中性粒细胞与淋巴细胞比值在肝硬化合并腹水感染患者早期诊断及疗效观察中的应用

目的：探讨中性粒细胞与淋巴细胞比值（NLR）在乙型肝炎肝硬化合并腹水感染早期诊断和疗效观察中的意义。方法回顾性分析232例乙型肝炎肝硬化患者（肝硬化代偿组51例、肝硬化合并腹水感染组109例和肝硬化腹水非感染组72例）和58名正常体检人员（正常对照组）的WBC、NLR、超敏C反应蛋白（HS-CRP）和降钙素原（PCT）的测定结果，观察腹水感染患者治疗前后各指标水平的变化，并以诊断性试验评价方法和ROC曲线比较NLR与其余指标的诊断价值。结果各组间NLR、HS-CRP、PCT和WBC水平差异均有统计学意义（F=7.31，11.21，17.22和6.88，P均<0.05），其中肝硬化腹水感染组均显著高于代偿组和非感染组（q=4.11~11.85，P<0.01）。NLR的灵敏度、特异性、阳性和阴性预测值均与HS-CRP和PCT接近；NLR对肝硬化腹水感染的ROC曲线下面积为0.92395%CI （0.893~0.975）]，PCT、HS-CRP和WBC分别为0.891、0.855和0.684。 NLR诊断界值为2.38，此时其灵敏度和特异性分别为93.57%和73.41%。治疗3 d和7 d后，细菌培养阴性者NLR平均水平均低于临界值，范围为（1.97~2.37）和（1.89~2.35），PCT、HS-CRP和WBC平均水平高于各自临界值。结论 NLR或可作为乙型肝炎肝硬化患者腹水感染早期诊断和抗感染疗效观察敏感而实用的指标。

Application of neutrophil-lymphocyte ratio on early diagnosis and curative effect in cirrhosis patients with ascites infection

Objective To explore the significance of neutrophil-lymphocyte ratio (NLR) to early diagnosis and curative effect in hepatitis B cirrhosis patients with ascites infection. Methods The white blood cell count (WBC), NLR, high-sensitive C reactive protein (HS-CRP) and procalcitonin (PCT) of 232 hepatitis B cirrhosis patients (51 cases of compensatory phase cirrhosis patients, 109 cases of cirrhosis patients with ascites infection and 72 cases of cirrhosis patients without ascites infection) and 58 healthy persons (control group) were analyzed retrospectively. The changes of patients with ascites infection were observed before and after treatment. The diagnostic tests and ROC curve were used to compare the diagnostic value of the indexes. Results The differences among the levels of NLR, HS-CRP, PCT and WBC in 4 groups were statistically significant (F=7.31, 11.21, 17.22 and 6.88, P all<0.05). The ascites infection patients were higher than other 3 groups (q=4.11-11.85, P<0.01). The sensitivity, specificity, positive predictive values and negative predictive values of NLR were all close to those of PCT and HS-CRP. The area under ROC curve of NLR 0.923, 95%CI (0.893-0.975)] was higher than that of PCT, HS-CRP and WBC (0.891, 0.855 and 0.684), respectively. The cut-off value of NLR was 2.38, while sensitivity and specificity were 93.57% and 73.41%, respectively. After 3 and 7 days of treatment, the the average NLR levels of patients with negative bacterial culture were lower than the cut-off value, the ranges were (1.97-2.37) and (1.89-2.35). However, the average PCT, HS-CRP and WBC levels were all higher than the respective cut-off values. Conclusions NLR may be a sensitive and practical parameter on early diagnosis and curative effect for ascites infection in hepatitis B cirrhosis patients.