多发伤患者中性粒细胞与淋巴细胞比值与创伤程度及预后关系研究

摘要

目的 研究炎症指标中性粒细胞与淋巴细胞比值(NLR)同多发伤患者创伤严重程度及预后间的关系,辅助临床评估创伤严重程度和预测不良预后.方法 将2012年7月~2015年12月安丘市中医院骨科收治的562例多发伤患者依据新损伤严重度评分(NISS)结果,分成创伤轻度组(n=50)、中度组(n=471)和重度组(n=41)三组,对比分析三组间患者入院10d内NLR水平差异,并采用Spearman相关分析探究NLR水平与NISS评分的相关性.根据患者预后分为生存组(n=522)和死亡组(n=40),对比两组间患者入院10d内NLR水平差异,并利用受试者工作特征(ROC)曲线分析NLR在多发伤患者预后评估中的价值.结果 (1)在轻度组、中度组和重度组中,随着创伤严重程度增加,NLR水平呈增高趋势;创伤重度组NLR水平最高,3组间差异有统计学意义(P<0.05);Spearman相关分析结果显示入院第2天NLR水平与NISS评分呈正相关.(2)死亡组患者NLR水平显著高于生存组,两组间差异有统计学意义(P<0.05);生存分析示低NLR组与高NLR组间死亡率差异有统计学意义(χ2=11.87,P<0.05);ROC曲线分析结果显示入院第2天NLR预测多发伤患者预后具有较高的敏感度及特异度.结论 多发伤患者NLR水平同多发伤严重程度呈正相关,并可预测不良预后,可作为有效的炎症指标用于辅助指导患者的抢救、治疗及疗效分析.%Objective To study the relationship between the neutrophil/lymphocyte ratio (NLR) and injury severity and prognosis in multiple trauma patients.Methods Based on the New Injury Severity Score (NISS),562 patients treated between Jul.2012 and Dec.2015 were divided into three groups,mild group (n=50),moderate group (n=471) and severe group (n=41).The NLR levels of the three groups were collected and compared.Spearman correlation analysis was used to assess the correlation between NLR level and NISS score.According to the clinical outcomes,the 562 patients were divided into survival group (n=522) and death group (n=40).The NLR levels during the 10 days of hospitalization were compared between the two groups.And receiver operating characteristics (ROC) curve analysis was used to identify the predictive potential of NLR in prognosis.Results During the study period,(1) NLR level was positively related with the severity of trauma.The NLR level of severe group was significantly higher than those of moderate group and mild group (P<0.05).Spearman analysis results showed that the NLR level at day 2 was positively correlated with NISS score.(2)The NLR level of the death group was higher than that of the survival group.Survival analysis suggested that patients with high NLR tended to have a decreased survival rate (χ2=11.87,P<0.05).ROC curve demonstrated that the NLR level at day 2 could predict the prognosis with high specificity and sensitivity.Conclusion NLR level is positively related with the trauma severity and prognosis of multiple trauma patients.NLR level,as a useful inflammatory marker,could be helpful for the rescue,treatment and prognosis of multiple trauma patients.