NLR与MLR对腹膜透析患者腹腔感染的诊断及预后评估价值

目的探讨中性粒细胞/淋巴细胞比值(NLR)、单核细胞/淋巴细胞比值(MLR)对腹膜透析患者腹腔感染的诊断及预后评估价值。方法采用回顾性研究方法,选择池州市人民医院肾脏内科2015年9月-2018年12月进行腹膜透析的患者416例为研究对象。收集患者透析前临床资料,连续随访观察至2019年12月31日。根据患者透析前NLR、MLR水平,分为NLR升高组、NLR正常组和MLR升高组、MLR正常组。采用Log-rank法比较其差异,诊断价值分析采用受试者工作特征曲线(ROC)评价NLR、MLR对患者腹腔透析期间发生腹膜炎的诊断价值。结果Kaplan-Meier生存分析结果显示,NLR、MLR升高组患者首次透析至腹膜炎发生的时间缩短(P<0.05);ROC分析结果显示,NLR、MLR、NLR+MLR对于腹膜透析患者发生腹膜炎诊断的曲线下面积分别为0.715、0.749、0.831(P<0.05);多发性腹膜炎组基线NLR、MLR水平高于单发性腹膜炎组(P<0.05);因腹膜炎病死患者基线NLR、MLR水平高于存活患者(P<0.05)。结论基线NLR、MLR升高的腹膜透析患者较早发生腹膜炎,其水平对于腹膜炎发生具有预测价值,且对于判断是否为多发性感染及患者死亡具有一定意义。

Values of NLR and MLR in diagnosis of abdominal infection and prediction of prognosis of peritoneal dialysis patients

OBJECTIVE To explore the values of neutrophil/lymphocyte ratio(NLR)and monocyte/lymphocyte ratio(MLR)in diagnosis of abdominal infection and prediction of prognosis of the peritoneal dialysis patients.METHODS A total of 416 patients who underwent peritoneal dialysis in nephrology department of Chizhou People’s Hospital from Sep 2015 to Dec 2018 were recruited as the study sujects.The clinical data were collected from the patients before the dialysis,the follow-up observation was continued until Dec 31,2019.The patients were divided into the NLR elevated group,the NLR normal group,the MLR elevated group and the MLR normal group according to the levels of NLR and MLR before the dialysis.The differences were compared with the use of Log-rank method,and the values of NLR and MLR in diagnosis of peritonitis were evaluated by using receiver operating characteristic(ROC)curve during the period of peritoneal dialysis.RESULTS The result of Kaplan-Meier survival analysis showed that the interval between the initial dialysis and the onset of peritonitis of the NLR elevated group and the MLR elevated group was significantly shortened(P<0.05).ROC curve analysis indicated that the areas under curve of the NLR,MLR and NLR plus MLR were respectively 0.715,0.749 and 0.831 in diagnosis of peritonitis in the peritoneal dialysis patients(P<0.05);the baseline NLR and MLR levels of the multiple peritonitis group were significantly higher than those of the single peritonitis group(P<0.05);the baseline NLR and MLR levels of the patients who died of peritonitis were significantly higher than those of the patients who survived(P<0.05).CONCLUSION The peritoneal dialysis patients with elevated baseline NLR and MLR levels may have the peritonitis in early time,the levels of NLR and MLR have the value in prediction of peritonitis and have certain significance in judgement of multiple infection and death of the patients.