南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (07): 965-971.doi: 10.12122/j.issn.1673-4254.2020.07.08

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COVID-19普通型与危重型患者的生化分析及中性粒细胞/淋巴细胞比值的临床应用

李红兵，赵茂军，徐英生   

  • 出版日期:2020-07-20 发布日期:2020-07-20
  • 基金资助:

Biochemical analysis between common type and critical type of COVID-19 and clinical value of neutrophil/lymphocyte ratio

  

  • Online:2020-07-20 Published:2020-07-20

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摘要： 目的 寻求影响COVID-19患者临床分型与转归的关键指标以指导临床诊疗，并探索中性粒细胞/淋巴细胞比值（NLR）在COVID-19中的应用。方法 收集2020年2~4月援鄂期间在湖北省鄂州市中心医院确诊的COVID-19患者共93例，其中ICU危重病例43例，随机选择呼吸科普通型病例50例进行对照研究，收集所有患者入院时和住院期间的基线资料、血常规、生化指标。计算NLR值，按照文献NLR四分类法对患者进行COX生存分析；根据患者转归信息绘制受试者工作曲线（ROC），根据NLR截断值将患者分为2类，与临床分类比较以评价截断值分类的科学性；根据患者转归、NLR截断值分类及临床分型进行多重二元logistics回归，筛选关键变量，并探讨其在COVID-19中的意义。结果 NLR四分类法不适合COVID-19患者预后判断；NLR预测患者死亡的截断值为11.26，敏感性为0.903，特异性为0.839；NLR<11.26患者血常规，生化指标与普通型无统计学差 异（P>0.05），NLR≥11.26患者上述指标与危重型患者无统计学差异（P>0.05）；NLR，白血病计数（WBC），中性粒细胞绝对值（NEUT），降钙素原（PCT），D-二聚体（DD），尿素氮（BUN），肌钙蛋白（I TNI），脑钠肽（BNP），乳酸脱氢酶（LDH）对患者临床分型、转归均有明显影响（P<0.05）；此外，血肌酐（Cr）、血清钙（Ca）、PH、乳酸（Lac）对患者转归有较大影响（P<0.05）；血清钠（Na）与动脉血二氧化碳分压（PCO2）对患者临床分型有较大影响（P<0.05）。结论 NLR可以作为COVID-19临床分型、预后评估、生化异常的重要预警因子；危重型及预后差的患者多合并细菌感染、炎症反应更强烈、心肺肾功能损伤更重，常伴有DD，LDH明显升高；NLR、NEUT、DD、TNI、BNP、LDH、Ca、PCT、PH、Lac对COVID-19预后影响较大，应动态观察。

关键词: 新型冠状病毒肺炎, 临床类型, 中性粒细胞/淋巴细胞比值, 生化分析

Abstract: Objective To identify the key biochemical indicators that affect the clinical type and outcomes of COVID-19 patients and explore the application of neutrophil/lymphocyte ratio (NLR) in COVID-19. Methods Ninety-three patients with confirmed diagnosis of COVID-19 admitted in Ezhou Central Hospital from February to April in 2020 were analyzed. Among them, 43 patients were selected from Intensive Care Unit (ICU) with the diagnosis of critical type of COVID-19, and 50 cases of common type were selected from the Department of Respiratory Medicine. The baseline data, blood routine test and biochemical indexes of the patients were collected on the first day of admission. NLRs of the patients were calculated, and COX survival analysis according to the NLR 4-category method was performed. The patients’ outcomes were analyzed with receiver operating curves (ROCs). The patients were divided into two groups according to NLR cutoff value for comparison of the biochemical indexes. Based on the patients’ outcomes, NLR cutoff value classification and clinical classification, multiple binary logistics regression was performed to screen the key variables and explore their significance in COVID-19. Results The NLR four-category method was not applicable for prognostic evaluation of the patients. The cut-off value of NLR for predict the prognosis of COVID-19 was 11.26, with a sensitivity of 0.903 and a specificity of 0.839; the laboratory indicators of the patients with NLR<11.26 were similar to those in patients of the common type; the indicators were also similar between patients with NLR≥11.26 and those with critical type COVID-19. NLR, WBC, NEUT, PCT, DD, BUN, TNI, BNP, and LDH had significant effects on the clinical classification and outcome of the patients (P<0.05); Cr, Ca, PH, and Lac had greater impact on the outcome of the patients (P< 0.05), while Na, PCO2 had greater impact on the clinical classification of the patients (P<0.05). Conclusion NLR can be used as an important reference for clinical classification, prognostic assessment, and biochemical abnormalities of COVID-19. Patients of critical type more frequently have bacterial infection with more serious inflammatory reactions, severer heart, lung and kidney damages, and much higher levels of DD and LDH than those of the common type. NLR, NEUT, DD, TNI, BNP, LDH, Ca, PCT, PH, and Lac have obvious influence on the prognosis of COVID-19 and should be observed dynamically

Key words: SARS-CoV-2, clinical type, the neutrophil-to-lymphocyte ratio, biochemical analysis