中性粒细胞与淋巴细胞比值在急性胰腺炎并发急性肝损伤患者病情诊断中的价值

摘要

目的 探讨急性胰腺炎(AP)并发急性肝损伤(ALI)患者中性粒细胞与淋巴细胞比值(NLR)与AP病情严重程度及肝功能损伤程度间的关系,评估NLR对AP并发ALI的预测价值.方法 收集2015年1月至2015年10月于宁夏医科大学总医院首次住院确诊为AP的患者236例,按是否并发ALI分为并发ALI组和未并发ALI组,依据NLR的中位数(6.35)分为高NLR组(NLR≥6.35)和低NLR组(NLR<6.35).对比分析各组住院天数、年龄、白蛋白、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、BISAP评分值等指标的差异,并采用受试者工作特征(ROC)曲线评估NLR预测急性胰腺炎并发急性肝损的有效性.结果 AP并发ALI组和未并发ALI组患者的年龄、白蛋白的差异均无统计学意义(P均>0.05).与未并发ALI组相比,并发ALI组患者的住院天数长,ALT、AST、TBIL数值升高,BISAP分值较高(P均<0.05).高NLR组和低NLR组患者的住院天数、年龄的差异均无统计学意义(P均>0.05),与低NLR组相比,高NLR组的白蛋白降低,ALT、AST、TBIL水平及BISAP分值增高(P均<0.05).AP并发ALI组患者的NLR(8.82±6.06)高于未并发ALI组患者(5.62±3.41)(t=2.79,P=0.007).NLR诊断AP并发ALI的受试者工作特征(ROC)曲线下面积为0.658(95%CI:0.532~0.785),以NLR6.35作为诊断的临界值,敏感度为67.6%,特异度为40%.结论 AP并发ALI患者NLR升高,NLR越高AP病情越重及肝功能损害程度越大,但NLR对AP并发ALI的诊断效能较差.%Objective To investigate the relationship between neutrophil-to-lymphocyte rate(NLR)and the severity of acute pancreatitis(AP)and AP related acute liver injury(ALI)patients and to evaluate the predictive value of NLR for AP related ALI.Methods From January 2015 to October 2015 in General Hospital of Ningxia Medical University,236 initial hospitalized patients diagnosed with AP were collected. The patients were divided into two groups according to their NLR median and whether they were with ALI,respectively. That was the high NLR group(NLR≥6.35)and low NLR group(NLR<6.35). The differences of hospitalization days, age,albumin,ALT,AST,TBIL and BISAP in each group were compared and analyzed. The receiver operating characteristic(ROC)curve was used to evaluate the effectiveness of NLR acute pancreatitis(AP)related acute liver injury(ALI).Results There was no significant difference in age and albumin between AP patients with ALI and without ALI(P﹥0.05). Compared with AP patients without ALI group,the hospitalization days,ALT, AST,TBIL and BISAP of AP patients with ALI group were significantly longer and higher(P<0.05). There was no significant difference in hospitalization days and age between high NLR group and low NLR group(P﹥0.05). Compared with low NLR group,the albumin was significantly lower in high NLR group and ALT,AST,TBIL and BISAP were all higher in high NLR group. NLR was(8.82±6.06)in patients with ALI,and was(5.62±3.41) in patients without ALI. The difference between the two groups was significant(t=2.79,P=0.007). The area under ROC curve of diagnosing AP related ALI by NLR was 0.658(95%CI:0.532~0.785)while the sensitivity was 67.6% and the specificity was 40% when NLR 6.35 as the critical value of diagnosis.Conclusion NLR was increased in AP related ALI patients and the higher the NLR,the more severe of AP and the degree of liver function damage,but it was less effective in the diagnosis of AP related ALI.