中性粒细胞淋巴细胞比值在预测乙肝肝衰竭中的诊断价值分析

摘要

目的 探讨中性粒细胞淋巴细胞比值( neutrophil-lymphocyte ratio,NLR)在预测慢性乙肝患者慢加急性肝衰竭( acute-on-chronic liver failure,ACLF)中的应用价值.方法 回顾性分析我院2014年1月至2017年10月收治的慢性乙肝患者244例的临床资料,其中重度慢性乙型肝炎89例(A组)、乙肝肝硬化失代偿期93例(B组)、慢加急性肝衰竭62例(C组),另选取同期健康体检者60名(NC组);收集患者血常规、肝功能、凝血功能指标,比较不同病情严重程度患者NLR、ALT、AST指标的差异,采用Spearman线性相关法分析各指标间的相关性;以PTA值为金标准,绘制受试者工作曲线( receiver operating characteristic curve,ROC)并评价NLR指标判断ACLF的诊断效能(包括诊断准确率、灵敏度、特异度、阳性预测值和阴性预测值等).结果 (1)NLR值在NC组和A组、B组和C组间比较,差异无统计学意义(P>0. 05);但B组和C组NLR值明显高于NC组和A组(P0. 05);(2)Spearman相关性分析发现,NLR水平与AST、ALT呈正相关(r=0. 461、0. 552,P0. 05). However, the NLR values of group B and group C were significantly higher than those of NC group and group A ( P0. 05); (2) Spearman correlation analysis found that NLR level was positively correlated with AST and ALT ( r=0. 461, 0. 552, P<0. 05) , and negatively correlated with PTA ( r= -0. 814, P<0. 001); (3) ROC curve showed that the AUC of NLR (predicted ACLF AUC=0. 752, 95% CI: 0. 679-1. 000) was significantly higher than that of AST (AUC=0. 611, 95% CI: 0. 418 -0. 979) and ALT (AUC=0. 572, 95% CI:0. 387-0. 956) , the best cut-off point of NLR was 2. 81; ROC curve showed that NLR predicted AUC of end-stage liver disease (AUC=0. 884, 95% CI: 0. 957-1. 000) was significantly higher than that of AST (AUC=0. 771, 95% CI: 0. 635-0. 988) and ALT (AUC=0. 624, 95% CI: 0. 505-1. 000), the best cut-off point of NLR was 3. 96. The di-agnostic accuracy, sensitivity, and positive predictive value of NLR in predicting ACLF and end-stage liver disease were significantly higher than those of AST and ALT. Conclusion The NLR has a high diagnostic value in the prediction of hepatitis B liver failure, and NLR=2. 81 and NLR=3. 96 can be used as reference indexes to judge ACLF and end-stage liver disease.