中性粒细胞与淋巴细胞计数比值在诊断呼吸机相关性肺炎中的应用

目的 探讨血清中性粒细胞与淋巴细胞计数比值(NLR)对呼吸机相关性肺炎(VAP)的诊断价值.方法 选取2018年12月—2019年12月新疆医科大学第五附属医院重症医学科收治有创机械通气治疗患者77例,根据7 d内是否发生VAP分为VAP组24例和非VAP组53例;根据抗感染治疗1周后不同效果将VAP组分为改善亚组(n...

The diagnostic value of the neutrophil-lymphocyte ratio in patients with ventilator-associated pneumonia

Objective To investigate the diagnostic value of serum neutrophil to lymphocyte ratio(NLR)in ventilator-associated pneumonia(VAP).Methods From December 2018 to December 2019,77 patients with invasive mechanical ventilation were treated in the intensive care department of the Fifth Affiliated Hospital of Xinjiang Medical University.According to the condition,they were divided into VAP group(n=24)and non VAP group(n=53).According to the effect of anti infection treatment after one week,VAP group was divided into improvement subgroup and deterioration subgroup.NLR,PCT and CPIS at different time points were obtained,and the diagnostic value of three indicators was analyzed The receiver operating characteristic(ROC)curve was drawn to judge its diagnostic value for VAP.Results There was no significant difference in NLR,PCT and CPIS between VAP group and non VAP group before mechanical ventilation(all P>0.05).NLR,PCT and CPIS of VAP group on the 4th day of mechanical ventilation were significantly higher than those at the beginning of mechanical ventilation(t/P=2.140/0.038,4.975/<0.001,9.952/<0.001).There was no significant difference in NLR,PCT and CPIS between non VAP group and the 4th day of mechanical ventilation(all P>0.05)05),the NLR,PCT levels and CPIS of VAP group were significantly higher than those of non VAP group on the fourth day of mechanical ventilation(t/P=7.126/<0.001,6.380/<0.001,6.364/<0.001).After one week of anti infection treatment,the above three indexes of improvement subgroup were significantly lower than those of deterioration subgroup(t/P=7.281/<0.001,14.930/<0.001,10.710/<0.001),and the above indexes of improvement subgroup were significantly lower than those of diagnosis of VAP(t/P=2.077/0.046,2.297/0.023,5.130/<0.001),while deterioration subgroup were significantly higher than those of diagnosis of VAP(t/P=2.243/0.045,2.371/0.035,2.428/0.032).When VAP was diagnosed,NLR,PCT and CPIS were positively correlated(r=0.847,0.836,P<0.001).The AUC of NLR in the diagnosis of VAP was 0.845.When the critical value was 8.765,the sensitivity and specificity were 83.33%and 75.47%respectively,Youden`s index was 0.588,when combined the 3 factors,the sensitivity,specificity and Youden index was 87.50%,75.47%and 0.630.Conclusion NLR has high sensitivity and specificity in the diagnosis of VAP.Monitoring its dynamic changes may be helpful for early diagnosis and prognosis evaluation of VAP.