中性粒细胞/淋巴细胞比值与急性胰腺炎严重程度及全身并发症的关系

目的]探讨中性粒细胞/淋巴细胞比值(Neutrophil to Lymphocyte Ratio,NLR)与急性胰腺炎(acute pancreatitis,AP)的严重程度及全身并发症之间的关系。方法]回顾性纳入182例AP患者,根据修订后的亚特兰大分类将AP患者分为轻症、中重症及重症3组。计算入院时NLR值四分位数,并将患者分为4组:NLR≤4.91组、4.92≤NLR<7.80组、7.81≤NLR≤13.78组、NLR≥13.78组,分别比较修订后的亚特兰大分类、Ranson评分、全身并发症在4组间差异有无统计学意义。采用受试者工作特征(ROC)曲线比较NLR、NLR48 h、白细胞计数及中性粒细胞计数预测AP全身并发症的有效性。结果]根据修订后的亚特兰大分类,患者入院时NLR水平重症组>中重症组>轻症组15.13(7.86)∶10.07(7.98)∶5.43(4.33),P<0.001]。重症组及中重症组AP患者NLR48 h水平明显高于轻症组患者8.10(6.74)∶7.62(4.57)∶3.16(2.58),P<0.001]。根据四分位数分组,随着NLR水平升高,Ranson评分重度、修订后亚特兰大分类重症、有全身并发症患者所占比例明显升高(均P<0.001)。计算炎性标志物预测AP全身并发症的ROC曲线下面积,入院时NLR曲线下面积最大,为0.863。当NLR截断值>10.56时,敏感性为85.7%,特异性为76.2%。结论]NLR与AP严重程度密切相关,且NLR是预测AP患者全身并发症的重要参数。

Relationship between the neutrophil-to-lymphocyte ratio and the severity and systemic complications in acute pancreatitis

Objective]To examine the relationship between the neutrophil to lymphocyte ratio(NLR)and the systemic complications and severity in acute pancreatitis(AP).Methods]A total of 182patients with acute pancreatitis were retrospectively enrolled and classified into mild,moderately severe and severe groups according to the revised Atlanta classification.Patients were grouped into quartiles according to their NLR values on admission,and four groups(NLR≤4.91,4.92≤NLR<7.80,7.81≤NLR≤13.78,NLR≥13.78)were formed.The receiver operating characteristic(ROC)curve was used to compare the effectiveness of NLR,NLR48h,white blood cell count and neutrophil count in predicting systemic complications of acute pancreatitis.Results]According to the revised Atlanta classification,NLR at the time of admission and at the 48th hour in the severe group was found to be statistically higher than the mild AP group.According to the NLR quartile grouping,we found that with the increase of NLR level,the proportion of patients in the severe group of Ranson score,the severe group of the revised Atlanta classified and the group with systemic complications increased significantly(P<0.001).The area under the ROC curve of NLR at the time of admission was 0.863.When the NLR cut-off value was>10.56,sensitivity and specificity were 85.70%and 76.20%.Conclusions]Neutrophil to lymphocyte ratio is closely related to the severity of AP.We also regard NLR as a valuable parameter for predicting the development of systemic complications in patients with AP.