中性粒细胞绝对数与血小板计数的比值对严重烧伤患者预后的判断价值

摘要

Objective To investigate the prognostic value e ofneutrophil-to-platelet ratio (NPR)on the 3-day-postburn in severely burned patients.Methods A total number of 416 patients was reviewed in this study,with the third day post-burn NPR documented.Based on the median NPR on the third day post bum,the patients were divided into two groups:high NPR group (＞ 0.077) and low (＜ 0.077) NPR group.Data on gender,age,inhalation injury,mechanical ventilation,early surgical treatment and burn index were analyzed.The data was analyzed with chi-square,Kaplan-Meier survival analysis,and Cox regression analysis.We drew a receiver operating characteristic (ROC) curve of NPR value for 58 severely burned patients to estimate the prognostic value of the 3-day-postburn NPR.Results The high NPR group and the low NPR group had in-hospital survival rate of 78.9％ and 93.2％ respectively,in which the difference was statistically significant (P ＜ 0.01).Cox regression analysis suggested that the NPR (HR:33.353;95％CI:4.050-274.704) on the third day would independently indicate the prognosis for severely burned patients (P ＜ 0.01).The ROC curve of 58 death cases showed that the total area of the third-day NPR was 0.742 (95％ CI:0.675-0.809,P ＜ 0.01) and 0.099 was the optimal threshold value for the third-day NPR (sensitivity:67.2％,specificity:70.1％).Conclusion NPR on the third day postern might has a strong clinical significance to serve as an independent prognostic indicator for patients with severe burn.%目的 探讨烧伤患者伤后第3天外周血中中性粒细胞绝对数与血小板计数的比值(NPR)在预后判断中的作用.方法 回顾性分析安徽医科大学第一附属医院烧伤科2008年1月至2015年12月期间收治的416例成人重度及以上烧伤患者的临床治疗,收集患者伤后第3天中性粒细胞和血小板计数的化验检查结果.依患者伤后第3天NPR中位数值,将其分为高NPR(≥0.077)和低NPR(＜0.077)2组,同时综合考虑2组患者性别、年龄、吸入性损伤、机械通气、早期手术、烧伤指数等资料.对观察指标值行x2或t检验,利用Kaplan-Meier法分析严重烧伤患者住院期间生存率,带入Cox回归分析并绘制58例死亡患者受试者工作特征(ROC)曲线,分析伤后第3天NPR对判断严重烧伤患者预后的作用.结果 伤后第3天高NPR组和低NPR组在严重烧伤住院期间生存率分别为78.9％和93.2％,差异具有统计学意义(P＜ 0.01).Cox回归分析提示伤后第3天NPR为预测烧伤后患者死亡的独立危险因素(HR:33,353;95％CI:4.050～274.704,P＜0.01).58例死亡患者ROC曲线显示,烧伤后第3天NPR值曲线下总面积为0.742 (95％CI:0.675～0.809,P＜ 0.01).其中伤后第3天NPR的最佳阈值为0.099(敏感度67.2％,特异度70.1％).结论 烧伤后第3天NPR对预测严重烧伤患者的预后有较强的临床意义.