NLR、PLR对侵袭性念珠菌感染致重症脓毒症患者的诊断意义及预后价值

Diagnostic and Prognostic Value of NLR and PLR for Invasive Candidiasis Infection in Severe Sepsis Patients

摘要: 目的：探究淋巴细胞计数和外周血炎症细胞比值(中性粒细胞/淋巴细胞比值NLR及血小板/淋巴细胞比值PLR)在侵袭性念珠菌感染(ICI)脓毒症中的变化以及临床诊断价值，为临床评估患者预后和预防侵袭性念珠菌感染提供科学依据。方法：选取2018年1月至2020年6月在复旦大学附属上海市第五人民医院综合ICU诊断重症脓毒症227例患者为研究对象，其中侵袭性念珠菌感染患者27例，非侵袭性念珠菌感染患者200例。检测所有研究对象血常规参数以及G试验水平，计算NLR以及PLR值，检测IL-6，IL-8和TNF-α水平。采用受试者工作特征曲线(ROC曲线)分析外周血炎症细胞比值对侵袭性念珠菌感染的诊断价值，采用COX分析影响侵袭性念珠菌感染重症脓毒症患者的预后因素。结果与非ICI组相比，ICI组患者、G实验、NLR以及PLR明显升高(P < 0.05)，淋巴细胞计数、淋巴细胞比率和G试验 ≥ 52.60ng/L与侵袭性念珠菌感染密切相关。NLR诊断ICI的敏感性为62.2%，特异性为86.5%；PLR敏感度为76.5%，特异度为86.5%；G试验敏感度为89.5%，特异度为92.7%。年龄、糖尿病、APCCHE II评分、腹腔感染、NLR、PLR和淋巴细胞计数均是影响ICH患者预后的危险因素(HR = 2.685、3.627、1.691、2.153、2.967、2.067、1.82)；多因素COX分析显示，NLR、PLR和淋巴细胞计数是影响ICI患者不良预后的独立危险因素(HR = 2.632、3.956、3.0163，P < 0.05)，ICI患者27 d死亡12例(44.4%)，存活15例。与预后良好者比较，预后不良者淋巴细胞计数水平降低，NLR和PLR升高，差异均有统计学意义(P < 0.05)。结论：侵袭性念珠菌感染重症脓毒症患者早期外周血参数中淋巴细胞计数和淋巴细胞比值(NLR, PLR)显著降低，作为一种源于全血细胞参数的炎症指标，对于侵袭性念珠菌感染的早期诊断具有一定的临床检测价值。

Abstract: Objective: To explore the diagnostic and prognostic value of lymphocyte neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) for invasive candidiasis infection (ICI) in critically ill patients with sepsis, and to provide scientific basis for clinical evaluation of prognosis and prevention of ICI. Methods: 227 patients with severe sepsis diagnosed in the general ICU of Shanghai Fifth People’s Hospital Affiliated to Fudan University from January 2018 to June 2020 were divided into the invasive Candida infection group (27 cases) and the non-invasive Candida infection group (200 cases). Peripheral blood routine parameters blood, G test, inflammatory factors such as interleukin (IL)-6, IL-8 and tumor necrosis factor were detected, and NLR and PLR values were calculated. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of inflammatory cell ratio in peripheral blood for ICI, and Cox was used to analyze the prognostic factors of severe sepsis patients with ICI. Results: Compared with non ICI group, G test, NLR and PLR in ICI group increased significantly (P < 0.05). Lymphocyte count, lymphocyte ratio and G test ≥ 52.60ng/l were closely related to the diagnosis of ICI. The sensitivity and specificity of NLR in the diagnosis of ICI were 62.2% and 86.5%, respectively; the sensitivity and specificity of PLR were 76.5% and 86.5%, respectively; the sensitivity and specificity of G test were 89.5% and 92.7%, respectively. Age, diabetes mellitus, the acute physiology and chronic health evaluation II (APACHE II) score, abdominal infection, NLR, PLR and lymphocyte count were the risk factors affecting the prognosis of patients with ICH (HR = 2.685, 3.627, 1.691, 2.153, 2.967, 2.067, 1.82); multivariate Cox analysis showed that NLR, PLR and lymphocyte count were the independent risk factors affecting the poor prognosis of patients with ICI (HR = 2.632, 3.956, 3.0163, P < 0.05), while 27 patients with ICI 12 cases (44.4%) died and 15 cases survived. Compared with the patients with good prognosis, the level of lymphocyte count in the patients with poor prognosis was lower, while NLR and PLR were higher (P < 0.05). Conclusions: In the early stage of severe sepsis patients with invasive Candida infection, lymphocyte count in peripheral blood and lymphocyte ratio (NLR, PLR) decreased significantly, which could be a certain clinical detection value for the early diagnosis of ICI as an inflammatory index derived from whole blood cell parameters.