中性粒细胞与淋巴细胞比值联合血清降钙素原对重症肺结核患者的预后评估价值

doi:10.19983/j.issn.2096-8493.20250028

摘要/Abstract

摘要：

目的:评估中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)及血清降钙素原(procalcitonin, PCT)对重症医学科(ICU)重症肺结核患者预后的价值。方法:回顾性分析2021年1月至2023年12月河北省胸科医院ICU收治的重症肺结核患者144例,依据患者入ICU 28d的生存状态分为生存组(67例)与死亡组(77例),收集患者的基本临床资料和入ICU 24h内NLR、血清PCT等化验检查结果进行组间比较,分析上述指标单独及联合检测对ICU重症肺结核患者预后的预测效能。结果:死亡组患者NLR及血清PCT水平分别为12.76 (9.49,23.44)和4.18 (2.64,5.66)ng/ml,均高于生存组[ 分别为8.13 (6.24, 15.06)和 2.31(1.09,3.52)ng/ml],差异均有统计学意义(Z值分别为-5.501和-5.343,P值均<0.001)。在单独预测ICU重症肺结核患者预后方面,NLR的受试者工作特征曲线下面积(AUC) 为0.766,敏感度为75.3%,特异度为70.1%;PCT预测的AUC为0.759,敏感度为77.9%,特异度为65.7%;二者联合预测的AUC为0.833,敏感度为81.8%,特异度为73.1%。结论:相较于单独检测,联合NLR与血清PCT检测对评估ICU重症肺结核患者的预后价值更高,可以为临床诊治提供参考。

关键词: 危重病, 结核,肺, 中性粒细胞减少, 淋巴细胞, 预后

Abstract:

Objective: To evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and serum procalcitonin (PCT) in ICU patients with severe pulmonary tuberculosis. Methods: All of 144 patients with severe pulmonary tuberculosis admitted to the ICU of Hebei Chest Hospital from January 2021 to December 2023 were retrospectively analyzed. Patients were divided into a survival group (n=67) and a death group (n=77) according to their survival status after 28 days in ICU. Basic clinical data. the results of NLR, serum PCT and other laboratory tests results within 24 hours of ICU admission were collected. The predictive efficacy of these indicators individually and in combination for prognosis of ICU patients with severe tuberculosis were compared between groups. Results: The levels of NLR and serum PCT in the death group were higher than those in the survival group (NLR: 12.76 (9.49, 23.44) vs 8.13 (6.24, 15.06)), PCT: 4.18 (2.64, 5.66) ng/ml vs 2.31 (1.09, 3.52) ng/ml), and the difference was statistically significant (Z=-5.501、-5.343, both P<0.001). For individual prognostic prediction in ICU patients with severe pulmonary tuberculosis, the area under the receiver operating characteristic curve (AUC) of NLR was 0.766, with a sensitivity of 75.3% and specificity of 70.1%. The AUC for PCT was 0.759, with a sensitivity of 77.9% and specificity of 65.7%. The AUC of the combination of the two indicators was 0.833, with a sensitivity of 81.8% and specificity of 73.1%. Conclusion: Compared to a individual test, the combined NLR and serum PCT detection demonstrates higher prognostic value for ICU patients with severe pulmonary tuberculosis, providing valuable insights for clinical diagnosis and treatment.

Key words: Critical illness, Tuberculosis, pulmonary, Neutropenia, Lymphocytes, Prognosis

中图分类号:

R521
R459.7

魏云霞, 王鑫, 龙雪娟. 中性粒细胞与淋巴细胞比值联合血清降钙素原对重症肺结核患者的预后评估价值[J]. 结核与肺部疾病杂志, 2025, 6(3): 330-334. doi: 10.19983/j.issn.2096-8493.20250028

Wei Yunxia, Wang Xin, Long Xuejuan. Prognostic value of neutrophil-to-lymphocyte ratio combined with serum procalcitonin in patients with severe pulmonary tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2025, 6(3): 330-334. doi: 10.19983/j.issn.2096-8493.20250028

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变量	生存组(67例)	死亡组(77例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	61.0(55.0,70.0)	66.0(57.0,74.5)	Z=-2.178	0.029
年龄组[例(构成比,%)]			χ²=6.703	0.035
18~50岁	9(13.5)	13(16.9)
51~65岁	35(52.2)	24(31.2)
>65岁	23(34.3)	40(51.9)
性别[例(构成比,%)]			χ²=1.788	0.181
男性	38(56.7)	52(67.5)
女性	29(43.3)	25(32.5)
BMI($\bar{x}±s$)	21.4±1.6	20.2±1.9	t=4.054	<0.001
pH[M(Q₁,Q₃)]	7.4(7.3,7.4)	7.4(7.3,7.4)	Z=-1.282	0.200
PO₂[mmHg,M(Q₁,Q₃)]	74.2(62.5,111.0)	72.0(61.9,92.1)	Z=-1.083	0.279
PCO₂[mmHg,M(Q₁,Q₃)]	41.8(34.5,51.9)	46.1(37.0,67.0)	Z=-1.142	0.254
OI[mmHg,M(Q₁,Q₃)]	141.7(111.0,178.8)	138.7(120.4,168.2)	Z=-0.451	0.652
APACHEⅡ评分[分,M(Q₁,Q₃)]	22.0(20.0,25.0)	23.0(21.0,30.0)	Z=-2.121	0.034
SOFA评分[分,M(Q₁,Q₃)]	9.0(7.0,11.0)	10.0(8.5,12.0)	Z=-2.291	0.022