外周血中性粒细胞淋巴细胞比值与创伤性失血患者输血疗效的相关性*

doi:10.3969/j.issn.1671-2587.2021.04.011

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (4): 459-464.DOI: 10.3969/j.issn.1671-2587.2021.04.011

外周血中性粒细胞淋巴细胞比值与创伤性失血患者输血疗效的相关性^*

刘波, 陈慧园, 张朝霞, 梁静, 陈苒, 石雪梅, 原霞

830000 新疆,乌鲁木齐,新疆维吾尔自治区第三人民医院输血科（刘波,陈慧园,陈苒,石雪梅,原霞）; 乌鲁木齐新疆医科大学第一附属医院输血科（张朝霞）; 乌鲁木齐新疆医科大学第六附属医院输血科（梁静）

收稿日期:2020-03-01 发布日期:2021-08-18
通讯作者: 原霞,女,主任技师,主要从事免疫学、微生物学方面研究,（Tel）18999929376。
作者简介:刘波（1985-）,男,土家族,重庆忠县人,主管检验师,硕士,主要从事血液检验与治疗方面研究,（E-mail）nextlife7@163.com。
基金资助:
*本课题受国家自然科学基金项目（No.81460323）、新疆维吾尔自治区自然科学基金（No.2016D01C214）资助

Correlation between Peripheral Blood Neutrophil Lymphocyte Ratio and the Efficacy of Blood Transfusion in Patients with Traumatic Blood Loss

LIU Bo, CHEN Hui-yuan, ZHANG Chao-xia, et al

Blood transfusion department, the Third People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830000

Received:2020-03-01 Published:2021-08-18

摘要/Abstract

摘要： 目的分析外周血中性粒细胞淋巴细胞比值与创伤性失血患者输血疗效的相关性。方法回顾性分析2017年1月至2019年12月我院收治的568例输血治疗的创伤性失血患者,根据输血疗效将其分为有效组（n=500）及无效组（n=68）,比较两组患者的年龄、性别等一般资料,并对两组患者的血红蛋白（Hemoglobin,Hb）、中性粒细胞淋巴细胞比值（Neutrophil lymphocyte ratio,NLR）等常用实验室指标进行比较,采用多因素Logistic回归对上述因素进行分析,并应用受试者工作曲线（receiver operating characteristic curve,ROC曲线）对相关因素预测输血疗效的诊断价值进行分析。结果有效组患者的年龄、ISS评分及NLR水平明显低于无效组,SBP、DBP、呼吸频率、GCS评分、Hb、PLT及APTT水平明显高于无效组（P均<0.05）;而两组患者的性别、创伤类型等因素间无明显差异（P均>0.05）;多因素Logistic分析示高GCS值（OR=0.804,95%CI：0.707-0.913）,高Hb（OR=0.937, 95%CI：0.908-0.967）、PLT水平（OR=0.984, 95%CI：0.976-0.992）是影响输血疗效的保护因素,而高ISS值（OR=1.288,95%CI：1.128-1.471）,高NLR（OR=4.434,95%CI：2.905-6.766）及APTT水平（OR=1.087,95%CI：1.033-1.145）是影响输血疗效的独立危险因素;ROC曲线示NLR的诊断效能明显高于GCS、ISS、Hb、APTT及PLT（Z=3.627,3.487,2.860,3.903,3.030;P均<0.05）,其中NLR诊断的最佳截点为4.41,此时敏感性为86.8%,特异性为67.0%。结论 NLR作为创伤性失血患者输血疗效的预测指标,具有较高的预测价值。

关键词: 中性粒细胞淋巴细胞百分比值, 创伤性失血, 输血疗效, 相关性分析

Abstract: Objective To analyze the correlation between the ratio of neutrophil lymphocytes in peripheral blood and the effect of blood transfusion in patients with traumatic blood loss. Methods This was a retrospective analysis of 568 traumatic blood loss patients admitted to our hospital from January 2017 to December 2019, which were divided into effective group (n=500) and ineffective group (n=68) according to the effect of blood transfusion. The general information such as age and gender of the two groups of patients, and the commonly used laboratory indicators such as hemoglobin (Hb), Neutrophil lymphocyte ratio (NLR) and so on were compared. Multi-factor Logistic regression was used to analyze the above factors, and the receiver operating characteristic curve (ROC curve) was used to analyze the diagnostic value of related factors to predict the efficacy of transfusion. Results The age, ISS score and NLR level of the patients in the effective group were significantly lower than those in the ineffective group. The levels of SBP, DBP, respiratory rate, GCS score, Hb, PLT and APTT were significantly higher than those in the ineffective group (all P<0.05); There were no significant difference among the patients' gender, trauma type, and other factors (all P>0.05); multivariate logistic analysis showed high GCS values (OR=0.804, 95% CI: 0.707-0.913) and high Hb (OR=0.937, 95% CI: 0.908-0.967), PLT level (OR=0.984, 95% CI: 0.976-0.992) were protective factors affecting the efficacy of transfusion, while high ISS value (OR=1.288, 95% CI: 1.128-1.471), high NLR (OR=4.434, 95% CI: 2.905-6.766) and APTT level (OR=1.087,95% CI: 1.033-1.145) were independent risk factors affecting the efficacy of blood transfusion; ROC curve showed that the diagnostic efficacy of NLR was significantly higher than that of GCS, ISS, Hb, APTT, and PLT (Z=3.627, 3.487, 2.860, 3.903, 3.030; all P<0.05). The optimal cut-off point for NLR diagnosis was 4.41. At this time, the sensitivity was 86.8% and the specificity was 67.0%. Conclusion NLR was a highly valuable predictor of transfusion efficacy in patients with traumatic blood loss.

Key words: Neutrophil lymphocyte percentage value, Traumatic hemorrhage, Transfusion effect, Correlation analysis

中图分类号:

R457

刘波, 陈慧园, 张朝霞, 梁静, 陈苒, 石雪梅, 原霞. 外周血中性粒细胞淋巴细胞比值与创伤性失血患者输血疗效的相关性^*[J]. 临床输血与检验, 2021, 23(4): 459-464.

LIU Bo, CHEN Hui-yuan, ZHANG Chao-xia, et al. Correlation between Peripheral Blood Neutrophil Lymphocyte Ratio and the Efficacy of Blood Transfusion in Patients with Traumatic Blood Loss[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2021, 23(4): 459-464.

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外周血中性粒细胞淋巴细胞比值与创伤性失血患者输血疗效的相关性^*

Correlation between Peripheral Blood Neutrophil Lymphocyte Ratio and the Efficacy of Blood Transfusion in Patients with Traumatic Blood Loss

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