(MRS)评分将患者分为预后良好组和预后不良组,计算PLR和测定D-D的水平,分析二者与...     

中性粒细胞/淋巴细胞比率联合血小板/淋巴细胞比率检测对于重症急性胰腺炎早期预测价值

目的:评估中性粒细胞／淋巴细胞比率（Neutrophil to lymphocyte ratio,NLR）联合血小板/淋巴细胞比率（platelet to lymphocyteratio,PLR）检测(NLR-PLR)对于重症急性胰腺炎(severe acute pancreatitis,SAP)早期预测价值。方法:连...     

中性粒细胞和淋巴细胞比值预测2型糖尿病患者微量白蛋白尿的价值

目的 探讨中性粒细胞和淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)对2型糖尿病(type 2 diabetes mellitus, T2DM)患者微量白蛋白尿的预测价值。方法 回顾性分析2020年11月至2021年6月河北省人民医院内分泌科收治的T2DM住院患者400例。根据24 h尿微量白蛋白检测结果分组,24 h尿微量白蛋白<30 mg为正常组(n=236), 30mg≤24 h尿微量白蛋白<300 mg为微量白蛋白尿组(n=164),比较两组一般资料及实验室检查结果。采用二分类Logistic回归分析探究T2DM患者微量白蛋白尿的影响因素,通过绘制受试者工作特征(receiver operating characteristic, ROC)曲线,评估NLR及联合诊断对T2DM患者微量白蛋白尿的预测价值。结果 微量白蛋白尿组年龄及高血压患者占比、白细胞(white blood cell, WBC)计数、中性粒细胞(absolute neutrophil, NEU)计数、NLR、甘油三酯(triacylglycerol, TG)、...     

Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection

OBJECTIVE: We sought to determine whether assessing D-Dimer might be helpful for the management of acute aortic dissection (AAD). DESIGN: Single-center retrospective case-control study. SETTING: University Hospital of Strasbourg France. PATIENTS: Patients were 94 consecutive patients admitted to our institution with confirmed AAD and in whom D-Dimer test had been performed at presentation. These patients were matched with 94 controls presenting with clinical suspicion of dissection, which was later ruled out. INTERVENTIONS: Patient characteristics and clinical course were analyzed. MEASUREMENTS AND MAIN RESULTS: Ninety-three (99%) patients with AAD had elevated D-Dimer (>400 ng/mL) with a median D-Dimer value of 8610 ng/mL (interquartile range, 2982-20,000 ng/mL). Receiver operating characteristic curves analysis showed that D-Dimer, but not C-reactive protein, troponin, lactate dehydrogenase, or leukocyte count, was predictive of a diagnosis of AAD, with a sensitivity and specificity of 99% and 34%, respectively. D-Dimer concentration positively correlated with the anatomical extension of the dissection to the different segments of the aorta (R = .47, p < .0001). A positive relationship was observed between D-Dimer and in-hospital mortality rate among patients with AAD (p = .037). On multivariate analysis, the independent predictors of in-hospital mortality were the presence of pericardial effusion (odds ratio, 6.80; confidence interval, 1.87-27.60), D-Dimer >5200 ng/mL (odds ratio, 5.38; confidence interval, 1.27-30.87), and female gender (odds ratio, 4.96; confidence interval, 1.39-19.95). CONCLUSIONS: D-Dimers are elevated in patients with AAD and provide valuable diagnostic and prognostic information. In patients with acute chest pain and elevated D-Dimer, a diagnosis of AAD should also be considered. D-Dimer might be a useful complementary tool to the current diagnostic work-up of patients with suspected AAD.     

中性粒细胞/淋巴细胞比值与CURB-65评分在老年社区获得性肺炎预后评价中的作用

目的:探讨中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）与英国胸科协会改良肺炎评分（CURB-65评分）在老年社区获得性肺炎（community acquired pneumonia,CAP）预后评价中的作用。方法:回顾性分析2019年1月至2020年3月安徽医科大学第三附属医院呼吸与危重症医学科收治的160例老年社区获得性肺炎患者的临床资料,根据患者30 d生存情况分为存活组127例和死亡组33例。收集患者的一般临床资料和入院时或入院24 h内血常规、肝肾功能、血钠、凝血功能,C反应蛋白、降钙素原,计算NLR及CURB-65评分。通过成组 t检验或 χ２检验比较两组上述指标的差异,采用多因素Logistic回归分析筛选老年CAP患者30 d死亡的高危因素;绘制受试者工作特征曲线（receiver operating characteristic,ROC）,分析NLR及CURB-65评分对死亡风险的预测价值。 结果:与存活组比较,死亡组患者年龄更大,合并存在神经系统疾病以及出现胸闷症状的比例较高（ P<0.05）。死亡组患者淋巴细胞总数、血红蛋白及血清白蛋白水平均明显低于存活组,中性粒细胞总数、血尿素氮、D二聚体、NLR、C反应蛋白、降钙素原及CURB-65评分均明显高于存活组（均 P<0.05）。多因素Logistic回归分析显示,NLR和CURB-65评分是老年CAP 30 d死亡的独立危险因素（ P<0.01）。ROC生存曲线结果显示,NLR的曲线下面积（AUC）为0.823[95% CI（0.747~0.900）],截断值为8.885,评估预后的敏感度为84.8%,特异度为74.8%。NLR联合CURB-65评分的AUC为0.872[95% CI（0.801~0.942）],截断值为0.248,评估预后的敏感度为84.8%,特异度为84.3%。两者联合均较其他单独评价指标有更好的预后评估价值。 结论:NLR和CURB-65评分是老年CAP患者死亡的高危因素,两者联合可较好的预测老年CAP的死亡风险。